Bulmer Andrew C, Nightingale Rachael, Hewage Wenu, Keijzers Gerben, Snelling Peter J
Alliance for Vascular Access Teaching and Research (AVATAR), School of Pharmacy and Medical Science Griffith University Gold Coast Campus Queensland Australia.
Department of Emergency Medicine Gold Coast University Hospital Southport Queensland Australia.
Australas J Ultrasound Med. 2024 Nov 27;28(1):e12414. doi: 10.1002/ajum.12414. eCollection 2025 Feb.
The purpose of this study was to sonographically evaluate whether intravenous (IV) flucloxacillin administration was associated with an increased risk of peripheral intravenous catheter (PIVC) thrombus formation.
This observational study included participants enrolled as a convenience sample from a larger prospective study of patients with cellulitis receiving IV antibiotics in the emergency department. Point-of-care ultrasound was used to evaluate the PIVCs for thrombus formation after insertion and at specified timepoints after IV administration of antibiotic or saline solution through to discharge. The primary endpoint included the presence and length of the thrombus in proximity of the catheter tip.
Between May 2021 and June 2022, 25 participants were enrolled and received either IV flucloxacillin (n = 10), other IV antibiotics (n = 8) or no IV antibiotics (control; n = 7). PIVC thrombus formation was sonographically detected in 100%, 67% and 17% of patients in flucloxacillin, other and control groups at 6-12 h (flucloxacillin vs. control; P = 0.015), with a mean length of 17.4 ± 8.1 (flucloxacillin vs. control; P = 0.46), 15.5 ± 13.4 (other vs. control; P = 0.73) and 7.3 ± 17.9 mm (control), respectively. Thrombus formation increased significantly in the flucloxacillin group over time (0->12 h; P = 0.03) but did not increase in the other or control groups.
The administration of IV flucloxacillin appears to promote the formation of a PIVC thrombus visible on ultrasound, but the clinical implications are uncertain. Although the vast majority appear to be asymptomatic, they have the potential to become a precursor to thrombophlebitis and lead to early PIVC failure.
It was feasible to identify and measure PIVC thrombus sonographically. Ultrasound showed that IV flucloxacillin administration appeared to be associated with more frequent formation of PIVC thrombus, with these increasing in length over time. Further research is required to confirm these findings in larger studies and to identify any clinical implications of the findings.
本研究旨在通过超声检查评估静脉注射氟氯西林是否会增加外周静脉导管（PIVC）血栓形成的风险。
本观察性研究纳入了作为便利样本的参与者，这些参与者来自一项更大规模的前瞻性研究，该研究对急诊科接受静脉抗生素治疗的蜂窝织炎患者进行了研究。使用即时超声检查在插入PIVC后以及通过静脉给予抗生素或盐溶液直至出院后的特定时间点评估PIVC是否形成血栓。主要终点包括导管尖端附近血栓的存在情况和长度。
在2021年5月至2022年6月期间，共纳入25名参与者，他们分别接受静脉注射氟氯西林（n = 10）、其他静脉抗生素（n = 8）或不接受静脉抗生素（对照组；n = 7）。在6 - 12小时时，氟氯西林组、其他组和对照组中通过超声检查发现PIVC血栓形成的患者比例分别为100%、67%和17%（氟氯西林组与对照组相比；P = 0.015），平均长度分别为17.4 ± 8.1（氟氯西林组与对照组相比；P = 0.46）、15.5 ± 13.4（其他组与对照组相比；P = 0.73）和7.3 ± 17.9毫米（对照组）。随着时间推移，氟氯西林组的血栓形成显著增加（0 -> 12小时；P = 0.03），而其他组或对照组则没有增加。
静脉注射氟氯西林似乎会促进超声可见的PIVC血栓形成，但其临床意义尚不确定。尽管绝大多数血栓似乎无症状，但它们有可能成为血栓性静脉炎的先兆并导致早期PIVC失效。
通过超声检查识别和测量PIVC血栓是可行的。超声显示静脉注射氟氯西林似乎与更频繁的PIVC血栓形成有关，且这些血栓长度会随时间增加。需要进一步研究以在更大规模的研究中证实这些发现，并确定这些发现的任何临床意义。
