Major Article
Prospective surveillance of phlebitis associated with peripheral intravenous catheters

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Background

Guidelines have been published for prevention of phlebitis associated with peripheral intravenous catheters (IVC), but this complication continues to occur. We sought to determine the rate of phlebitis associated with peripheral IVCs to identify predictors for phlebitis and to isolate pathogenic bacteria from phlebitic catheter tips.

Methods

Nine-point prevalence studies were conducted during the years 1996-2003 of all hospitalized patients with a peripheral IVC. During the last 3 surveys, conducted in 2003, phlebitic lines were removed, and, for each line, 1 to 2 nonphlebitic lines, in place for 48 to 72 hours, were removed and cultured as controls. In between these surveys, findings and guidelines for improvement were distributed to the staff.

Results

During these surveys, 40% ± 8% of hospitalized patients had a peripheral IVC. The rate of peripheral IVC-associated phlebitis decreased from 12.7% (20/157) in 1998 to 2.6% (5/189) in 2003 (P < .01). Factors significantly associated with phlebitis included pain (P < .001), presence of the catheter for longer than 3 days (P < .05), and cleanliness of the dressing (P < .01).

Conclusion

The rate of phlebitis associated with peripheral intravenous catheters decreased significantly throughout the study period. The identification of predictors for phlebitis and the dissemination of this information in an educational drive may have contributed to this improvement.

Section snippets

Setting

This study was conducted in Shaare Zedek Medical Center, a 550-bed community-based, university-affiliated hospital located in Jerusalem. All major departments are represented in our facility with the exception of neurosurgery, and transplantations are not performed.

Point prevalence surveys

The first 6 point-prevalence studies were performed in 1996 (2 surveys), 1998 (1), 1999 (1), 2000 (1), and 2002 (1). Surveys 7 to 9 were conducted during the year 2003. The populations included in these surveys included all

Results

Nine prospective points prevalence surveys of phlebitis associated with peripheral IVC were performed in Shaare Zedek Medical Center between the years 1996 and 2003. The results of these studies are demonstrated in Fig 1. Overall, 40% ± 8% of hospitalized patients were treated with a peripheral IVC. The rate of catheter-associated phlebitis was 6.6% ± 3.3% (mean ± SD) with a range of 12.7% to 2.6%. From the time of the first survey in 1996 to the last, in 2003, the trend for decrease in the

Discussion

Peripheral IVC form an essential component of patient care in hospitals,11 and many patients are treated with an IVC at some point during their hospital stay. The predominant complication associated with these devices is infection.11, 12 Guidelines for management of IVC have been published to reduce rates of phlebitis and related complications, which may result in unnecessary suffering for the patient, prolongation of hospitalization, and need for broad-spectrum antibiotics with associated

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Study was conducted as part of T. Malach's MD thesis at the Hebrew University-Hadassah Medical School, Jerusalem, Israel.

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