@2024 Afarand., IRAN

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ISSN: 2252-0805    The Horizon of Medical Sciences 2018;24(3):166-171

Background
The need for direct administration of fluids and drugs into the bloodstream has made catheter placement as the most common invasive hospital intervention in the world [1]. … [2-5]. Phlebitis has been very much considered in studies of venous catheter complications and it is one of the major causes of catheter failure [6].
Previous Studies
The incidence of this complication has been reported by 18-35% in different regions [7]. However, according to the Infusion Nursing Society, for each population, the rate of accepted phlebitis is 5% or less [4, 8]. … [9, 10]. According to the published studies on the risk factors of injectable phlebitis, soluble temperature is one of the effective factors in the development of phlebitis [11]. In a study conducted by Hajihosseini et al., the local effects of the temperature on wet phlebitis as warm compression have been studied. Local warm compression is effective in phlebitis symptoms due to peritoneal catheter [12]. In the study of Panley et al., the incidence of phlebitis and vascular injury decreased in heated injective mannitols [13].
Aim(s)
This study was conducted with the aim of determining the effect of uniformization of the temperature of venous administration with body temperature on phlebitis.
Research type
This is a randomized controlled clinical trial study.
Research society, place and time
The study population included all patients, who were admitted to internal ward of Imam Ali Hospital in 2016 and treated with venous solutions and drugs.
Sampling method and number
Sample size was calculated to be 48 based on Hajihosseini et al. [12], using the formula for comparing the means, considering the 10% fall for each group, it was considered 53. 106 patients were selected by purposive and convenience methods and they were randomly and by permuted block randomization assigned to 4 groups in the intervention and control groups. The inclusion criteria include informed consent, aged 18-65 years, complete awareness, lack of ground diseases such as leukemia, immunodeficiency and dermatitis, upper extremity health, lack of immunosuppressive drugs and chemotherapy, having at least 72 hours of venous catheter, not receiving venous irritant medications and hyperosmolar solutions that have been shown to increase the amount of phlebitis after their injection [14], lack of history of injecting drug use as an addiction, and ultimately not having fever more than 37.5°C. Exclusion criteria included the patient's lack of satisfaction to continue cooperation, the need for injection of venous-stimulating drugs and hyperosmolar solutions during the study, receiving liquids and venous drugs less than 72 hours, dispatching the patient to other centers, and adhesive allergy (transparent dressing).
Used devices&materials
The data collection form was completed by the nurse and based on patients’ records and statement. The first part contains demographic information, diagnosis, diabetes, smoking, and body mass index, and the second part contains information on catheterization and the complications and factors associated with phlebitis, which was provided by the researcher, using the sources, books, and related publications; also, face and content validity were confirmed by 10 faculty members. Angiocate (short venous catheter) number 22 (blue) was installed in the veins of the forearm side by a trained nurse after disinfection of the catheter entrance site with 70% alcohol. The catheter site was also fixed by transparent dressing. In the intervention group, solutions and prescribed drugs were heated by SINO MDT SN-1500 serial infusion pump, which is capable of heating the injectable solution at the body temperature, immediately before entering the vein, and it was prescribed at 37°C by venous catheter. In the control group, the solutions and drugs were placed in the patient's room 2 hours before injection, to be cooled at room temperature (about 24°C), and, then, the contact thermometer was attached to the microscope by several layers of leukoplast adhesive and was applied by the pump without applying heat. The received solutions and drugs including isotonic solutions containing normal saline (0.9% Sodium chloride, 3.1%, 3.2%, and 0.3% normal saline, and 33.3% dextrose) were with venous drugs that were injected on the first, second, and third day, respectively, with an average volume of 2, 1.5, and 1 liter, respectively. The used venous medications include the injection of cefotaxime 2 g every 8 hours and intravenous acetaminophen injection (PRN) diluted with 100 cc of the solution received by microset during 30 minutes. The site of catheterization was investigated immediately after the onset of infusion due to the incidence of hematoma and the catheter performance was verified, and in case of the complications noted, it was excluded. The catheter site was, then, examined at regular intervals every 2 hours after the installation of the angiocate based on the phlebitis scale of the nursing association, whose validity and reliability was previously verified [9, 15], by a research assistant, who did not know about the allocation of the groups. This scale consists of 5 degrees from zero to 4 degrees; zero: no symptom, grade 1: redness with or without pain, grade 2: pain with redness or edema, grade 3: pain with redness or edema, plus formation of red streaks throughout the vein and vein tenderness and rectangular vein touch less than 1 inch, and grade 4: grade 3 symptoms plus rectangular vein touch less than 1 inch and purulent secretion. As soon as phlebitis grade 2 appeared, the catheter was removed and reported as a phlebitis in the catheter information form as the cause of the catheter remove. The data were analyzed by SPSS 22, using Kolmogrov-Smirnov test for determining the normality of the data, independent t-test for comparing mean age, body mass index, and mean of received volume of two groups, and Chi-square test for comparing the two groups in terms of gender, education, marital status, underlying diseases, addiction, and phlebitis.
Findings by Text
The mean age of the patients in the two groups was 44.05±11.05 and the majority of the patients were female (58.5). The two groups were homogeneous for variables such as age, gender, body mass index, education, marital status, underlying diseases, addiction, and mean of received volume (Tables 1 and 2). There was no significant difference in the incidence of phlebitis between the control and intervention groups (Table 3). However, in the intervention group, the incidence of phlebitis decreased in the first and second 24 hours (Table 4).
Main comparison to the similar studies
Hajihosseini et al. conducted a study to compare the effects of both wet and dry compression and piroxicam gel methods on phlebitis caused by venous catheter. It was found that the level of phlebitis recovery in both groups was significantly different from that of the control group and was not consistent with the results of the present study [12]. In a study carried out by Panley et al., it was shown that warm mannitol injection had a significant effect on reducing the incidence of phlebitis, which is not consistent with the results of the current study [13]. The results of studies performed by Rigofortado [1] and Choi et al. [16] also showed a lack of gender difference in the incidence of phlebitis. Most studies have more reported the incidence of phlebitis in men [17].
Suggestions
None declared by the authors.
Limitations
We can note the unpredictable type of drug and dose received by the patient; we tried to enter the individuals into the study, who use conventional drugs with conventional doses.
Conclusions
The uniformization of the temperature of the injectable solution with normal body temperature on the first and second day of the intervention has little effect, but this does not have a significant effect on the incidence of phlebitis.
Acknowledgments
We would like to extend our gratitude to all the officials, doctors, and employees of the internal ward of Imam Ali Hospital, who helped us in this study. We also appreciate the patients, who made this research possible with informed consent.
Conflict of interest
There is no conflict of interest.
Ethical Permissions
This project under the IRCT code IRCT2017011531959N1 has ethical authorization from the Regional Ethics Council in Gonabad University of Medical Sciences.
Funding Sources
None declared by the authors.

TABLES and CHARTS

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