• Anesthesia and analgesia · Dec 2018

    In-Line Filtration Reduces Postoperative Venous Peripheral Phlebitis Associated With Cannulation: A Randomized Clinical Trial.

    Why should you care?

    Not only is venous cannulation a common procedure, but so is resultant thrombophlebitis – occurring in up to 75% of patients. This has important morbidity, patient-experience and economic consequences.

    What does this study add?

    Although many risk factors have been identified (insertion sterility, location, access technique, drug use, micro-particles, etc.), Villa and friends investigated whether in-line filters would reduce phlebitis incidence.

    This modest, single-center trial randomized surgical patients between in-line filter (for 96 hours) or standard line, before anesthesia induction. Filter user reduced thrombophlebitis 13-fold at 48 hours, and at 96 hours sustained potency of 50% more of the cannulae.

    What sort of filters did they use?

    They used an 11 cm2 positively-charged 0.2 µm filter for fluid and most drugs, a 4.5 cm2 1.2 µm filter for propofol infusions, and a positively-charged 1.65 cm2 0.2 µm for opioid infusions.

    The filters did slow gravity-fed infusion rates as they aged, however this was not clinically significant when using a peristaltic pump.

    The take-home...

    We should be better stewards of our patient's IV access. For short-term access <48h focus should be on technique and sterility, but for access needed for 48h or longer, an inline filter offers significant benefit with limited downside.

    summary
    • Gianluca Villa, Cosimo Chelazzi, Rosa Giua, Lorenzo Tofani, Giovanni Zagli, Paolo Boninsegni, Fulvio Pinelli, A Raffaele De Gaudio, and Stefano Romagnoli.
    • From the Section of Anesthesia, Intensive Care and Pain Medicine, Department of Health Sciences, University of Florence, Florence, Italy.
    • Anesth. Analg. 2018 Dec 1; 127 (6): 1367-1374.

    BackgroundPeripheral venous cannulation is an everyday practice of care for patients undergoing anesthesia and surgery. Particles infused with intravenous fluids (eg, plastic/glass/drugs particulate) contribute to the pathogenesis of peripheral phlebitis. The aim of this study is to demonstrate the efficacy of in-line filtration in reducing the incidence of postoperative phlebitis associated with peripheral short-term vascular access.MethodsIn this controlled trial, 268 surgical patients were randomly assigned to in-line filtration and standard care (NCT03193827). The incidence of phlebitis (defined as visual infusion phlebitis [VIP] score, ≥2) within 48 hours was compared between the 2 groups, as well as the onset and severity of phlebitis and the reasons for removal of the cannula. The lifespan of venous cannulae was compared for the in-line filter and no-filter groups through a Kaplan-Meier curve.ResultsThe incidence of phlebitis within 48 hours postoperatively was 2.2% and 26.9% (difference, 25% [95% confidence interval {CI}, 12%-36%]; odds ratio, 0.05 [0.01-0.15]), respectively, for the in-line filter and no-filter groups (P < .001). From 24 to 96 hours postoperatively, patients in the no-filter group had higher VIP scores than those in in-line filter group (P < .001). Venous cannulae in the in-line filter group exhibited prolonged lifespan compared to those in the no-filter group (P = .01). In particular, 64 (47.8%) of cannulae in the in-line filter group and 56 (41.8%) of those in the no-filter group were still in place at 96 hours postoperatively. At the same time point, patients with a VIP score <3 were 100% in the in-line filter group and only 50% for the no-filter group. In-line filtration was a protective factor for postoperative phlebitis (hazard ratio, 0.05 [95% CI, 0.014-0.15]; P < .0001) and cannula removal (hazard ratio, 0.7 [95% CI, 0.52-0.96]; P = .02).ConclusionsIn-line filtration has a protective effect for postoperative phlebitis and prolongs cannula lifespan during peripheral venous cannulation in surgical patients.

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    Notes

    summary
    1

    Why should you care?

    Not only is venous cannulation a common procedure, but so is resultant thrombophlebitis – occurring in up to 75% of patients. This has important morbidity, patient-experience and economic consequences.

    What does this study add?

    Although many risk factors have been identified (insertion sterility, location, access technique, drug use, micro-particles, etc.), Villa and friends investigated whether in-line filters would reduce phlebitis incidence.

    This modest, single-center trial randomized surgical patients between in-line filter (for 96 hours) or standard line, before anesthesia induction. Filter user reduced thrombophlebitis 13-fold at 48 hours, and at 96 hours sustained potency of 50% more of the cannulae.

    What sort of filters did they use?

    They used an 11 cm2 positively-charged 0.2 µm filter for fluid and most drugs, a 4.5 cm2 1.2 µm filter for propofol infusions, and a positively-charged 1.65 cm2 0.2 µm for opioid infusions.

    The filters did slow gravity-fed infusion rates as they aged, however this was not clinically significant when using a peristaltic pump.

    The take-home...

    We should be better stewards of our patient's IV access. For short-term access <48h focus should be on technique and sterility, but for access needed for 48h or longer, an inline filter offers significant benefit with limited downside.

    Daniel Jolley  Daniel Jolley
     
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