Thrombophlebitis

The cephalosporins generally cause few side effects (80,132,219—221). Thrombophlebitis occurs as a result of intravenous administration of all cephalosporins. Hypersensitivity reactions related to the cephalosporins are the most common side effects observed, but these are less common than found with the penicillins. Clinically only about 5—10% of patients with allergic reactions to the penicillins manifest the same reactions to the cephalosporins, and data would contradict any tme cross-reactivity to cephalosporins in patients who have previously reacted to penicillin (80,132,219). 

Thrombophlebitis. Inflammation of the veins involving the formation of blood clots. 

Other adverse reactions that may be seen with administration of the cephalosporins are headache, dizziness, nephrotoxicity (damage to the kidneys by a toxic substance), malaise, heartburn, and fever. Intramuscular (IM) administration often results in pain, tenderness, and inflammation at the injection site Intravenous (IV) administration has resulted in thrombophlebitis and phlebitis. 

When the drug is given IV, the nurse inspects the needle insertion site for signs of extravasation or infiltration (see Chap. 2). In addition, it is important to inspect the needle insertion site and the area above the site several times a day for signs of redness, which may indicate thrombophlebitis (inflammation of a vein with formation of a clot within the vein) or phlebitis (inflammation of a vein), if either problem occurs, the nurse contacts the primary health care provider and the IV must be discontinued and restarted in another vein, preferably in another extremity. 

MONITORING DRUGS GIVEN INTRAVENOUSLY. For optimal results, die nurse inspects the needle site and die area around die needle every hour for signs of extravasation of die IV fluid. The nurse performs diese assessments more frequently if the patient is restiess or uncooperative It is important to check the rate of infusion every 15 minutes and adjust it as needed. The nurse should inspect die vein used for die IV infusion every 4 hours for signs of tenderness, pain, and redness (which may indicate phlebitis or thrombophlebitis). If tiiese are apparent, die nurse must restart the IV in another vein and bring the problem to the attention of the primary health care provider. 

The most common adverse reactions seen with this drug are related to the gastrointestinal tract and may include nausea, anorexia, and occasionally vomiting and diarrhea The most serious adverse reactions are associated widi die CNS and include seizures and numbness of die extremities. Hypersensitivity reactions also may be seen. Thrombophlebitis may occur widi intravenous (IV) use of die drug. 

Thromboembolism or fat embolism, thrombophlebitis, necrotizing angiitis, syncopal episodes, cardiac arrhythmias, aggravation of hypertension... 

The most common adverse reaction associated with the administration of fat emulsion is sepsis caused by administration equipment and thrombophlebitis caused by vein irritations from concurrently administering hypertonic solutions. Less frequently occurring adverse reactions include dyspnea, cyanosis, hyperlipidemia, hypercoagulability, nausea, vomiting, headache flushing, increase in temperature sweating, sleepiness, chest and back pain, slight pressure over the eyes, and dizziness. 

The clinical scenario and the severity of the volume abnormality dictate monitoring parameters during fluid replacement therapy. These may include a subjective sense of thirst, mental status, skin turgor, orthostatic vital signs, pulse rate, weight changes, blood chemistries, fluid input and output, central venous pressure, pulmonary capillary wedge pressure, and cardiac output. Fluid replacement requires particular caution in patient populations at risk of fluid overload, such as those with renal failure, cardiac failure, hepatic failure, or the elderly. Other complications of IV fluid therapy include infiltration, infection, phlebitis, thrombophlebitis, and extravasation. 

Acyclovir 20 mg/kg IV every 8 hours (neonates) Alternative Therapy Foscarnet 120-200 mg/kg IV per day in divided doses every 8-12 hours neurotoxicity, phlebitis Nephrotoxicity, electrolyte imbalances, nausea/ vomiting, headache, penile ulceration, thrombophlebitis, seizures ... 

Adverse reactions CNS Convulsions, confusion, drowsiness, myoclonus, fever Dermatologic Rash Metabolic Electrolyte imbalance Hematologic Positive Coombs test, hemolytic anemia Local Rain, thrombophlebitis Renal Acute interstitial nephritis Miscellaneous Anaphylaxis, hypersensitivity, Jarisch-Herxheimer reaction CNS Seizures, confusion, drowsiness, myoclonus, CNS stimulation Cardiovascular Myocardial depression, vasodilation, conduction disturbances Hematologic Positive Coombs test, hemolytic anemia, neutropenia Local Thrombophlebitis, sterile abscess at injection site Renal Interstitial nephritis Miscellaneous Pseudoanaphylactic reactions, hypersensitivity, Jarisch-Herxheimer reaction, serum sickness... 

Amphotericin B is the mainstay of treatment of patients with severe endemic fungal infections. The conventional deoxycholate formulation of the drug can be associated with substantial infusion-related adverse effects (e.g., chills, fever, nausea, rigors, and in rare cases hypotension, flushing, respiratory difficulty, and arrhythmias). Pre-medication with low doses of hydrocortisone, acetaminophen, nonsteroidal anti-inflammatory agents, and meperidine is common to reduce acute infusion-related reactions. Venous irritation associated with the drug can also lead to thrombophlebitis, hence central venous catheters are the preferred route of administration in patients receiving more than a week of therapy. 

Anastrozole is a selective nonsteroidal aromatase inhibitor that lowers estrogen levels. The pharmacokinetics of anastrozole demonstrate good absorption, with hepatic metabolism the primary route of elimination and only 10% excreted unchanged by the kidney. The elimination half-life is approximately 50 hours. Anastrozole is used for the adjuvant treatment of postmenopausal women with hormone-positive breast cancer and in breast cancer patients who have had disease progression following tamoxifen. Side effects include hot flashes, arthralgias, osteoporosis/bone fractures, and thrombophlebitis. 

PN can be administered via a smaller peripheral vein (e.g., cephalic or basilic vein) or via a larger central vein (e.g., superior vena cava). Peripheral PN (PPN) is infused via a peripheral vein and generally is reserved for short-term administration (up to 7 days) when central venous access is not available. PN formulations are hypertonic, and infusion via a peripheral vein can cause thrombophlebitis. Factors that increase the risk of phlebitis include high solution osmolarity, extreme pH, rapid infusion rate, vein properties, catheter material, and infusion time via the same vein.20 The osmolarity of PPN admixtures should be limited to 900 mOsm/L or less to minimize the risk of phlebitis. The approximate osmolarity of a PN admixture can be calculated from the osmolarities of individual components ... 

Thrombophlebitis Inflammation of a blood vessel (e.g., vein) associated with the stimulation of clotting and formation of a thrombus (or blood clot). 

Commonly administered LVPs include such products as Lactated Ringers Injection USP, Sodium Chloride Injection USP (0.9%), which replenish fluids and electrolytes, and Dextrose Injection USP (5%), which provides fluid plus nutrition (calories), or various combinations of dextrose and saline. In addition, numerous other nutrient and ionic solutions are available for clinical use, the most popular of which are solutions of essential amino acids or lipid emulsions. These solutions are modified to be hypertonic, isotonic, or hypotonic to aid in maintaining both fluid, nutritional, and electrolyte balance in a particular patient according to need. Indwelling needles or catheters are required in LVP administration. Care must be taken to avoid local or systemic infections or thrombophlebitis owing to faulty injection or administration technique. 

Thrombophlebitis or thromboembolic disorder, or a history of these conditions... 

Thrombophlebitis is a common complication this risk is greater with solution osmolarities greater than 600 to 900 mOsm/L (Table 60-2). 

Diazepam, a long-acting benzodiazepine can be used either intravenously (risk of thrombophlebitis) or intramuscularly or rectally (both of the last two routes are associated with slow absorption). 

Diazepam may be used in status epilepticus where it is administered intravenously. However, there is a risk of thrombophlebitis. Diazepam has a long half-life and it is rapidly absorbed into the brain. 

This drug is used for preventing and treating thrombosis, thrombophlebitis, thromboe-molium, and for preventing thrombo-formation in post-operational periods. Synonyms of this drug are bishydroxycoumarin, dicumol, cromolyn, and others. 

Like coumarin derivatives, phenindione, a compound of the indandione class, acts by altering biosynthesis of coagulant proteins in the liver. It is used for preventing and treating thrombosis, thrombophlebitis, and thromboembolism. However, because of a number of side effects such as poly urea, polydipsia, tachycardia, and others, it is rarely used in practical medicine. Synonyms of this drug are pindone, bindan, gevuUn, indan, phenyhne, and rectadione. 

Resistance Increased resistance to the drug is frequently encountered in fever, thrombosis, thrombophlebitis, infections with thrombosing tendencies. Ml, cancer, and postoperative states. 

Thrombotic disorders Thrombotic disorders (thrombophlebitis, cerebrovascular disorders, retinal thrombosis, pulmonary embolism) occasionally occur in patients taking progestins. 

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