Oakland University William Beaumont School of Medicine, Rochester, MI, USA.
Beaumont Hospital, Royal Oak, MI, USA.
J Vasc Access. 2022 Sep;23(5):754-763. doi: 10.1177/11297298211009019. Epub 2021 Apr 16.
Thrombophlebitis associated with peripheral intravenous catheters (PIVCs) is a poorly described complication in the literature. Given limited accuracy of current assessment tools and poor documentation in the medical record, the true incidence and relevance of this complication is misrepresented. We aimed to identify risk factors in the development of thrombophlebitis using an objective methodology coupling serial diagnostic ultrasound and clinical assessment.
We conducted a single-site, prospective observational cohort study. Adult patients presenting to the emergency department that underwent traditionally placed PIVC insertion and were being hospitalized with an anticipated length of stay greater than 2 days were eligible participants. Using serial, daily ultrasound evaluations and clinical assessments via the phlebitis scale, we identified patients with asymptomatic and symptomatic thrombosis. The primary goal was to identify demographic, clinical, and IV related risk factors associated with thrombophlebitis. Univariate and multivariate analyses were employed to identify risk factors for thrombophlebitis.
A total of 62 PIVCs were included between July and August 2020. About 54 (87.10%) developed catheter-related thrombosis with 22 (40.74%) of the thrombosed catheters were characterized as symptomatic. Multivariate cox regression demonstrated that catheter diameter relative to vein diameter greater than one-third [AHR = 5.41 (1.91, 15.4) = 0.0015] and angle of distal tip of catheter against vein wall ⩾5° [AHR = 4.39 (1.39, 13.8) = 0.0116] were associated with increased likelihood of thrombophlebitis.
Our study found that the increased proportion of catheter relative to vein size and steeper catheter tip angle increased the risk of thrombophlebitis. Catheter size relative to vein size is a modifiable factor that should be considered when inserting PIVCs. Additional larger prospective investigations using objective methodologies are needed to further characterize complications in PIVCs.
外周静脉导管（PIVC）相关血栓性静脉炎在文献中描述甚少，是一种并发症。鉴于目前评估工具的准确性有限，以及病历记录不佳，该并发症的真实发生率和相关性被错误地描述了。我们旨在通过结合连续诊断性超声和临床评估的客观方法，确定血栓性静脉炎发展的危险因素。
我们进行了一项单站点、前瞻性观察队列研究。符合条件的参与者是到急诊科就诊、接受传统放置 PIVC 插入术且预计住院时间超过 2 天的成年患者。我们通过连续的每日超声评估和使用静脉炎量表进行临床评估，来识别无症状和有症状的血栓形成患者。主要目标是确定与血栓性静脉炎相关的人口统计学、临床和静脉内相关危险因素。我们采用单变量和多变量分析来确定血栓性静脉炎的危险因素。
在 2020 年 7 月至 8 月期间，共纳入了 62 例 PIVC。大约 54 例（87.10%）发生了导管相关性血栓形成，其中 22 例（40.74%）血栓形成的导管表现为有症状。多变量 Cox 回归显示，导管直径与静脉直径的比值大于三分之一[风险比（AHR）=5.41（1.91，15.4）=0.0015]和导管远端尖端与静脉壁之间的角度≥5°[AHR=4.39（1.39，13.8）=0.0116]与血栓性静脉炎的可能性增加相关。
我们的研究发现，导管与静脉大小的比例增加和导管尖端角度增大增加了血栓性静脉炎的风险。导管与静脉大小的比例是一个可改变的因素，在插入 PIVC 时应加以考虑。需要使用客观方法进行更多的大型前瞻性研究，以进一步描述 PIVC 的并发症。
