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J Hosp Infect. 2016 Mar;92(3):280-6. doi: 10.1016/j.jhin.2015.10.021. Epub 2015 Nov 24.

Nursing care as a predictor of phlebitis related to insertion of a peripheral venous cannula in emergency departments: findings from a prospective study.

Author information

1
Udine University, Udine, Italy. Electronic address: alvisa.palese@uniud.it.
2
Verona University, Verona, Italy.
3
Udine University, Udine, Italy.
4
Azienda per i Servizi Sanitari Provincia, Trento, Italy.
5
Azienda Ospedaliera Verona, Verona, Italy.
6
Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy.
7
Azienda ULSS n. 9, Treviso, Italy.
8
Azienda per i Servizi Sanitari n. 2 'Isontina', Gorizia, Italy.
9
Azienda ULSS n. 6, Vicenza, Italy.
10
Azienda per i Servizi Sanitari n. 4 'Medio Friuli', Udine, Italy.
11
Azienda Ospedaliero-Universitaria S. Orsola-Malpighi, Bologna, Italy.
12
Fondazione Zancan, Padua, Italy.
13
Bologna University, Italy.

Abstract

BACKGROUND:

To date, few studies have investigated the occurrence of phlebitis related to insertion of a peripheral venous cannula (PVC) in an emergency department (ED).

AIM:

To describe the natural history of ED-inserted PVC site use; the occurrence and severity of PVC-related phlebitis; and associations with patient, PVC and nursing care factors.

METHODS:

A prospective study was undertaken of 1262 patients treated as urgent cases in EDs who remained in a medical unit for at least 24h. The first PVC inserted was observed daily until its removal; phlebitis was measured using the Visual Infusion Phlebitis Scale. Data on patient, PVC, nursing care and organizational variables were collected, and a time-to-event analysis was performed.

FINDINGS:

The prevalence of PVC-related phlebitis was 31%. The cumulative incidence (78/391) was almost 20% three days after insertion, and reached >50% (231/391) five days after insertion. Being in a specialized hospital [hazard ratio (HR) 0.583, 95% confidence interval (CI) 0.366-0.928] and receiving more nursing care (HR 0.988, 95% CI 0.983-0.993) were protective against PVC-related phlebitis at all time points. Missed nursing care increased the incidence of PVC-related phlebitis by approximately 4% (HR 1.038, 95% CI 1.001-1.077).

CONCLUSIONS:

Missed nursing care and expertise of the nurses caring for the patient after PVC insertion affected the incidence of phlebitis; receiving more nursing care and being in a specialized hospital were associated with lower risk of PVC-related phlebitis. These are modifiable risk factors of phlebitis, suggesting areas for intervention at both hospital and unit level.

KEYWORDS:

Catheterization; Emergency departments; Medical units; Missed nursing care; Peripheral; Phlebitis; Survival analysis; Vascular access devices

PMID:
26792683
DOI:
10.1016/j.jhin.2015.10.021
[Indexed for MEDLINE]

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