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Pharmacological Interventions
to Treat Phlebitis
Systematic Review
ABSTRACT
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.
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RESEARCH DESIGN
AND METHODOLOGY
Search Strategy
The literature search strategy involved a systematic
review based on the question What are the actions used
for the treatment of phlebitis? A publications search was
performed in the following indexed databases: Cochrane
Library, MEDLINE, EMBASE, and CINAHL. Keywords
included phlebitis, treatment, saline solution, heparin
solution, heparinoid substances, nitroglycerin, glyceryl
trinitrate, cold compress, warm compress, and notoginseny. Pertinent keywords were also searched in Portuguese
and Spanish in the BDENF and LILACS databases. An
inverse search was also done through a referenced bibliography included in the found documents.
The following cross-searches were also performed,
using the keywords phlebitis and treatment, phlebitis
and saline solution, phlebitis and heparin solution,
phlebitis and heparinoid substances, phlebitis and nitroglycerin, phlebitis and cold compress, phlebitis and
warm compress, and phlebitis and notoginseny.
Selection Criteria
NUMBER 2
RESULTS
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DISCUSSION
In some studies, topical anti-inflammatories were
recommended as a simple, safe, and effective alternative
for the treatment of phlebitis cases deriving from
infusional therapy in comparison with systemic antiinflammatories. This is due to the collateral effects
systemic anti-inflammatories produce, such as headache,
epigastric pain, nausea, and local pruritis.14 When compared with polysulfate of mucopolysaccharide, a medication that is generally used as a control for clinical
studies on the treatment of phlebitis, the topical antiinflammatories were found to be as effective.17
The heparinoid substances, such as polysulfate of
mucopolysaccharide, present specific pharmacological properties for percutaneous application and are
ultimately intended to reduce the localized inflammation. Polysulfate of mucopolysaccharide has an anticoagulant action in working on thromboplastin and
thrombin, inhibiting or delaying the formation of
thrombi and their subsequent growth. On the other
hand, upon activating plasmin and plasminogen, polysulfate of mucopolysaccharide stimulates fibrinolysis.
Journal of Infusion Nursing
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TABLE 1
Methodological Detail
Intervention
Result
Conclusion/
Recommendation
Berqvist et al16
Almenar et al15
Becheruci
et al17
The following were evaluated: pain, edema, and erythema. Response to treatment
was considered to be a
reduction of phlebitis by at
least 30%. Both G-topical and
G-oral attained a phlebitis
reduction score of 60%,
versus 20% for G-control.
However, G-oral presented
collateral effects: headache,
epigastric pain, nausea, and
local pruritis.
Gouping et al18
Quasi-experimental study.
n 65 patients, divided into
2 groups: A 34 patients
and B 31 patients.
Group A application of 14 g
of notoginseny cream. Group
B 14 g of Hirudoid
(mucopolysaccharidepolysulfuric acid). The
treatments were applied at
the site where the phlebitis
had developed, from 0800
until 2000, with an interval of
4 h each time.
Trillo and
Esteban14
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CONCLUSIONS OF REVIEWERS
AND RECOMMENDATION FOR
FURTHER RESEARCH
Several pharmacological interventions have been used
to treat infusion phlebitis. Although not all drugs may
be commercially available in different countries, knowledge of them is relevant for nursing practice and for
clinical research development.
Study results suggest that the use of topical notoginseny cream and NTG is more effective in the treatment of
phlebitis in comparison with the use of creams or ointments containing polysulfate of mucopolysaccharide, also
known as heparinoid substances. In turn, vehicles containing heparinoid substances were considered as effective as
topical anti-inflammatories, which only underscores the
efficacy of notoginseny and NTG. However, no result permits us to conclude that either treatment is more effective
in the cure or regression of phlebitis.
Although the sample consisted mostly of a randomized controlled trial, notoginseny and NTG were evaluated in studies that reported various clinical outcomes
and considered different types of phlebitis, which were
not well defined in some studies. Thus, the evaluation of
the efficacy of these products in terms of the type of
phlebitis was impaired.
The studies used presented some limitations regarding
the definition of variables and the reading of the clinical
outcomes. The profile of the patients studied makes it
impossible to analyze and determine whether the sample
was pertinent in terms of evaluating the efficacy of the
products. Variables were not explicitly explained, the site
of the study was mentioned only in 1 publication, and no
study offered a calculation of the size of the sample.
Except for notoginseny cream, the FDA has approved
substances referred to in this review for the treatment of
diseases other than phlebitis. Therefore, it is important
to conduct clinical studies evaluating the efficacy of possible alternatives to the treatment of phlebitis.
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