Comparison of the effect of clobetasol ointment with nitroglycerin ointment on the prevention of superficial phlebitis caused by angiocysts in patients admitted to the male surgery department of Wali Asr Hospital (AJ), Arak city, 2013

Dissertation

Master's course in intensive care nursing

Abstract:

Introduction: Nowadays, one of the most common invasive methods in medical care is the use of intravenous injections, and like any other method, it has many complications, the most common of which is phlebitis, and one of the The treatment goals are to prevent it. Therefore, this study was conducted with the aim of determining the effect of clobetasol ointment with nitroglycerin ointment on the prevention of superficial phlebitis caused by angiocata.

Materials and methods: This study was conducted by the clinical trial method on 144 patients admitted to the male surgery department of Valiasr Hospital, Arak in 2013. Patients were randomly divided into three groups A (Clobetasol), B (Nitroglycerin) and C (Control). The data collection tool of the questionnaire included demographic information (age and type of disease), information related to venous treatment (place of cannulation, type of serum received, drugs received) and a phlebitis measurement scale (from zero, which means no phlebitis to four, phlebitis with rope and palpable vein). In the intervention groups, after venipuncture, 1.5 cm (about 2 grams) of ointment was used in the distal part of the angioket and the area was bandaged with sterile gauze. In three time periods of 24, 48 and 72 hours from the time of vein extraction, the site was checked for phlebitis. In order to analyze the data, Fisher's exact statistical tests and Chi-square and spss19 software were used.

Findings: The research results showed that the age group of 20 to 39 years old was the most frequent age group. The most common cannulation site in the clobestazole group was 62.5%, in the nitroglycerin group, 59.5% and in the control group, 46.9% was the back of the hand. The results of the research related to the occurrence of phlebitis in the studied groups by the time elapsed since the placement of the angioette showed that there was no significant difference in the first 24 hours after the placement of the angioette in the three groups. But in 48 and 72 hours after catheter placement, there was a significant difference between the intervention and control groups (P<0.0001). There was no significant difference in the degree of phlebitis reduction between the intervention and control groups at 24 and 48 hours after angiocyte placement. (P<0.026.(.

Conclusion: The results of this study showed that the use of nitroglycerin ointment was more effective in preventing the occurrence of superficial phlebitis caused by angioket than clobetasol ointment. Therefore, based on the results of this study, it is suggested that clobetasol ointment and nitroglycerin ointment to prevent the occurrence of phlebitis in patients who need long-term use of Angioket (more than 48 hours) should be used.

Key words: clobetasol ointment, nitroglycerin ointment, phlebitis, angioket

1-1. Statement of the problem:

Intravenous treatment is 70 years old, but without a doubt, injecting medicinal substances into the veins was one of the dreams of mankind centuries ago. Today, more than 80 to 90% of hospitalized patients receive intravenous therapy during their treatment, and more than 500 million peripheral vein catheters are inserted annually[1]. During a research conducted in Yazd, 50%[2] and a similar research in Tehran, 55% of hospitalized patients received intravenous therapy, which indicates the extent of the use of this treatment method in the country[3]. More than 25 million intravascular catheters are placed in American hospitals every year [4]. Catheters are used with the purpose of delivering nutrients to the body, correcting or preventing water and electrolyte disorders, blood transfusions or its products, drug administration, and blood sampling[5]. Harrison writes that the intravenous method is appropriate when oral medications are not effective, the level of drug concentration in the blood is unknown, or larger doses of the drug are required for treatment[6].

Although accessing the venous system, taking blood and directly administering any solution into the veins are associated with many risks, the intravenous route is often the best or the only way to choose. The purpose of venipuncture is to access the venous blood flow in order to obtain blood for laboratory or diagnostic tests, injection of fluids, electrolytes, drugs, blood products, nutritional supplements and hemodynamic monitoring [7]. Today, one of the most common invasive methods in medical care is the use of intravenous injections.

The most important advantage of intravenous infusion is to prepare an intravenous route for giving drugs, liquids and anesthetics in emergency situations. It does not cause infection in the site, faster absorption compared to other methods, rapid drug release, maintaining a controlled concentration of substances or drugs in the blood, and also saves the nurse's time. Intravenous infusion, like any other method, has many side effects [9]. The most important of them are liquid leakage, phlebitis1, fluid accumulation in the body, infection and bleeding in the injection area [10]. The most common of these complications is phlebitis and the most dangerous of them is infection [10, 11].

Local complications are usually seen near the insertion site. These side effects have a lot in common and are not very serious compared to systemic side effects. The immediate diagnosis of these complications by the nurse based on the existing signs and symptoms, as well as based on the correct implementation of nursing interventions, many of these symptoms can be prevented [10]. Systemic complications usually occur inside the vascular system, which usually originates from the injection area. For example, we can mention thrombophlebitis, which has the potential to move to the lung and cause pulmonary embolism, so the treatment of systemic complications seems much more difficult than peripheral complications [14]. It may last for a few days to a few weeks, and its symptoms include: fever, redness, inflammation, shooting pain, swelling in the injection area [16].

1. Phlebitis

Phlebitis caused by a venous catheter should be considered important because it can indicate the accumulation of bacteria that leads to a bloodstream infection and ultimately leads to increased length of hospitalization, increased treatment costs, loss of the venous line, and in some cases even the death of the patient [17]. Clot, causing thrombophlebitis 1, embolism 2 and reducing the lifespan of venous cannula 3 [18]. Research has shown that phlebitis is the main cause of removing peripheral catheters. The high prevalence of phlebitis increases economic costs [19], wastes nurses' time, increases patients' problems such as infection, patient discomfort, and finally leads to removing the catheter and placing it in a new place, which in turn makes it more difficult to access the vessels and may cause the use of more invasive methods such as catheter placement in central veins, which has far more complications. It is also possible to delay the administration of intravenous drugs and even increase the duration of hospitalization [20].

In the presence of bacterial phlebitis, the risk of septicemia increases up to 18 times[21]. Phlebitis is a potentially dangerous source for causing systemic infections, so that the chance of systemic infections increases 8 times in the presence of phlebitis [2]. The American Nursing Association states that the acceptable prevalence of phlebitis is 5% or less, while studies conducted from 1966 to 2001 report the overall prevalence of phlebitis at 25-35% [17]. Another study mentions the prevalence of phlebitis among patients with intravenous injection between 25 and 70% [2]. Examining the results of research shows that the prevalence of complications caused by intravenous injections in our country is higher than in other parts of the world (20-80%)[22].