Catheter-related thrombophlebitis and endothelium.

Peripheral intravenous catheterization is a common invasive procedure

among inpatients, and to prevent phlebitis and infection is accepted as

the standard procedure the changing of catheters every three days, but this

the practice has not been rigorously tested.

Webster and colleagues comparing routine replacement of intravenous

peripheral catheters with replacement only when clinically indicated,

found no significant difference in catheter failure (phlebitis or

infiltration) per 1000 device hours, but the costs were 25% higher with

routine replacement.

Maki refers that the low incidence of phlebitis in the Webster’s trial

may be explained by the highly experienced team that have inserted and

provided care of the catheters.

Maki’s commentary seems very pertinent because of vascular endothelium,

which has antithrombotic properties, is very friable which is illustrated

in the lab by its easy removal from the vascular wall with a simple passage

of cotton. Vascular endothelium may be injured by the catheter when the

diameter of catheter and vein are similar, or when it is placed on mobile

zones producing movements inside the vessel, or by some drugs (diazepam,

iv anesthetics, antibiotics, anticancer drugs) especially when the venous

flow is small to dilute drugs. Experienced teams avoid factors that may

easily damage vascular endothelium.

Webster’s trial refers collected baseline personal, clinical, and catheter-related data (the type of infusate, drugs injected and their pH level, type

and size of catheter used, and the site of insertion). It could be

interesting to study a possible relation of the catheter location, or

drugs infused with the phlebitis incidence. It is possible that the

catheters placed on antecubital veins have a fewer incidence of phlebitis

than those placed on flexor zones. Some caustic drugs must be administered

diluted or in veins with greater blood flow. I have seen many cases of phlebitis from

catheters placed on hand’s veins (low blood flow) after administration of

diazepam.

Finally, it is also important to have in mind, not only the dangers and

economical costs, but also the PAIN elicited by catheter introduction in

certain places like the hands, which are one of the most sensitive areas

of our body.

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