BACKGROUND:

Up to 80% of hospitalised patients receive intravenous therapy at some point during their admission. About 20% to 70% of patients receiving intravenous therapy develop phlebitis. Infusion phlebitis has become one of the most common complications in patients with intravenous therapy. However, the effects of routine treatments such as external application of 75% alcohol or 50% to 75% magnesium sulphate (MgSO4) are unsatisfactory. Therefore, there is an urgent need to develop new methods to prevent and alleviate infusion phlebitis.

OBJECTIVES:

To systematically assess the effects of external application of Aloe vera for the prevention and treatment of infusion phlebitis associated with the presence of an intravenous access device.

SEARCH METHODS:

The Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator (TSC) searched the Specialised Register (last searched February 2014) and CENTRAL (2014, Issue 1). In addition the TSC searched MEDLINE to week 5 January 2014, EMBASE to Week 6 2014 and AMED to February 2014. The authors searched the following Chinese databases until 28 February 2014: Chinese BioMedical Database; Traditional Chinese Medical Database System; China National Knowledge Infrastructure; Chinese VIP information; Chinese Medical Current Contents; Chinese Academic Conference Papers Database and Chinese Dissertation Database; and China Medical Academic Conference. Bibliographies of retrieved and relevant publications were searched. There were no restrictions on the basis of date or language of publication.

SELECTION CRITERIA:

Randomised controlled trials (RCTs) and quasi-randomised controlled trials (qRCTs) were included if they involved participants receiving topical Aloe vera or Aloe vera-derived products at the site of punctured skin, with or without routine treatment at the same site.

DATA COLLECTION AND ANALYSIS:

Two review authors independently extracted the data on the study characteristics, description of methodology and outcomes of the eligible trials, and assessed study quality. Data were analysed using RevMan 5.1. For dichotomous outcomes, the effects were estimated by using risk ratio (RR) with its 95% confidence interval (CI). For continuous outcomes, mean differences (MD) with 95% CIs were used to estimate their effects.

MAIN RESULTS:

A total of 43 trials (35 RCTs and eight qRCTs) with 7465 participants were identified. Twenty-two trials with 5546 participants were involved in prevention of Aloe vera for phlebitis, and a further 21 trials with 1919 participants were involved in the treatment of phlebitis. The included studies compared external application of Aloe vera alone or plus non-Aloe vera interventions with no treatment or the same non-Aloe vera interventions. The duration of the intervention lasted from one day to 15 days. Most of the included studies were of low methodological quality with concerns for selection bias, attrition bias, reporting bias and publication bias.
The effects of external application of fresh Aloe vera on preventing total incidence of phlebitis varied across the studies and we did not combine the data. Aloe vera reduced the occurrence of third degree phlebitis (RR 0.06, 95% CI 0.03 to 0.11, P < 0.00001) and second degree phlebitis (RR 0.18, 95% CI 0.10 to 0.31, P < 0.00001) compared with no treatment. Compared with external application of 75% alcohol, or 33% MgSO4 alone, Aloe vera reduced the total incidence of phlebitis (RR 0.02, 95% CI 0.00 to 0.28, P = 0.004 and RR 0.43, 95% CI 0.24 to 0.78, P = 0.005 respectively) but there was no clear evidence of an effect when compared with 50% or 75% MgSO4 (total incidence of phlebitis RR 0.41, 95% CI 0.16 to 1.07, P = 0.07 and RR 1.10 95% CI 0.54 to 2.25, P = 0.79 respectively; third degree phlebitis (RR 0.28, 95% CI 0.07 to 1.02, P = 0.051 and RR 1.19, 95% CI 0.08 to 18.73, P = 0.9 respectively; second degree phlebitis RR 0.68, 95% CI 0.21 to 2.23, P = 0.53 compared to 75% MgSO4) except for a reduction in second degree phlebitis when Aloe vera was compared with 50% MgSO4 (RR 0.26, 95% CI 0.14 to 0.50, P < 0.0001).
For the treatment of phlebitis, Aloe vera was more effective than 33% or 50% MgSO4 in terms of both any improvement (RR 1.16, 95% CI 1.09 to 1.24, P < 0.0001 and RR 1.22, 95% CI 1.16 to 1.28, P < 0.0001 respectively) and marked improvement of phlebitis (RR 1.97, 95% CI 1.44 to 2.70, P < 0.001 and RR 1.56, 95% CI 1.29 to 1.87, P = 0.0002 respectively). Compared with 50% MgSO4, Aloe vera also improved recovery rates from phlebitis (RR 1.42, 95% CI 1.24 to 1.61, P < 0.0001). Compared with routine treatments such as external application of hirudoid, sulphonic acid mucopolysaccharide and dexamethasone used alone, addition of Aloe vera improved recovery from phlebitis (RR 1.75, 95% CI 1.24 to 2.46, P = 0.001) and had a positive effect on overall improvement (marked improvement RR 1.26, 95% CI 1.09 to 1.47, P = 0.0003; any improvement RR 1.23, 95% CI 1.13 to 1.35, P < 0.0001). Aloe vera, either alone or in combination with routine treatment, was more effective than routine treatment alone for improving the symptoms of phlebitis including shortening the time of elimination of red swelling symptoms, time of pain relief at the location of the infusion vein and time of resolution of phlebitis. Other secondary outcomes including health-related quality of life and adverse effects were not reported in the included studies.

AUTHORS' CONCLUSIONS:

There is no strong evidence for preventing or treating infusion phlebitis with external application of Aloe vera. The current available evidence is limited by the poor methodological quality and risk of selective outcome reporting of the included studies, and by variation in the size of effect across the studies. The positive effects observed with external application of Aloe vera in preventing or treating infusion phlebitis compared with no intervention or external application of 33% or 50% MgSO4 should therefore be viewed with caution.

RATIONALE, AIMS AND OBJECTIVES:

Phlebitis is a common and painful complication of peripheral intravenous cannulation. The aim of this review was to identify the measures used in infusion phlebitis assessment and evaluate evidence regarding their reliability, validity, responsiveness and feasibility.

METHOD:

We conducted a systematic literature review of the Cochrane library, Ovid MEDLINE and EBSCO CINAHL until September 2013. All English-language studies (randomized controlled trials, prospective cohort and cross-sectional) that used an infusion phlebitis scale were retrieved and analysed to determine which symptoms were included in each scale and how these were measured. We evaluated studies that reported testing the psychometric properties of phlebitis assessment scales using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines.

RESULTS:

Infusion phlebitis was the primary outcome measure in 233 studies. Fifty-three (23%) of these provided no actual definition of phlebitis. Of the 180 studies that reported measuring phlebitis incidence and/or severity, 101 (56%) used a scale and 79 (44%) used a definition alone. We identified 71 different phlebitis assessment scales. Three scales had undergone some psychometric analyses, but no scale had been rigorously tested.

CONCLUSION:

Many phlebitis scales exist, but none has been thoroughly validated for use in clinical practice. A lack of consensus on phlebitis measures has likely contributed to disparities in reported phlebitis incidence, precluding meaningful comparison of phlebitis rates.

Objective To systematically review the effect of pre-treating the catheters with dexamethasone for preventing PICC-associated phlebitis. Methods We electronically searched PubMed, EMbase, The Cochrane Library (Issue 4, 2012), CNKI, CBM, WanFang Data and CQVIP for studies about pre-treating the catheters with dexamethasone to prevent PICC-associated phlebitis from inception to March 2013. Relevant studies including grey literature were also manually searched. Two reviewers independently screened studies according to the inclusion and exclusion criteria, extracted data and evaluated the methodological quality of the included studies. Then meta-analysis was performed using the software RevMan 5.0. Results A total of 13 studies involving 1 965 cases (1 025 cases in the dexamethasone group, and 940 cases in the control group) were included. The results of meta-analysis showed that pre-treating the catheters with dexamethasone could significantly decrease the incidence of PICC-associated phlebitis (RR=0.29, 95%CI=0.22 to 0.39, P<0.000 1). However, no significant difference was found for the PICC-associated other complications, such as pipe blockage, bleeding, swelling of puncture site, allergy and atopic catheter. Conclusion Pre-treating the catheters with dexamethasone soltion before inserting could reduce the incidence of PICC-associated phlebitis. The aforementioned conclusion needs to be further validated by more high-quality and large-scale randomized controlled trials. © 2014 Editorial Board of Chin J Evid-based Med.

This study presents a systematic review for evaluating effective pharmacological actions for the treatment of phlebitis stemming from infusion therapy. The studies reviewed were categorized according to the type of therapeutic approach proposed by the author and by the level of evidence presented. The review found that topical nitroglycerin and notoginseny were more effective in the reduction of the inflammatory process when compared with other proposed alternatives. Nevertheless, the development of research related to possible alternatives for the treatment of phlebitis is important.

Durante el proceso fisiopatológico que produce la flebitis, tiene lugar una vasoconstricción y una agregación plaquetaria. Por tanto, pensamos que la aplicación de un vasodilatador como ...lan itroglicerina, mejorarra los síntomas,de la flebitis posperfusión y serIa un tratamiento alternativo a la comúnmente utilizada pomada de heparinoides, sobre cuya eficacia en el tratamiento de esta dolencia no existe ~~penas documentación., Analizamos 22 pacientes ingresados en la Unidad de Medicina Interna de un hospital de nuestra ciudad, que padecían flebitis secundaria a infusión endovenosa, a los cuales se les aplicó, de forma aleatoria, uno de los dos tratamientos en estudio: parches trans-, dérmicos de nitroglicerina de 5 mg versus pomada de heparinoides. Fueron 11 pacientes en cada grupo. Concluimos que la flebitisposperfusión es un problema bastante común en pacientes hospitalizados, y sus síntomas pueden ser eficazmente reducidos con el uso de parches de nitroglicerina como tratamiento

Purpose/Design: We sought to identify the definitions and symptoms used in assessment of infusion phlebitis, scope the number of scales available to assess phlebitis incidence and severity, and evaluate evidence regarding their reliability, validity, responsiveness, and feasibility. Methods: We conducted a systematic literature review of the Cochrane Library, Ovid MEDLINE, and EBSCO CINAHL until November 2012. All English-language studies (RCTs, prospective cohort, and cross-sectional) that included phlebitis associated with peripheral intravenous cannulation in adults as a primary outcome measure, or that evaluated an infusion phlebitis scale, were retrieved. Studies that assessed infusion phlebitis using a provided definition or scoring tool were included in the review. Results: Phlebitis related to peripheral intravenous cannulation was the primary outcome measure in 316 studies; of these, 222 provided no definition of phlebitis. Of the 94 studies that reported measuring infusion phlebitis incidence and/or severity, 62 used an assessment scale and 32 used a definition only. We identified 57 different assessment scales, which differed in symptoms included, definitions of symptoms, and cutpoints for a phlebitis diagnosis. None of the studies reported comprehensive psychometric testing. Psychometric analyses were undertaken for four assessment tools, but these analyses had many limitations. Nevertheless, the evidence from these studies suggests that inter-rater reliability for these phlebitis assessment scales is modest. Limitations: We only reviewed articles published in English, and we did not contact any of the authors for further psychometric details. Conclusions: No phlebitis assessment measure reported in the literature met rigorous psychometric standards. Many phlebitis scales and tools have been developed, but none have been sufficiently validated for use in the clinical setting. Consequently, a lack of consensus on phlebitis assessment criteria has led to disparities in reported phlebitis incidence, precluding any meaningful comparison of reported phlebitis rates. You can go to http://www.avainfo.org/posters to view this poster.

OBJECTIVE:

To evaluate the treatment of phlebitis wishful golden powder efficacy and safety.

METHODS:

We searched the Cochrane Library, PubMed database, Embase databases, ISI database, CBM database, CNKI database, VIP database, Wanfang database into wishful golden powder in 50% magnesium sulfate for phlebitis randomized controlled trials (RCT), the system Evaluation (SR) and Meta-analysis of randomized controlled trials included methodological quality assessment and Meta-analysis, systematic reviews and included reference Meta-analysis conclusions.

RESULTS:

wishful golden powder and 50% magnesium sulfate solution for the treatment of phlebitis included 10 RCT. After treatment, the total effective phlebitis was statistically significant [RR 12.96,95% CI (5.81,28.89)], P0.000 01; significant efficiency difference was statistically significant [OR 9.11,95% CI (3.98,20.88 )], P0.000 01; wishful golden powder 72 h of treatment on the incidence of phlebitis and phlebitis incidence of skin damage grade I was no significant difference with magnesium sulfate [RR were 7.76 and 0.13,95% CI, respectively (0.94,64.19) and (0.02,1.07)], P0.05.

CONCLUSION:

wishful golden powder to be effective in treating phlebitis, its efficacy is superior to 50% magnesium sulfate, and no adverse reactions reported.

Nursing care provided to patients using peripheral venous catheters (PVC) is a constant need due to the high frequency of catheter use. The aim of this systematic review was to define the scientific evidence on nursing interventions for patients with peripheral venous catheters and their impact on the prevention of phlebitis. Scientific studies published in reference databases, between April 2004 and March 2010, were selected following the PICOD model and previously defined inclusion/exclusion criteria. Nineteen studies were identified and divided into three main areas: nursing interventions related to PVC placement; to patient surveillance; and to nurses' knowledge. These three areas were identified as relevant and as having an impact on the occurrence of phlebitis. Nursing interventions for patients having PVC can prevent phlebitis. However, the scientific evidence is limited, and so there is a need for further research on the impact of nurses' training on their clinical practice and interventions.

Objetivo: Realizar una revisión sistemática de la literatura sobre la aparición de flebitis en niños, relacionada con catéteres venosos periféricos cortos. Metodología: Se buscó en las bases de datos PubMed, Scopus y Scielo, con los términos libres catéter venoso, infección, flebitis y sinónimos, sin límite de idioma, publicados en los últimos 10 años (desde las recomendaciones del CDC). Resultados: De un total inicial de 1.486 referencias, se seleccionaron 9 artículos que midieran la frecuencia de flebitis y su relación con el tiempo de permanencia del catéter. Estos fueron realizados en poblaciones heterogéneas, con diferentes definiciones de flebitis, y distintos desenlaces de interés; el tiempo de aparición de flebitis fue un desenlace secundario en todos. Discusión: A diferencia de los adultos, en niños no hay estudios encaminados a evaluar el tiempo adecuado de permanencia del catéter venoso periférico corto. Se requiere más investigación en este campo.

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