Incidence of Infiltration and Phlebitis and Risk Factors Among Chemotherapy Patients: An Observational Prospective Cohort Study

Yıl 2023, , 18 - 26, 29.03.2023

Şule Bıyık Bayram Emel Gülnar Nevnihal Akbaytürk Nurcan Çalışkan

https://doi.org/10.5152/JANHS.2023.2287143

Cited By: 1

Öz

Objective: This study aimed to identify the incidence rate of infiltration, phlebitis, and risk factors in chemotherapy patients.

Methods: This observational prospective cohort study was conducted in the oncology and hematology clinics of a hospital in Turkey. Peripheral intravenous catheter insertion sites (n = 175) on
99 patients were monitored. Researchers monitored the peripheral intravenous catheter insertion sites for 5 days after nurses inserted them. The ethics committee approved the study.

Results: The incidence of infiltration and phlebitis was, respectively, 9.7% and 17.5%. The incidence rate of infiltration was significantly higher, respectively, in the case of vesicants and the presence
of neutropenia among patients over 52 years of age. It was determined that the risk of infiltration in women was 0.21 times higher than in men. When the neutropenia value was put into the
model alone, it was determined that the risk of infiltration increased 0.414 times in the case of neutropenia.

Conclusion: The patient’s gender, the presence of neutropenia, and the chemotherapy drug type affect the incidence of infiltration. Regular follow-up of the catheter site will reduce the workload
of the nurse by ensuring the continuation of patient care and treatment without interruption. It will also reduce the frequency of the catheterization procedure and prevent the difficulties it
brings to the patient.

Anahtar Kelimeler

Catheterization, drug therapy, nursing, phlebitis

Kemoterapi Alan Hastalarda İnfiltrasyon ve Flebit Görülme Sıklığı ve Risk Faktörleri: Gözlemsel Prospektif Çalışma

Öz

Amaç: Bu çalışma, kemoterapi alan hastalarda infiltrasyon ve flebit görülme sıklığı ve risk faktörlerini belirlemek amacıyla yapılmıştır.

Yöntemler: Bu çalışma Türkiye’de bir Üniversite Hastanesinin Onkoloji ve Hematoloji Kliniklerinde gözlemsel prospektif olarak yapılmıştır. Çalışmada, periferik intravenöz kateter uygulaması yapılan 99 hastanın 175 kateter bölgesi takip edilmiştir. Çalışma kriterlerine uyan hastaların hastanede kaldıkları süre içinde tekrarlı takılan kateter bölgeleri 5 gün takip edilmiştir. Çalışmanın yapılabilmesi için etik kuruldan ve kurumdan yazılı izin alınmıştır.

Bulgular: Çalışma sonucunda periferik intravenöz kateter uygulamasının %9,7’sinde infiltrasyon, %17,7’sinde flebit görülmüştür. 52 yaş üstü, nötropenik ve vezikan ilaç kullanımının infiltrasyon riskini arttırdığı belirlenmiştir. Kadınlarda infiltrasyon riskinin erkeklere göre 0,21 kat daha fazla olduğu belirlenmiştir. Nötropeni tek başına modele alındığında nötropeni durumunda infiltrasyon riskinin 0,414 kat arttığı belirlenmiştir.

Sonuç: Çalışma sonucunda, hastanın cinsiyeti, nötropeni ve ilaç türünün infiltrasyon durumunu etkilediği belirlenmiştir. Kateter bölgesinin düzenli takip edilmesi hasta bakımının ve tedavisinin aksamadan devamını sağlayacaktır. Ayrıca kateterizasyon işleminin sıklığını azaltacak ve hastaya getirdiği zorlukları önleyecektir.

Anahtar Kelimeler

Flebit, hemşire, ilaç uygulaması, kateterizasyon

Kaynakça

• 1.Gao Y, Jiang T, Mei S, Zhang S, Zhu C, Sun Y. Meta-analysis of Aloe vera for the prevention and treatment of chemotherapy-induced phlebitis. Int J Clin Exp Med. 2016;9(6):9642-9650.
• 2.Potter PA, Perry AG, Stockert PA, et al. Fundamentals of Nursing. 9th ed. Missouri: Elsevier; 2017.
• 3. Pérez Fidalgo JA, García Fabregat L, Cervantes A, et al. Management of chemotherapy extravasation: ESMO–EONS clinical practice guidelines. Eur J Oncol Nurs. 2012;16(5):528-534. [CrossRef]
• 4. Doellman D, Hadaway L, Bowe-Geddes LA, et al. Infiltration and extravasation: update on prevention and management. J Infus Nurs. 2009;32(4):203-211. [CrossRef]
• 5. Bahçetepe N, Kutlubay Z, Engin B, Tüzün Y. Cutaneous effects of chemotherapeutic agents [in Turkish]. Dermatoz. 2013;4(2):69-76.
• 6. Dychter SS, Gold DA, Carson D, Haller M. Intravenous therapy: a review of complications and economic considerations of peripheral access. J Infus Nurs. 2012;35(2):84-91. [CrossRef]
• 7. Taylor C, Lillis C, LeMone P, et al. Fundamentals of Nursing: The Art and Science of Nursing Care. 8th ed. Pennsylvania: Lippincott Williams & Wilkins; 2011:1381-1413.
• 8.Uzun S. Intravenous fluid therapy. Atabek Aştı T, Karadağ A, eds. Clinical Practice Skills and Methods [in Turkish]. Adana: Nobel Kitabevi; 2011;2014:535-582.
• 9.Mattox EA. Complications of peripheral venous access devices: prevention, detection, and recovery strategies. Crit Care Nurse. 2017;37(2):1-14. [CrossRef]
• 10. Macklin D. Phlebitis. Am J Nurs. 2003;103(2):55-60. [CrossRef]
• 11. Webster J, McGrail M, Marsh N, Wallis MC, Ray-Barruel G, Rickard CM. Postinfusion phlebitis: incidence and risk factors. Nurs Res Pract. 2015:691934. [CrossRef]
• 12. 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. J Infus Nurs. 2018;41(2):131-137. [CrossRef]
• 13. Buzatto LL, Massa GP, Peterlini MAS, Whitaker IY. Factors associated with phlebitis in elderly patients with amiodarone intravenous infusion. Acta Paul Enferm. 2016;29(3):260-266. [CrossRef]
• 14. Rodrigues CC, Guilherme C, Da Costa ML, et al. Risk factors for vascular trauma during antineoplastic chemotherapy: contributions of the use of relative risk. Acta Paul Enferm. 2012;25(3):448-452. [CrossRef]
• 15. The official gazette. Regulation amending the regulation on nursing; 2011. Available at: http://www.resmigazete.gov.tr/eskiler/2011/04/20110419-5.htm. Accessed 09 February 2020.
• 16. Simin D, Milutinović D, Turkulov V, Brkić S. Incidence, severity and risk factors of peripheral intravenous cannula‐induced complications: an observational prospective study. J Clin Nurs. 2019;28(9-10):15851599. [CrossRef]
• 17.Genç A. (Ed. Can G) Ekstravazasyon (Onkoloji Hemşireliği). Nobel Tıp Kitabevleri, İstanbul; 2014.
• 18. Viale PH. Management of hypersensitivity reactions: a nursing perspective. Oncology (Williston Park). 2009;23(2):26-30.
• 19. Uslusoy E, Mete S. Predisposing factors to phlebitis in patients with peripheral intravenous catheters: a descriptive study. J Am Acad Nurse Pract. 2008;20(4):172-180. [CrossRef]
• 20. Nassaji-Zavareh M, Ghorbani R. Peripheral intravenous catheter related phlebitis and related risk factors. Singapore Med J. 2007;48(8):733-736.
• 21. Furtado LCdR. Incidence and predisposing factors of phlebitis in a surgery department. Br J Nurs. 2011;20(suppl7):S16-S25. [CrossRef]
• 22. Arias-Fernández L, Suérez-Mier B, del Carmen Martínez-Ortega M, et al. Incidence and risk factors of phlebitis associated to peripheral intravenous catheters. Enfirm Clin (English Edition). 2017;27(2): 79-86.
• 23. Abolfotouh MA, Salam M, Bani-Mustafa A, White D, Balkhy HH. Prospective study of incidence and predictors of peripheral intravenous catheter-induced complications. Ther Clin Risk Manag. 2014;10:9931001. [CrossRef]
• 24. Atay S, Şen S, Cukurlu D. Phlebitis-related peripheral venous catheterization and the associated risk factors. Niger J Clin Pract. 2018;21(7):827-831. [CrossRef]
• 25. Daud A. Incidence of phlebitis among adult patients with peripheral intravenous catheter in an East Coast Hospital Malaysia. Int J Care Scholars. 2018;1(2):5-8. [CrossRef]
• 26. Ozkaraman A. Evaluation of the Effect of Isometric Handgrip Exercise on the Peripheral Intravenous Chemotherapy Administration in Patients with Non-Hodgkin Lymphoma [PhD Thesis]. Turkey: University of Ege; 2014.
• 27. Urbanetto Jde S, Peixoto CG, May TA. Incidence of phlebitis associated with the use of peripheral IV catheter and following catheter removal. Rev Lat-Am Enferm. 2016;24:e2746. [CrossRef]
• 28. Lenhardt R, Seybold T, Kimberger O, Stoiser B, Sessler DI. Local warming and insertion of peripheral venous cannulas: single blinded prospective randomised controlled trial and single blinded randomised crossover trial. BMJ. 2002;325(7361):409-410. [CrossRef]
• 29. INS, Infusion Nurses Society. Infusion nursing standards of practice. J Infus Nurs. 2016;29(suppl 1):1-92.
• 30. Gorski L, Hadaway L, Hagle ME, et al. Infusion Nurses Society. Infusion nursing: standards of practice. J Infus Nurs. 2006;29:1-92.
• 31. Roberts R, Borley A, Hanna L, Dolan G, Ganesh S, Williams EM. Identifying risk factors for anthracycline chemotherapy-induced phlebitis in women with breast cancer: an observational study. Clin Oncol (R Coll Radiol). 2021;33(4):230-240. [CrossRef].
• 32. Marsh N, Webster J, Ullman AJ, et al. Peripheral intravenous catheter non‐infectious complications in adults: a systematic review and meta‐analysis. J Adv Nurs. 2020;76(12):3346-3362. [CrossRef]
• 33. Larsen EN, Marsh N, O'Brien C, Monteagle E, Friese C, Rickard CM. Inherent and modifiable risk factors for peripheral venous catheter failure during cancer treatment: a prospective cohort study. Support Care Cancer. 2021;29(3):1487-1496. [CrossRef]
• 34. Shintani Y, Murayama R, Abe‐Doi M, Sanada H. Incidence, causes, and timing of peripheral intravenous catheter failure related to insertion timing in the treatment cycle in patients with hematological malignancies: a prospective descriptive study. Jpn J Nurs Sci. 2022;19(4):e12484. [CrossRef]
• 35. Santos-Costa P, Paiva-Santos F, Sousa LB, et al. Nurses' practices in the peripheral intravenous catheterization of adult oncology patients: a mix-method study. J Pers Med. 2022;12(2):151. [CrossRef]
• 36. Hedayatinejad M, Fayazi S, Jahani S, Sakimalehi A, Hedayatinejad E. Survey of complications of peripheral venous catheterization at an intensive care unit (ICU) of Susa city. Jentashapir J Health Res. 2016;7(5):1-7. [CrossRef]
• 37. Washington GT, Barrett R. Peripheral phlebitis: a point-prevalence study. J Infus Nurs. 2012;35(4):252-258. [CrossRef]
• 38. Liu C, Chen L, Kong D, Lyu F, Luan L, Yang L. Incidence, risk factors and medical cost of peripheral intravenous catheter-related complications in hospitalised adult patients. J Vasc Access. 2020;10. [CrossRef]
• 39. Miliani K, Taravella R, Thillard D, et al. Peripheral venous catheter related adverse events: evaluation from a multicentre epidemiological study in France (the CATHEVAL Project). PLoS One. 2017;12(1):e0168637. [CrossRef]
• 40. Wallis MC, McGrail M, Webster J, et al. 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. [CrossRef].