title: Low-angled peripheral intravenous catheter tip placement decreases phlebitis.
abstract: BACKGROUND
  Peripheral intravenous catheters (PIVCs) are frequently removed due to phlebitis. We hypothesized that catheters made of polyurethane, which is more flexible than Teflon, would decrease phlebitis, and that flexibility could be estimated by measuring the catheter-tip angle. Ultrasonography in two groups of patients with different catheter types was then used to compare catheter-tip angles and phlebitis.
  
  
  METHODS
  Observational studies were carried out at a medical ward in a university hospital. Infusion therapy was administered to one group of patients in 2014 using Teflon catheters (control group, n = 200), and to another group of patients in 2015 using polyurethane catheters (investigational group, n = 207). The symptoms were assessed according to a scale developed by the Infusion Nurses Society. Long-axis ultrasonography images taken immediately before catheter removal were used to measure the angle between the central line of the catheter within 2 mm from the distal point and a tangent to the vessel wall.
  
  
  RESULTS
  There were no significant differences between the two groups with respect to sex, age, and medical diagnosis. In the control and investigational groups, the rates of phlebitis were 37% (73/200) and 17% (36/207), respectively (p<0.001). The median angles of the catheter tip were 7.8° and 4.1°, respectively (p<0.001). Phlebitis occurred more frequently when the catheter-tip was placed at angle >5.8°.
  
  
  CONCLUSIONS
  The frequency of phlebitis was lower in the polyurethane, in which the catheter was placed at lower angle, almost parallel to the vessel. Our results will aid in developing new catheters and in improving PIVC-securement techniques.
authors.affiliation: Department of Advanced Nursing Technology, Graduate School of Medicine, The University of Tokyo, Tokyo - Japan.|Terumo Corporation, General Hospital Products R&D Section, Tokyo - Japan.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Tanabe
authors.affiliation: Department of Advanced Nursing Technology, Graduate School of Medicine, The University of Tokyo, Tokyo - Japan.
authors.forename: Ryoko
authors.initials: R
authors.lastname: Murayama
authors.affiliation: Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo - Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Yabunaka
authors.affiliation: Department of Advanced Nursing Technology, Graduate School of Medicine, The University of Tokyo, Tokyo - Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Oe
authors.affiliation: Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo - Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Takahashi
authors.affiliation: Nursing Department, The University of Tokyo Hospital, Tokyo - Japan.
authors.forename: Chieko
authors.initials: C
authors.lastname: Komiyama
authors.affiliation: Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo - Japan.
authors.forename: Hiromi
authors.initials: H
authors.lastname: Sanada
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D020878:Device Removal; D004867:Equipment Design; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007262:Infusions, Intravenous; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D010689:Phlebitis / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D018583:Pliability; D011138:Polytetrafluoroethylene; D011140:Polyurethanes; D011446:Prospective Studies; D012307:Risk Factors; D014041:Tokyo; D016896:Treatment Outcome; D014463:Ultrasonography; D034941:Upper Extremity / Q000098:blood supply*; D062666:Vascular Access Devices; D014680:Veins / Q000000981:diagnostic imaging
chemical_list: D011140:Polyurethanes; D011138:Polytetrafluoroethylene