title: Phlebitis in amiodarone administration: incidence, contributing factors, and clinical implications.
abstract: BACKGROUND
  Intravenous amiodarone is an important treatment for arrhythmias, but peripheral infusion is associated with direct irritation of vessel walls and phlebitis rates of 8% to 55%. Objectives To determine the incidence and factors contributing to the development of amiodarone-induced phlebitis in the coronary care unit in an academic medical center and to refine the current practice protocol.
  
  
  METHODS
  Medical records from all adult patients during an 18-month period who received intravenous amiodarone while in the critical care unit were reviewed retrospectively. Route of administration, location, concentration, and duration of amiodarone therapy and factors associated with occurrence of phlebitis were examined. Descriptive statistics and regression methods were used to identify incidence and phlebitis factors.
  
  
  RESULTS
  In the final sample of 105 patients, incidence of phlebitis was 40%, with a 50% recurrence rate. All cases of phlebitis occurred in patients given a total dose of 3 g via a peripheral catheter, and one-quarter of these cases (n = 10) developed at dosages less than 1 g. Pain, redness, and warmth were the most common indications of phlebitis. Total dosage given via a peripheral catheter, duration of infusion, and number of catheters were significantly associated with phlebitis.
  
  
  CONCLUSIONS
  Amiodarone-induced phlebitis occurred in 40% of this sample at higher drug dosages. A new practice protocol resulted from this study. An outcome study is in progress.
authors.affiliation: All authors are at Stanford University, Stanford, California. Linda Norton is the nurse research coordinator and Paul Wang is a professor of medicine, Arrhythmia Service, Stanford University School of Medicine. Linda K. Ottoboni is the arrhythmia/device nurse coordinator, Stanford Hospital and Clinics, and Ann Varady is a statistical analyst programmer, Stanford Prevention Research Center. Nancy Becker is the unit educator and Theresa Cotter is the assistant patient care manager, Coronary Care Unit/Cardiac Surveillance Unit, Stanford Hospital and Clinics. Chia-Yu Yang-Lu is the Marfan Clinic nurse coordinator, Eileen Pummer is a quality manager, Annette Haynes is a cardiology clinical nurse specialist, Lynn Forsey is a program director-nurse scientist, and Kelly Matsuda is a clinical pharmacist, Stanford Hospital and Clinics.
authors.forename: Linda
authors.initials: L
authors.lastname: Norton
authors.forename: Linda K
authors.initials: LK
authors.lastname: Ottoboni
authors.forename: Ann
authors.initials: A
authors.lastname: Varady
authors.forename: Chia-Yu
authors.initials: CY
authors.lastname: Yang-Lu
authors.forename: Nancy
authors.initials: N
authors.lastname: Becker
authors.forename: Theresa
authors.initials: T
authors.lastname: Cotter
authors.forename: Eileen
authors.initials: E
authors.lastname: Pummer
authors.forename: Annette
authors.initials: A
authors.lastname: Haynes
authors.forename: Lynn
authors.initials: L
authors.lastname: Forsey
authors.forename: Kelly
authors.initials: K
authors.lastname: Matsuda
authors.forename: Paul
authors.initials: P
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000638:Amiodarone / Q000008:administration & dosage / Q000009:adverse effects*; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage / Q000009:adverse effects; D002140:California / Q000453:epidemiology; D002300:Cardiac Care Facilities / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data*; D002406:Catheterization, Peripheral / Q000009:adverse effects* / Q000706:statistics & numerical data; D004305:Dose-Response Relationship, Drug; D057286:Electronic Health Records / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D007262:Infusions, Intravenous / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010689:Phlebitis / Q000139:chemically induced* / Q000453:epidemiology; D012189:Retrospective Studies
chemical_list: D000889:Anti-Arrhythmia Agents; D000638:Amiodarone