Thrombophlebitis catheter

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. 

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 ... 

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. 

After rapid intravenous administration hypotension, shock, and atrioventricular block can occur and can be fatal (2). The rate of infusion should not exceed 5 mg/minute. Qther adverse effects reported during intravenous infusion include sinus bradycardia (236), facial flushing, and thrombophlebitis (236-239). The risk of this last complication can be reduced by infusing the drug into as large a vein as possible and preferably via a central venous catheter, or perhaps by using a very dilute solution of the drug (240). 

A major complication of intravenous infusion is thrombophlebitis, which is a principle limitation of peripheral parenteral nutrition. Its precise pathogenesis is unclear, but venospasm has been proposed as the most likely cause. However, in a study with ultrasound techniques to monitor vein caliber, there was no evidence to support this hypothesis, although thrombophlebitis was observed (10). The author suggested that the initiating event may be venous endothelial trauma, caused by the venepuncture itself, abrasion at the catheter tip, or the delivery of the feeding solution. 

Intravenous administration of erythromycin into peripheral veins relatively commonly causes thrombophlebitis, although the lactobionate form of erythromycin may be less irritating to veins than other parenteral forms (11,12). In a prospective study of 550 patients with 1386 peripheral venous catheters, the incidence of phlebitis was 19% with antibiotics and 8.8% without erythromycin was associated with an increased risk (13). 

Thiopental is used for i.v. anesthetic induction in the horse, usually to precede intubation and maintenance with inhalation anesthetics. It is used at 5-10% in the horse, with the higher concentration allowing for a significant reduction of the volume of injection. Thiopental at these concentrations should only be injected i.v. via a preplaced i.v. catheter, preferably placed in a large vein, such as the jugular vein. Even with these precautions, evidence of jugular thrombophlebitis can be seen at 48 h after the routine administration of guaifenesin and 10% thiopental to horses (Dickson et al 1990). 

The frequency of replacement of catheters and administration sets depends on the local environmental conditions and the catheter material. Catheters made from polytetrafluoroethylene (Teflon) are associated with an increased incidence of thrombophlebitis and have a tendency to crack... 

Thrombophlebitis can be identified by heat, swelling or the presence of any exudate around the catheter insertion site or a palpable thrombus ("corded" feel) in the catheterized vein. Catheter-ized veins should be examined at least daily. 

Ultrasonography of a catheterized vein can help to identify thrombus formation. It is prudent to continue to check the vein for 2-3 days after catheter removal because thrombophlebitis may develop or become apparent in this period. 

Rotation or prompt removal of catheters during periods of sepsis is indicated for prevention of septic thrombophlebitis. 

More recently the drug has also been given intravenously for infections with coccidioidomycosis. Stevens (18 -) treated 14 patients with chronic coccidioidomycosis with dosages of up to 3.6 g/day for periods of up to 3 months. In one patient a pruritic maculopapular rash developed. The most common side effect was thrombophlebitis, but this problem can possibly be circumvented by the use of a central venous catheter. Sung (19 ) treated one patient with coccidioidomycosis with dosages of 800 mg per 8 hours and noticed dryness of the eyes and joint pains. The complaints disappeared on a slightly lower dose of 600 mg per 8 hours. 

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