Impact of Physician Inspection in the Detection of Phlebitis and Factors Contributing to it in Admitted Children of a Te
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ORIGINAL ARTICLE
Impact of Physician Inspection in the Detection of Phlebitis and Factors Contributing to it in Admitted Children of a Tertiary Care Hospital: A Prospective Study Maria Robert 1 & Bipin Jose 1 & Susan John 2 Received: 3 May 2020 / Accepted: 28 September 2020 # Dr. K C Chaudhuri Foundation 2020
Abstract Objective To determine whether additional dedicated observations by a doctor would increase the pickup rate of phlebitis and related complications due to intravenous cannulation. Also, to identify the common demographic and clinical factors predisposing to phlebitis in children. Methods This prospective study was conducted from January 2019 through December 2019. A total of 184 children with 341 cannulations were enrolled. The authors added dedicated inspection of cannula by the physician during rounds in attempt to increase the detection of phlebitis. The difference in detection rates of thrombophlebitis by physician and routine observation along with the demographic and clinical variables contributing to thrombophlebitis in hospitalized children were studied. Results Total incidence of thrombophlebitis was 35/341 (10.3%), which included 2 extravasations. Nineteen events (55%) were picked up by routine nursing observations and an additional 16 (45%) by the physician. Among the factors contributing to phlebitis, maternal education status 95th centile 02 Maternal education N = 184 < 12th standard 07 28 > 12th standard ♦Age expressed in years (S.D.)
P value
No phlebitis N = 149 4.0 (3.74) 73 (80)
0.059 0.469
15 103 26 05
0.954
05 144
0.018
Indian J Pediatr Table 2
Comparison of cannula characteristics in the study population
Variable
No. of cannulas observed (N = 341)
P value
Phlebitis (N = 35) No phlebitis (N = 306) Cannula location Dorsum of hand Forearm Leg Others Cannula size 20 G and 22 G 24 G Cannula splint Splinted Not splinted Indwell time < 72 h > 72 h IVF with potassium Yes No HRM or fluid boluses Yes No
27 6 2 0
261 12 26 07
11 24
50 256
0.008
16 19
193 113
0.046
34 1
270 36
31 4
170 136
0.001
5 30
15 291
0.022
0.008
0.092
HRM High-risk medications (Aminophylline infusion, K correction (>60 mEq/L); IVF Intravenous fluids with maintenance potassium
statistically significant risk factor for thrombophlebitis (15.4% vs. 2.9% in the group without fluids) (P < 0.05). Incidence of thrombophlebitis did not differ significantly in the antibiotics group. Most of the patients received ceftriaxone as the sole antibiotic. High-risk infusions, in particular aminophylline, potassium corrections and bolus fluids were studied and were found to cause more phlebitis compared to the group without it (25% vs. 9.3%, P = 0.022). Logistic regression of variables was done which were found to be significant on univariate analysis, maternal educational status less than 12th standard, bigger cannula size, cannula location in forearm, intravenous fluids containing potassium, high risk medications like aminophylline, potassium correction were still having statistically significant risk.
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