RESUMO
Fundamento y objetivo: Valorar la influencia de los factores de riesgo en la incidencia y cinética de flebitis.Material y métodos: Todos los catéteres cortos de inserción periférica insertados durante un mes (1201 catéteres y 967 pacientes) en un hospital médico-quirúrgico general. Los factores de riesgo de flebitis se analizaron mediante regresión de Cox. Se calcularon la probabilidad acumulada, el riesgo condicional de flebitis y el beneficio teórico del recambio en diferentes periodos. Resultados: Fueron predictores independientes de desarrollo de flebitis el sexo femenino, la inserción de un catéter en el servicio de urgencias o en las unidades medico-quirúrgicas, la localización en el antebrazo y la administración de amoxicilina-clavulánico y aminoglucósidos con hazard ratios (intervalo de confianza al 95%) respectivas de: 1.46 (1.09-2.15), 1.94 (1.01-3.73), 2.51(1.29-4.88), 1.93(1.10-3.01), 2.15 (1.45-3.20) y 2.10 (1.01-4.63). La máxima incidencia se alcanzó de forma más precoz en los catéteres con ≥2 factores de riesgo (dias 3 y 4) que en los de <2 (dias 4 y 5). El riesgo condicional aumentó de 0.08 flebitis/1 cat-día para los catéteres de ≤1 factor de riesgo hasta 0.26 para aquellos con ≥3. El mayor beneficio del recambio del catéter se obtuvo a las 60 horas, variando en función de los factores de riesgo: 24.8% reducción con ≥3, 13.1% con 2 y 9.2% con ≤1. Conclusiones: La dinámica de aparición de flebitis se halla muy influenciada por la interacción de los factores de riesgo. El recambio sistemático cada 72 horas solo parece ser estrictamente necesario en los catéteres de alto riesgo (AU)
Background and objectives: To assess the influence of risk factors on the rates and kinetics of peripheral vein phlebitis (PVP) development and its theoretical influence in absolute PVP reduction after catheter replacement. Methods:All peripheral short intravenous catheters inserted during one month were included (1201 catheters and 967 patients). PVP risk factors were assessed by a Cox proportional hazard model. Cumulative probability, conditional failure of PVP and theoretical estimation of the benefit from replacement at different intervals were performed. Results: Female gender, catheter insertion at the emergency or medical-surgical wards, forearm site, amoxicillin-clavulamate or aminoglycosides were independent predictors of PVP with hazard ratios (95 confidence interval) of 1.46 (1.09-2.15), 1.94 (1.01-3.73), 2.51 (1.29-4.88), 1.93 (1.20-3.01), 2.15 (1.45-3.20) and 2.10 (1.01-4.63), respectively. Maximum phlebitis incidence was reached sooner in patients with ≥2 risk factors (days 3-4) than in those with <2 (days 4-5). Conditional failure increased from 0.08 phlebitis/one catheter-day for devices with ≤1 risk factors to 0.26 for those with ≥3. The greatest benefit of routine catheter exchange was obtained by replacement every 60h. However, this benefit differed according to the number of risk factors: 24.8% reduction with ≥3, 13.1% with 2, and 9.2% with ≤1. Conclusions: PVP dynamics is highly influenced by identifiable risk factors which may be used to refine the strategy of catheter management. Routine replacement every 72h seems to be strictly necessary only in high-risk catheters (AU)
Assuntos
Humanos , Flebite/etiologia , Infecções Relacionadas a Cateter/complicações , /efeitos adversos , Estudos de Coortes , Fatores de RiscoRESUMO
BACKGROUND AND OBJECTIVES: To assess the influence of risk factors on the rates and kinetics of peripheral vein phlebitis (PVP) development and its theoretical influence in absolute PVP reduction after catheter replacement. METHODS: All peripheral short intravenous catheters inserted during one month were included (1201 catheters and 967 patients). PVP risk factors were assessed by a Cox proportional hazard model. Cumulative probability, conditional failure of PVP and theoretical estimation of the benefit from replacement at different intervals were performed. RESULTS: Female gender, catheter insertion at the emergency or medical-surgical wards, forearm site, amoxicillin-clavulamate or aminoglycosides were independent predictors of PVP with hazard ratios (95 confidence interval) of 1.46 (1.09-2.15), 1.94 (1.01-3.73), 2.51 (1.29-4.88), 1.93 (1.20-3.01), 2.15 (1.45-3.20) and 2.10 (1.01-4.63), respectively. Maximum phlebitis incidence was reached sooner in patients with ≥2 risk factors (days 3-4) than in those with <2 (days 4-5). Conditional failure increased from 0.08 phlebitis/one catheter-day for devices with ≤1 risk factors to 0.26 for those with ≥3. The greatest benefit of routine catheter exchange was obtained by replacement every 60h. However, this benefit differed according to the number of risk factors: 24.8% reduction with ≥3, 13.1% with 2, and 9.2% with ≤1. CONCLUSIONS: PVP dynamics is highly influenced by identifiable risk factors which may be used to refine the strategy of catheter management. Routine replacement every 72h seems to be strictly necessary only in high-risk catheters.
