Biomechanical aspects of catheter-related thrombophlebitis

Short peripheral catheters (SPCs) are the most common intravenous devices used in medical practice. Short peripheral catheter thrombophlebitis (SPCT) is the most frequent complication associated with SPCs, causing discomfort and usually leading to removal of the catheter and insertion of a new one at a different site. The aim of this research was to explore whether biomechanical factors, in addition to biochemical factors, also play a role in the formation of thrombophlebitis. Hence, two of the biomechanical aspects of SPCT were investigated: the physical pressure load exerted by the SPC on the endothelial monolayer, and disturbances in the flow patterns due to the SPC. Endothelial activation was studied by subjecting human umbilical vein endothelial cells (HUVEC) to a weight load of SPC pieces and measuring the release profile of von-Willebrand Factor (vWF) over time, using ELISA. vWF release was chosen as the measure for endothelial activation since it was the major component of the Weibel-Palade Bodies (WPBs), which underwent exocytosis by endothelial cells during activation. Flow patterns were analyzed on a 3D computational fluid dynamics (CFD) model of a brachiocephalic vein with SPC. vWF release profiles were significantly higher in the HUVECs subjected to the load, indicating HUVEC activation. CFD simulations demonstrated a decrease in flow velocities along the catheter body, between the catheter and the vein, due to an enlarged boundary layer. Results indicate that the contact region between the SPC body and the vein wall can be partially responsible for SPCT development, and inflammatory and coagulatory processes initiated by stimulated endothelial cells may be amplified due to disturbed blood flow.

Application of Ji Desheng Snake Pills Combined with Hypertonic Glucose External Application in Treating Drug-Induced Superficial Phlebitis Caused by Parenteral Nutrition

Objective: The efficacy of Ji Desheng snake pills combined with hypertonic glucose external application in treating drug-induced superficial phlebitis caused by parenteral nutrition (PN) is observed. Methods: Fifty-two cases of drug-induced superficial phlebitis after peripheral parenteral nutrition (PPN) were selected, which were randomly divided into experimental group and control group in accordance with the phlebitis grading. In the experimental group, Ji Desheng snake pills were crushed to make a paste with 50% glucose solution, which was then applied to the affected area of phlebitis, the surface was covered with clean gauze, and properly fixed with tape or bandage. The drug was replaced once a day. In the control group, the gauze soaked with 50% magnesium sulfate solution was used, which was applied to the affected part three times a day in wet, and the efficacy was observed respectively on the 1st, 3rd, 5th and 7th days after applying the drug. Results: On the 1st and 3rd days after treatment, the observed effective rate of the experimental group was higher than that of the control group (42.31% vs. 15.38% and 76.92% vs. 46.15%, respectively). The difference was statistically significant (p th and 7th days after treatment, there was no statistical significance with respect to the efficacy between the experimental group and the control group (p > 0.05). Conclusion: The significant efficacy could be found in early stage after drug-induced superficial phlebitis was treated by Ji Desheng snake pills combined with hypertonic glucose external application, which was superior to that of the traditional treatment of wet application by using gauze soaked in 50% magnesium sulfate solution.

Application of Modeling Drugs in Animal Models of Chemical Phlebitis: Review

Objective: This review aims to determine the impact of different drugs and methods on the successful establishment of an animal model for chemical phlebitis (CP). Design: Search the Cochrane Library, ProQuest Academic Journal Library, PubMed, Web of Science, Ovid, Embase, CINAHL complete (EESCO) and other related databases to determine the literature. Screen out articles consistent with this review and summarize them. Results: Since the establishment of the database, a total of 1463 articles have been retrieved. After reading the title, abstract and full text, and excluding non-related and duplicate articles, 22 reports were finally included. Among them, there are 8 articles using different medication methods to compare the effects of establishing a CP model. The included articles explored the effects of different animal models, drug types, and their dose, concentration, speed, and time on the CP model. Conclusion: The factors of dose, concentration and time were positively correlated with the incidence of CP. The effect of speed factors on CP and the results of different animal models are inconsistent. It requires further research in the future.

Effectiveness of Magnesium Sulphate with Glycerin Dressing versus Heparinoid Ointment Application on Management of Phlebitis among Patients Admitted in Selected Wards of BPKIHS

Background: Phlebitis is the inflammation of the tunica intima of the vein. If left untreated may lead to infection or thrombus formation. Early detection and appropriate interventions reduce the occurrence and severity of cannula related phlebitis. Objective: To evaluate the effectiveness of magnesium sulphate with glycerin dressing as compared to heparinoid ointment application on management of peripheral cannula induced phlebitis. Materials and Methods: A Quasi-experimental design was carried among admitted patients in Medical-Surgical Units of BPKIHS. Out among 50 admitted patients with cannula induced phlebitis. Simple random sampling technique was used to allocate the wards to each interventional group and purposive sampling technique to select samples where instruments baseline Performa and observation scale was used to collect data. Results: The study findings revealed significantly reduction of phlebitis score after 48 hours of treatment with both interventions. Thus it was concluded that both the applications were effective in reducing level of phlebitis. Regarding effectiveness, there was a statistically significant difference in phlebitis score in both experimental groups after comparison baseline within 8, 16, 32, 40, 48 hours of administration of intervention (P = 0.05). The mean visual infusion scale score was more in MSG group as compared with that of HPA group. It shows that there is more reduction of VIP score in Magnesium sulphate with glycerin (MSG) group. Conclusion: In the research, study findings revealed that Magnesium sulphate with glycerin dressing is more effective than heparinoid ointment on management of peripheral cannula induced phlebitis.

Clinical observation and experimental study on Kangfuxin fluid in treating indwelling needle-related phlebitis

Objective To investigate the therapeutic effect of Kangfuxin Fluid on indwelling needle-related phlebitis by observation of clinical samples and pharmacological study.Methods Eighty-five patients with indwelling needle-related phlebitis in the neurosurgery department of a Grade A hospital in Shanxi Province from June 2019 to November 2021 were randomly divided into the study group(43 cases)and the vehicle group(42 cases).Patients in the study group were treated with KFX,and patients in the control group were treated with hydrocolloid dressing.The time for symptoms(such as redness and pain)to disappear was recorded.The effect of tissue repair was evaluated by the fin crosscutting model and the anti-inflammatory effect was evaluated by the inflammatory models.Q-PCR assay was used to detect the mRNA expression levels of IL-6 and TNF-αin LPS-stimulated zebrafish.The effect on promoting angiogenesis was evaluated by the inter-segmental blood vascular defect model of zebrafish.Results The curative effect of the study group was better than the control group.The pain resolution time and the swelling resolution time in the study group were(1.67±0.90)d and(2.25±0.92)d,respectively,shorter than those in the control group(P<0.05).KFX can improve the ISV index,increase the regeneration length of the fin,inhibit the migration of neutrophils in three inflammatory models and reduce the mRNA expression levels of IL-6 and TNF-αin LPS-stimulated zebrafish.Conclusion KFX exerts great clinical efficacy in the treatment of indwelling needle-induced phlebitis which may be associated with inflammation inhibition,angiogenesis promotion,and tissue repair.

A clinical study on the prevention of phlebitis caused by Cinobufagin using hand exercise combined with Jinhuang ointment

Objective:The aim of this study is to observe the clinical effect of hand exercise combined with jinhuang ointment on the prevention of phlebitis due to cinobufagin.Methods:A total of 90 cancer patients who have been receiving intravenous(Ⅳ)infusion of cinobufagin from May 2018 to June 2019 in the oncology department of our hospital were selected.They were then divided into three groups in a random manner,which include 30 cases in the control group,30 cases in the jinhuang ointment group,and 30 cases in the group of hand exercise combined with jinhuang ointment.The control group had a routine care before cinobufagin was infused from the first day of hospitalization.During the routine care mentioned previously,the jinhuang ointment group was given locally jinhuang ointment inunction,qd,and kept for 6 hours.Hand exercises were then done on the combined group excluding jinhuang ointment application,qd,at 10min.After treatment for 1 week,the phlebitis and pain incidences on the venipuncture site were then compared between the three groups.Results:After the 1-week treatment,the incidences of grade Ⅰ/Ⅱ phlebitis in the control group,the jinhuang ointment group,and the group of hand exercise combined with jinhuang ointment were 53.5%,23.3%,and 10%,respectively.The results have shown a significant decrease in the jinhuang ointment group and the combined group as in comparison with the control group(P=0.0169,P=0.0003).Even with the incidence of the combined group being lower than that of the jinhuang ointment group,no statistically significant difference(P=0.1659)was found.The incidences of grade Ⅲ/Ⅳ phlebitis in the control group,the jinhuang ointment group,and the group of hand exercise combined with jinhuang ointment were 23.3%,3.3%,and 3.3%,respectively.Both the jinhuang ointment group and the combined group had significantly lower results than that of the control group(P=0.0003,P=0.0227).There was no difference in the results of the combined group and the jinhuang ointment group.The incidences of pain in the control group,the jinhuang ointment group,and the group of hand exercise combined with jinhuang ointment were 56.7%,36.7%,and 20%,respectively.There was no significant difference in the results of the jinhuang ointment group and the control group(P=0.1205);the combined group has shown a significant decrease in the incidence compared with the control group(P=0.0035);the incidence of pain in the combined group was lower than that of the jinhuang ointment group,but without a statistical difference(P=0.1520).Conclusion:Hand exercise together with jinhuang ointment inunction can significantly reduce the incidence of phlebitis produced by cinobufagin.

Enterocolic phlebitis:a rare cause of bowel ischemia and review of the literature

Enterocolic phlebitis(EP)is a rare cause of bowel ischemia due to isolated venulitis of the bowel wall and mesentery without arterial involvement.EP is often misdiagnosed as inflammatory bowel disease,carcinoma,or diverticulitis due to non-specific symptoms as well as non-specific clinical and radiologicalfindings.While unresponsive to pharmacotherapy,surgical resection of the affected bowel appears to be the only successful therapy with a very low recurrence rate.Etiology of EP remains unknown.We report a case of EP with rare presentation in the left hemicolon and unusual histologicalfindings emphasizing the heterogeneity of this cause of enterocolic ischemia.The review and comparison of the three enti-ties—EP,mesenteric inflammatory veno-occlusive disease(MIVOD),and idiopathic myointimal hyperplasia of mesenteric veins(IMHMV),all describing patterns of bowel ischemia due to isolated pathology of mesenteric veins—reveal that the current terminology is unclear.EP and MIVOD are very similar and may be considered the same disease.IMHMV,though,differs in localization,symptom duration,and histologicalfindings but also shares features with EP and MIVOD.Further studies and harmonized terminology are inevitable for better understanding of the disease,prevention of unnecessary pharmacotherapy,and reduction in time to diagnosis.

Efficacy of topical chamomile on the incidence of phlebitis due to an amiodarone infusion in coronary care patients:a double-blind,randomized controlled trial

BACKGROUND：Amiodarone is a useful antiarrhythmic drug.Phlebitis,caused by intravenous amiodarone,is common in patients in coronary care units（CCUs）.OBJECTIVE：The aim of this study was to evaluate the effect of topical chamomile on the incidence of phlebitis due to the administration of an amiodarone infusion into the peripheral vein.DESIGN,SETTING,PARTICIPANTS AND INTERVENTIONS：This was a randomized,double-blind clinical trial,conducted on 40 patients（n=20 per group）in two groups—an intervention group（chamomile ointment）and a control group（lanoline,as a placebo）,hospitalized in the CCUs and undergoing an amiodarone infusion into the peripheral vein over 24 h.Following the cannulation and commencement of the infusion,placebo or chamomile ointment was rubbed in,up to 10 cm superior to the catheter and repeated every eight hours for three days.The cannula site was then assessed based on the phlebitis checklist.MAIN OUTCOME MEASURES：The incidence and time of occurrence of phlebitis,relative risk,severity of phlebitis were the main outcome measures.RESULTS：Nineteen patients（19/20）in the control group had phlebitis on the first day of the study and one patient（20/20）on the second day.In the intervention group,phlebitis occurred in 13 cases（13/20）on the first day and another two（2/7）was found on the second day.The incidence of phlebitis was significantly different between two groups（P=0.023）.The cumulative incidence of phlebitis in the intervention group（15/20）is significantly later and lower than that in the control group（20/20）during two days（P=0.008）.Two patients in the intervention group did not develop phlebitis at all during the 3-day study.Also,the relative risk of phlebitis in the two groups was 0.68（P=0.008 5）.A significant difference was not observed with regard to phlebitis severity in both groups.CONCLUSION：It seems that phlebitis occurred to a lesser extent and at a later time frame in the intervention group compared to control group.Topical chamomile may be effective in decreasing the incidence of phlebitis due to an amiodarone infusion.

Effects of anisodamine on the expressions of vascular endothelial growth factor and intercellular adhesion molecule 1 in experimental infusion phlebitis

Background Infusion phlebitis is the most common side effect of clinical intravenous drug therapy and several clinical studies have demonstrated that anisodamine can effectively prevent the occurrence of infusion phlebitis.This study was designed to investigate effects of anisodamine on the expressions of vascular endothelial growth factor （VEGF） and intercellular adhesion molecule 1 （ICAM-1） in a rabbit model of infusion phlebitis and to analyze the mechanisms of anisodamine effect on the prevention and treatment of experimental infusion phlebitis.Methods Twenty-four specific pathogen-free male Japanese white rabbits were randomly assigned to the control group,the model group,the magnesium sulfate group and the anisodamine group.The rabbit model of infusion phlebitis,induced by intravenous administration,was established and expressions of VEGF and ICAM-1 were determined and contrasted with the control group treated with normal saline.We evaluated expression by histopathology,immunohistochemistry,reverse transcription-polymerase chain reaction,and Western blotting assay.Results Pathohistological changes of the model group were observed,such as loss of venous endothelial cells,inflammatory cell infiltration,edema and thrombus.The magnesium sulfate group and the anisodamine group showed significant protective effects on vascular congestion,inflammatory cell infiltration,proliferation,swelling of endothelium and perivascular hemorrhage.The model group showed the highest expressions of VEGF and ICAM-1 of the four groups （P〈0.01）.On the contrary,anisodamine alleviated the inflammatory damage by significantly reducing the expressions of VEGF and ICAM-1 compared with the model group （P 〈0.01）.There was no significant difference in the expressions of VEGF and ICAM-1 between the magnesium sulfate group and the anisodamine group （P 〉0.05）.Conclusion Anisodamine alleviates inflammatory damage by significantly reducing the expressions of VEGF and ICAM-1,and shows significant protective effects

Comparison between two methods of preventing Amiodaroneinduced phlebitis

Background Two different interventions are to be tested on patients who have phlebitis caused by Amiodarone therapy. The aim is to prevent or reduce the incidence of phlebitis and observe the effects of both methods. Methods A total of 101 patients are divided into observation and control groups ： 51 in the observation group and 50 in the control group. In the observation group, fresh slices of potato were applied on the affected areas of the patients＇ skin, and partially covered with plastic wrap to hold it in place. In the control group, Hirudoid creams were applied on the affected areas of the patients＇ skin. The treatments are administered thrice a day, with each treatment taking 20 minutes. The patients are then observed for incidence of phlebitis at the 24 hour, 48 hour and 72 hour interval. Results Comparing the results of each group across the time intervals, we find that the former is more effective than the latter, and the difference is statistically significant（P 〈 0.05）. Conclusions Applying fresh potato slices is more effective than using Hirudoid cream for treating Amiodarone-induced phlebitis. It is easy to be administered, affordable, and should be considered for wider clinical application.

喜辽妥联合硫酸镁湿敷在血液肿瘤患儿化疗性静脉炎中的应用效果探究

目的:探讨喜辽妥联合硫酸镁湿敷治疗血液肿瘤患儿化疗性静脉炎的临床效果。方法:选择2015年1—2016年10月我院儿科收治的90例因血液肿瘤化疗而放置留置针的患儿。按随机数字表法分为观察组和对照组,各45例。在放置留置针的过程中,对照组予硫酸镁湿敷,观察组联合应用硫酸镁湿敷和喜辽妥软膏。比较两组静脉炎发生率,发生静脉炎患儿的治愈时间,以及患儿在治疗过程中的舒适度。结果:观察组静脉炎发生率低于对照组,差异有统计学意义(P<0.05);在发生静脉炎后,观察组缓解时间短于对照组,差异有统计学意义(P<0.05);对于整个治疗过程中的舒适程度评价,观察组评分高于对照组,差异有统计学意义(P<0.05)。结论:喜辽妥联合硫酸镁湿敷能够有效预防化疗性静脉炎的发生,提高患儿在放置留置针期间的舒适度,并能在较短时间内治愈静脉炎,具有较高的临床应用价值。

Influence of compound aescine gel on ultrastructure of vein infused mannitol and its mechanism

Purpose: When hypertonic solution 20% mannitol solution was injected into vein, inflammatory mediators and Mitogen-activated protein kinases activated by mannitol can directly induce the fading of vascular endothelial cell, which leads to phlebitis. The study aims to observe the influences of reparil-gel N coated at the proximal parts of the puncture point and basing on this along with infusing heated mannitol to veins to the injure and ultrastructure of veins which were infused the 20% mannitol solution by indwelling needle in vein. Methodology: There are 15 adult New Zealand rabbits. We randomly divided 24 ear veins of 12 adult New Zealand rabbits into Control group, Gelatum group, Gel heated group and injected 20% mannitol solution by vein detained needle in three groups. In Gelatum group, we coated the proximal end of the puncture point with a thin layer of compound aescine gel. Based on Gelatum group, we heated 20% mannitol solution to 35oC-37oC in Gel heated group. Then we observed the intravenous parts and took the veins of each group out to observe their morphology and ultrastructural after the second day of transfusion. 6 ear veins of the rest 3 rabbits as Health group weren’t given any interventions, the veins were taken out to observe their morphology. Results: Comparison between Gelatum group and Gelatum heated group on vascular dilatation, Infiltration of inflammatory cell and Formation of thrombus had no significance, P> 0.05, while the case was different for the comparison on injury of vascular wall, perivascular edema and perivascular hemorrhage, P< 0.05). The statistical significance exists between control group and Gelatum group and Gel heated group, P< 0.05. It was observed under the electron microscope that, in control group, the membrane of endothelial cell peeled off and the mitochondria swelled and vacuolized. In Gelatum group, the membrane of endothelial cell was defective, the parts of the mitochondria were fuzzy, intercellular substance was slightly edematous. In Gel heated group, the mitochondria were clear and intercellular substance slightly swelled. It could be found that the function of phagocyte was complete. Conclusions: Compound aescine gel can prevent phlebitis or reduce the incidence of phlebitis. The combined intervention of coating with a thin layer of compound aescine gel and heating mannitol solution can produce better effect.

Comparative Study of Histological Alterations in Intravascular Catheter Region with and without the Use of Local Corticosteroid

Introduction: Central venous access is one of the most common procedures in pediatric surgery worldwide for infusion of antibiotics, electrolytes, chemotherapy, total parenteral nutrition, etc. Local regional complications due the permanence of venous catheters are described most frequently as: thrombosis, infection, edema and local cellulites, mobilization and catheter loss. As a result, the catheter must be prematurely removed. The use of local corticosteroid (Betamethasone) can be an alternative to lengthen the catheter maintenance. Aim: This study objective is to analyze perivascular inflammatory alterations in phlebotomies with polytetrafluoroethylene (20 GA) catheter in two periods of permanence 15 and 30 days with or without local Corticosteroid. Material & Method: 32 New Zealand adult rabbits were submitted to catheterization of the External Right Jugular Vein(RJV) and were divided in 4 groups: G1: with 8 rabbits’ catheters collected in the 15th day, without corticosteroid use;G2: with 8 rabbits’ catheters collected in the 15th day, with corticosteroid use;G3: with 8 rabbits’ catheters collected in the 30th day, without corticosteroid use;G4: with 8 rabbits’ catheters collected in the 30th day, with corticosteroid use;G5: Control was the contralateral vein of the rabbit itself. Results: G2 presented lower inflammatory incidence when compared to G1, despite this difference was not statistically significant (p = 0.7333). G4 also displayed lower inflammatory incidence than G3, however it was not statistically significant (p = 0.3571). When G1 and G3 were compared with G2 and G4, there was also lower incidence of the inflammatory process in those subjects using Betamethasone, although this difference was not statistically significant (p = 0.3202). Conclusion: Betamethasone used in the vascular catheters insertion areas through phlebotomy can lessen local inflammatory manifestations of venous catheterizations.

中西医结合治疗下肢深部静脉炎69例临床观察

目的：探讨中西医结合治疗下肢深静脉炎的临床效果。方法：本组69例病人均采用药物保守治疗，主要是中医辨证分型治疗、抗感染、抗凝、扩张血管、溶栓及外治法。结果：69例患者中，治愈43例，占62．3％；好转22例，占31．8％；无效4例，占5．9％。结论：运用中西医结合的方法治疗周围血管病，能缩短治疗时间，收效更快，效果更佳，能达到祛标达本的治疗目的。

Venous Catheterization Experimental Model in Rabbits:Histological Alterations in the Catheter Region

Central venous access is one of the most common surgery procedures worldwide, especially in pediatric surgery. Local and regional complications as the result of venous catheter permanence time are frequently described as: thrombosis, infection, edema and local cellulite, movement and loss of the catheter. Other severe complications such as endocardiac and hemorrhagic lesions are also described and considered the cause of catheter early removal. In the literature few studies have addressed vascular and perivascular lesions and complications as the result of central venous access to peripheral veins, given the difficulty of setting up venous catheterization experimental models to study blood vessels and perivascular tissue alterations after catheterization. In the present venous catheterization experimental model, rabbits were divided into two groups based on the time that the venous catheters were maintained in their veins. Group a composed of 7 New Zealand male rabbits was submitted to a 15-day treatment;and the 6 New Zealand male rabbits of group B were treated during 90 days. Both groups presented similar inflammatory conditions since there was no significant difference between groups. Therefore, the results may well suggest that the endothelial inflammatory reaction could have developed at an early initial short period and by maintaining the catheter, the inflammatory reactions would have decreased or disappeared. Aimed at studying these vascular and perivascular alterations in venous catheterization, the present study proposes an experimental rabbit model that allows the analysis of differences in local vascular and perivascular histological variations and compares histological differences between both venous catheterization groups each of them with different periods of treatment.

Hot Compress with Chinese Herbal Salt Packets Reducing PICC Catheter Complications: A Randomized Controlled Trial

Objective： To explore the preventive effect of applying hot compress with Chinese herbal salt packets（CHSP） to puncture vessels under aseptic conditions during peripherally inserted central catheter（PICC） on postoperative phlebitis. Methods： A total of 720 hospitalized patients undergoing first PICC were assigned to treatment and control groups（360 cases each group） according to a random number table. The control group received conventional catheterization and nursing care. The treatment group was first given hot compress with CHSP（which consisted of honeysuckle 30 g, Semen brassicae 30 g, Salvia miltiorrhiza 30 g, Angelica dahurica 30 g, Semen raphani 30 g, Evodia rutaecarpa 30 g, and coarse salt 20 g） on the punctured vessel under aseptic conditions for 5–10 min before conventional catheterization. The main efficacy indices were the vessel diameters before and during catheterization and the success rate of a single catheter, and the secondary efficacy indiex was the incidence of superficial phlebitis within 1 week after catheterization. Results： The vessel diameter during catheterization of the treatment group was remarkably increased compared with the control group [（7.96±0.42） mm vs.（4.39±0.54） mm, P〈0.01]. The success rate of the single catheter of the treatment group was significantly higher than that of the control group [94.00%（329/350） vs. 73.72%（244/329）, P〈0.01]. The incidence of superficial phlebitis within 1 week after catheterization in the treatment group was lower than that in the control group（P=0.007）. There was no adverse event with CHSP. Conclusion： Hot compress with CHSP during PICC is applicable as it can effectively improve the success rate of a single catheter and reduce the incidence of superficial phlebitis after catheterization（Trial registration No. ChiCTR-ONC-17010498）.