Management of Superficial Phlebitis

Tradition v. Science
Isabel Ng Hui Leng Senior Staff Nurse (Research) Nursing Service 23 Sep 2011

Past

Present

Management of superficial phlebitis

Inflammatory process that arises from the sensitization of the vascular endothelium Mechanical, chemical Affect between 20% to 80% of patients on infusion therapy Phlebitis Rating Scale (MOH CPG 1/2002)

Management of superficial phlebitis

So whats the mystery?

Primary hypothesis

Are there differences in the treatment effect?

Size of redness Rate of resolving phlebitis

Active ingredient: Magnesium sulphate For weepy wounds and boils

Active ingredient: MPS (mucopolysaccharide) For the treatment of bruises, swelling, scars and various inflammatory conditions of the veins. Inhibits inflammation, relieves pain and tension in the afflicted area and shortens the duration of the problem. Helps with inflamed veins to treat various inflammatory conditions of the veins requiring medical supervision

To reduce swelling

Reduces superficial thrombophlebitis such as varicose veins.

Case definition

Redness associated with peripheral catheters Accompanying signs

Pain Swelling Streak formation Palpable cord

Method: Population

Inclusion criteria

Consecutive cases of redness associated with peripheral catheters between Dec 2009 to Feb 2010

Exclusion criteria

Thrombophlebitis Extravasations Presence of pus at the affected site Fragile skin Known sensitivity to the topical applications

Method: Intervention
No application Therapy Observe the affected area closely at each shift

GMS Therapy
Soften the magnesium sulphate paste by placing the bottle in a cup of hot water Apply the liquid paste generously with a spatula on the affected area Dress it with gauze and bandage Daily dressing

Hirudoid Therapy
Squeeze adequate Hirudoid cream unto the affected area Gently rub the cream (with the gloved finger) into the skin until it disappears Be careful not to apply the cream into the catheter puncture site 12 hourly dressing

Redness, swelling, pain, streak formation, palpable cord

The principal nurse will escalate to the team physician if the affected area worsens

Method

Randomization

Simple Generated by the computer List kept by the project administrator

Sequential

Allocation

Concealment

Sealed, white opaque envelope

Method: Procedure
1. 2. 3.

Screening Informed consent Outline the affected area (redness)

4.

Apply the allocated treatment

Method: Procedure
5.
1.
2.

Re-assess (and or treat) at defined intervals

4 hourly for 12 hours 12 hourly

6.
1.
2. 3.

Terminate the follow up when:

Redness resolves; or Patient discharges; or Reaches 5th day

7.

Document the care and observations in the data collection form

P=0.83

P=0.61

P=0.79 P=0.99 P=0.0153

P=0.66 P=0.12 P=0.54 P=0.32

P=0.09
p75 p50

No-application GMS Hirudoid

P=0.38

p25

P=0.18

Discussion

Selection bias

Not all consecutive cases were included (same for all groups) Difficulty to trace the area very accurately when the redness is subsiding (same for all groups) Specific IV that contributes to the healing progress (continuous/bolus at the same time) Difficult to follow up patient post discharge (same for all groups)

Systematic error

Possible confounding

Missing data

Practice change

Credits

APN Kamilah Jabin SNM Koh Bee Hoon SSN Phyllis Wong SSN Isabel Ng Hui Leng

With support from TTSH Nursing Service and A/Prof Tay Jam Chin

The project would not be possible with our ENs who labored with us 24/7 on data collection and counting of millions of squares!