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Relationship between peripheral insertion site and catheter-related phlebitis in adult hospitalized patients: a systematic review - Relazione tra sito anatomico di inserimento del catetere venoso periferico e flebite catetere correlata nei pazienti adulti ospedalizzati: una revisione sistematica

Dania Comparcini, Valentina Simonetti, Stijn Blot, Marco Tomietto, Giancarlo Cicolini

Abstract

AIM. To explore the relationship between the anatomical site of peripheral venous catheteriza- tion and risk of catheter-related phlebitis.

BACKGROUND. Peripheral venous catheterization is frequently associated with phlebitis. Recent guidelines, recommend the use of an upper-extremity site for catheter insertion but no univocal consensus exists on the anatomical site with lower risk of phlebitis.

DESIGN. Systematic review.

METHODS: We searched Medline (PubMed) and CINAHL (EBSCOhost) databases until the end of January 2017. We also reviewed the reference lists of retrieved articles and gray literature was excluded. Searches were limited to articles published in English with no restriction imposed to date of publication. The primary outcome was the incidence of phlebitis associated with anato- mical site of peripheral catheterization. We included randomized controlled trials and observa- tional studies on adult patients who required a peripheral catheter for the administration of medi- cation, intermittent or continuous fluid infusion.

RESULTS. Antecubital fossa veins are associated with lower phlebitis rates, while hands veins are the most risky sites to develop phlebitis. There is no consensus regarding vein in forearm.

CONCLUSION. Choosing the right anatomical site to insert a peripheral venous catheter is impor- tant to decrease phlebitis rate. Further studies should compare indwelling time in different anato- mical sites with phlebitis rate. A more standardized approach in defining and assessing phlebitis among studies is recommended.

KEY WORDS: systematic review, phlebitis, peripheral venous catheterization, anatomical sites.

RIASSUNTO

OBIETTIVO. Esplorare la relazione tra il sito anatomico di inserimento del catetere venoso peri- ferico e il rischio di flebite correlata.

INTRODUZIONE. Il cateterismo venoso periferico è spesso associato a flebiti. Linee Guida recenti raccomandano l’utilizzo delle vene degli arti superiori per l’inserimento del catetere ma non esiste univoco consenso circa il sito anatomico correlato al minor rischio di sviluppare flebite.

METODI. Abbiamo effettuato una revisione sistematica della letteratura consultando i database Medline (PubMed) e CINAHL (EBSCOhost) fino al termine del mese di Gennaio 2017. Inoltre, abbiamo revisionato le citazioni bibliografiche degli articoli reperiti e la letteratura grigia è stata esclusa. Sono stati ricercati articoli pubblicati in lingua inglese, senza limiti posti per la data di pubblicazione. Abbiamo incluso: gli studi che riportavano dati sui tassi di flebite associati al sito anatomico di cateterismo periferico; gli studi clinici randomizzati controllati e gli studi osserva- zioni condotti su pazienti adulti che necessitavano dell’inserimento di un catetere venoso perife- rico per la somministrazione intermittente o continua di liquidi e farmaci.

RISULTATI. L’inserimento del catetere venoso periferico nelle vene della fossa antecubitale è asso- ciato ad un minor tasso di flebiti, mentre le vene della mano sono il sito a maggior rischio di sviluppare flebite. Non esiste consenso circa le vene dell’avambraccio.

CONCLUSIONI. La scelta del sito anatomico corretto per l’inserimento di un catetere venoso peri- ferico è importante per diminuire i tassi di flebite. Ulteriori studi dovrebbero comparare i tassi di flebite associati al tempo di permanenza dei cateteri venosi periferici inseriti in differenti siti anatomici. Si raccomanda, inoltre, un approccio maggiormente standardizzato nella definizione e valutazione del grado di flebite all’interno dei diversi studi.

PAROLE CHIAVE: revisione sistematica, flebiti, cateterismo venoso periferico, siti anatomici.

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