title: Nursing care as a predictor of phlebitis related to insertion of a peripheral venous cannula in emergency departments: findings from a prospective study.
abstract: BACKGROUND
  To date, few studies have investigated the occurrence of phlebitis related to insertion of a peripheral venous cannula (PVC) in an emergency department (ED).
  
  
  OBJECTIVE
  To describe the natural history of ED-inserted PVC site use; the occurrence and severity of PVC-related phlebitis; and associations with patient, PVC and nursing care factors.
  
  
  METHODS
  A prospective study was undertaken of 1262 patients treated as urgent cases in EDs who remained in a medical unit for at least 24h. The first PVC inserted was observed daily until its removal; phlebitis was measured using the Visual Infusion Phlebitis Scale. Data on patient, PVC, nursing care and organizational variables were collected, and a time-to-event analysis was performed.
  
  
  RESULTS
  The prevalence of PVC-related phlebitis was 31%. The cumulative incidence (78/391) was almost 20% three days after insertion, and reached >50% (231/391) five days after insertion. Being in a specialized hospital [hazard ratio (HR) 0.583, 95% confidence interval (CI) 0.366-0.928] and receiving more nursing care (HR 0.988, 95% CI 0.983-0.993) were protective against PVC-related phlebitis at all time points. Missed nursing care increased the incidence of PVC-related phlebitis by approximately 4% (HR 1.038, 95% CI 1.001-1.077).
  
  
  CONCLUSIONS
  Missed nursing care and expertise of the nurses caring for the patient after PVC insertion affected the incidence of phlebitis; receiving more nursing care and being in a specialized hospital were associated with lower risk of PVC-related phlebitis. These are modifiable risk factors of phlebitis, suggesting areas for intervention at both hospital and unit level.
authors.affiliation: Udine University, Udine, Italy. Electronic address: alvisa.palese@uniud.it.
authors.forename: A
authors.initials: A
authors.lastname: Palese
authors.affiliation: Verona University, Verona, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Ambrosi
authors.affiliation: Udine University, Udine, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Fabris
authors.affiliation: Azienda per i Servizi Sanitari Provincia, Trento, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Guarnier
authors.affiliation: Azienda per i Servizi Sanitari Provincia, Trento, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Barelli
authors.affiliation: Azienda per i Servizi Sanitari Provincia, Trento, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Zambiasi
authors.affiliation: Azienda Ospedaliera Verona, Verona, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Allegrini
authors.affiliation: Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Bazoli
authors.affiliation: Azienda ULSS n. 9, Treviso, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Casson
authors.affiliation: Azienda per i Servizi Sanitari n. 2 'Isontina', Gorizia, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Marin
authors.affiliation: Azienda ULSS n. 6, Vicenza, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Padovan
authors.affiliation: Azienda per i Servizi Sanitari n. 4 'Medio Friuli', Udine, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Picogna
authors.affiliation: Azienda Ospedaliero-Universitaria S. Orsola-Malpighi, Bologna, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Taddia
authors.affiliation: Fondazione Zancan, Padua, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Salmaso
authors.affiliation: Bologna University, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Chiari
authors.affiliation: Verona University, Verona, Italy.
authors.forename: O
authors.initials: O
authors.lastname: Marognolli
authors.affiliation: Verona University, Verona, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Canzan
authors.affiliation: Verona University, Verona, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Saiani
mesh_terms: D000368:Aged; D002406:Catheterization, Peripheral / Q000009:adverse effects* / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D009732:Nursing Care / Q000379:methods*; D010689:Phlebitis / Q000453:epidemiology* / Q000209:etiology*; D011446:Prospective Studies
keywords: Catheterization; Emergency departments; Medical units; Missed nursing care; Peripheral; Phlebitis; Survival analysis; Vascular access devices