Effect of Skin Antiseptics Used in Peripheral Intravenous Catheter Application on Phlebitis Development: A Double- Blind Randomized Controlled Trial

Year 2024, , 406 - 413, 28.06.2024

Alev Keskin , Zehra Eskimez

https://doi.org/10.33808/clinexphealthsci.1324171

Abstract

Objective: This study aimed to examine the effect of antiseptics used in peripheral intravenous catheter (PIVC) application on phlebitis development.
Methods: This is a double-blind randomized controlled trial that is suitable for the Consolidated Standards of Reporting Trials (CONSORT) statement. The study was carried out at a University Hospital in Turkey. The study participants were 60 patients (experiments 30 and control 30). 2% chlorhexidine was used as a skin antiseptic in the intervention group and 70% alcohol was used in the control group. In both groups, the catheter insertion site was observed every 8 hours for 72 hour. Data were obtained using the “Personal Information Form” and “Phlebit Scale”. Independent samples t-test (t-table value), Mann–Whitney U test (Z-table value) and Fisher’s exact test, continuity correction, or Pearson’s χ2 cross tables were used for data analysis.
Results: No statistically significant difference was found between 2% chlorhexidine and 70% alcohol in preventing the development of phlebitis after PIVC application (p > 0.05).
No statistically significant relationship was found between the intervention and control groups in terms of sex, BMI, substance abuse, alcohol use, smoking, chronic disease, or PIVC application area (p>0.05). The highest degree of phlebitis that developed in the intervention and control groups was 1st degree. There was also no statistically significant difference between the groups in terms of degree of phlebitis and phlebitis development time (p > 0.05).
Conclusions: In line with the findings obtained from this study, it is thought that both skin antiseptics used when inserting a peripheral intravenous catheter are effective in preventing the development of phlebitis and will guide healthcare personnel in the selection of antiseptics.

Keywords

Nursing, Phlebitis, Antiseptic, Peripheral Intravenous Catheter

Supporting Institution

Çukurova University

Project Number

The authors received no financial support for the research, authorship, and/or publication of this article

Thanks

The authors would like to thank all of the patients and nurses who participated and supportived in the study

References

• Kuş B, Büyükyılmaz F. Effectiveness of vialon biomaterial versus teflon catheters for peripheral intravenous placement: A randomized clinical trial. Jpn J Nurs Sci 2020; 17: e12328. DOI: 10.1111/jjns.12328.
• Mihala G, Ray-Barruel G, Chopra V, Webster J, Vallis M, Marsh N, Mc Grail M, Rickard CM. Phlebitis signs and symptoms with peripheral intravenous catheters: Incidence and correlation study. Journal of Infusion Nursing 2018; 41: 260–263. DOI: 10.1097/NAN.0000000000000288.
• Chopra V, Flanders SA, Saint S, Wolle SC, O’Grady NP, Safdar N, Trerotola SO, Saran R, Moureau N, Wiseman S, Pittiruti M, Akl EA, Lee AY, Courey A, Swaminathan L, LeDonne J, Becker C, Krein SL, Bernstein SJ. The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC): results from a multi specialty panel using the RAND/UCLA appropriateness method. Ann Intern Med 2015; 163: 31-39. DOI: 10.7326/M15-0744.
• Ulusal Damar Erişimi Yönetimi Rehberi 2019. Hastane İnfeksiyonları Dergisi 2019;23(Ek 1):1-54. (Turkish)
• O’Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J, O Heard S, Lipsett PA, Masur H, Mermel LA, Pearson ML, I Raad I, Randolph AG, Rupp ME, Saint S. The health care infection control practices advisory committee (hicpac). summary of recommendations: Guedlines For the Prevention of İntravasculer Catheter-Related Infections. Clinical İnfectious Diseases 2011; 52(9): 1087-1099. DOI: 10.1093/cid/cir138.
• Abadi SA, Etamadi S, Saeedi ZA. Investigating role of mechanical and chemical factors in thecreation of peripheralvein in flammarion in hospitalization patients in hospital in Zahedan, Life Science Journal 2013; 10 (1): 379-383. ISSN: 1097-8135.
• Mermel LA. Short-term peripheral venous catheter–related blood stream infections: A systematic review. Clinical Infectious Diseases 2017; 65: 1757-1762. DOI: 10.1093/cid/cix562
• Infusion Nursing Standards of Practice (INS). J Infus Nurs 2016; 29: (1 Suppl), S1-92. DOI: 10.1097/00129804-200601001-00001
• Wallis MC, McGrail M, Webster J, Marsh N, Gowardman J, Playford EG, Rickard CM. Risk factors for peripheral intravenous catheter failure: a multivariate analysis of data from a randomized controlled trial. Infect Control Hosp Epidemiol 2014; 35(1): 63- 68. DOI: 10.1086/674398
• Alexandrou E, Ray-Barruel G, Carr PJ, Frost SA, Inwood S, Higgins N, Lin F, Alberto L, Mermel L, Rickard CM. Use of short peripheral intravenous catheters: characteristics, management, and out comes worldwide. J Hosp Med 2018; 13(5): E1-E7. DOI: 10.12788/jhm.3039
• Milutinović D, Simin D, Zec D. Risk factorforphlebitis: a questionnairestudy of nurses’ perception. Rev. Lat-Am. Enfermagem 2015; 23(4): 677- 84. DOI: 10.1590/0104-1169.0192.2603
• Gorski LA. The 2016 Infusion Therapy Standards of Practice. Home Healthc Now 2017; 35(1): 10-18. DOI: 10.1097/NHH.0000000000000481
• CDC Guidelines for the Prevention of Intravascular Catheter- Related Infections 2011. Retrieved from https://www.cdc.gov/infectioncontrol/guidelines/bsi/recommendations.html
• Abdollahi F, Arbabisarjou A. Comparing the effect of disinfectant solution of %2 chlorexdine gluconate and %70 alcohol on prevention of phlebitis. Der Pharmacia Lettre 2016; 8(6): 129-134. ISSN: 0975-5071
• Sarani H, Moulaei N, Tabas EE, Safarzai E, Jahani S. Comparison of the effects of alcohol chlorhexidine and alcohol-chlorhexidine on local catheter related infections rate: A double blind clinical trial study. Medical Surgical Nursing Journal 2018; 7(2): e85962. doi: 10.5812/msnj.85962.
• Ashk TT, Soleymanian T, Farahani BZ, Alavi MH, Samini M. Effects of skin disinfection by alcohol and chlorhexidine on catheter-related phlebitis: A clinical trial study. Advances in Nursing and Midwifery 2006; 16(53): 39-46.
• Guanche-Sicilia A, Sánchez-Gómez MB, Castro-Peraza ME, Rodríguez-Gómez JÁ, Gómez- Salgado J, Duarte-Clíments G. Prevention and Treatment of Phlebitis Secondary to the Insertion of a Peripheral Venous Catheter: A Scoping Review from a Nursing Perspective. Healthcare 2021; 9: 611. DOI: 10.3390/healthcare9050611
• Kolahdoozipour J, Abdollahzadeh F, Zamanzadeh V, Vahedi S, Lotfi M, Heidarzadeh M. The comporison of the effect of chlorhexidine gloconate %2 and alcohol ethylic %70 in prevention of phlebitis. GMUSH Journal 2009; 15(1): 48-54.
• Zamanzadeh V, Kolahdoozipour J, Abdollahzadeh F, Lotfi M. Comporison of the effect of chlorhexidin egloconate %2, alcohol ethylic %70 and povidone-iodine %10 in prevention of phlebitis. Med J Tabriz Uni Med Sciences 2009; 30(3): 55-60.
• Kaur P, Thakur R, Kaur S, Bhalla A. Effect of chlorhexidine gluconate before peripheral intravenous cannulation on phlebitis. Journal of Nursing Science And Practice 2012; (1)2.
• Gallant P, Schultz A. Evaluation of a visual infision phlebitis scale for determining appropriate discontinuation of peripheral intravenous catheters. Journal of İntravenous Nursing 2006; 29(6): 338-345. DOI: 10.1097/00129804-200611000-00004
• Braga LM, Oliveria A, Henriques MAP, Rodrigues MA, Rodrigues C, Pereira SCP, Parreira PD. Translation and adaptation of the phlebitis scale for the portuguese population. Journal of Nursing Referência 2016; 4(11): 101-109. DOI: 10.12707/RIV16048
• Gunasegaran N, See MTA, Leong ST, Yuan LX, Ang SY. A randomized controlled study to evaluate the effectiveness of 2 treatment methods in reducing incidence of short peripheral catheter-related phlebitis. Journal of Infusion Nursing 2018; 41(2): 131–137. DOI: 10.1097/NAN.00000 00000 000271
• Bagheri-Nesami M, Khodadadian-Miri J, Yazdani-Cherati J, Tabiban S, Ala SH. The comparison of 2% nitroglycerin ointment and 2% chlorhexidine solution effect in preventing catheter-related phlebitis. Journal of Babol University of Medical Sciences 2014; 16: 7–15. DOI: 10.18869/acadpub.jbums.16.6.7.
• Lilley C, Powls A, Gray A. A prospective randomised double blind comparison of 0.5% versus 0.05% aqueous chlorhexidine for skin antisepsis prior to line insertion in neonates. Arch Dis Child 2006; 91(I): A17-A19.
• Valles J, Fernandez I, Alcaraz D, Chacon E, Cazorla A, Canals M, Mariscal D, Fontanals D, Moron A. Prospective randomized trial of 3 antiseptic solutions for prevention of catheter colonization in an intensive care unit for adult patients. Infection Control & Hospital Epidemiology 2009; 29(9): 847-853.
• Adams D, Quayum M, Worthington T, Lambert P, Elliott T. Evaluation of a 2% chlorhexidine gluconate in 70% isopropyl alcohol skin disinfectant. J Hosp Infect 2005; 61 (4): 287-90. DOI: 10.1016/j.jhin.2005.05.015
• Maki DG. Chlorhexidine's role in skin antisepsis: questioning the evidence– Author's reply. Lancet 2014; 384 (9951): 1345-1346. DOI: 10.1016/S0140-6736(14)61813-4
• Cicolini G, Manzoli L, Simonetti V, Flacco ME, Comparcini M, Capasso L, Baldassarre AD, Elfarauki GE. Phlebitis risk varies by peripheral venous catheter site and increases after 96 hours: a largemulti-center prospective study. Journal of Advanced Nursing 2014; 70(11): 2539– 2549. DOI: 10.1111/jan.12403
• Pasalıoğlu KB, Kaya H. Catheter indwell time and phlebitis development during peripheral intravenous catheter administration. Pakistan Journal of Medical Medical Sciences 2014; 30(4): 725-730. DOI: 10.12669/pjms.304.5067