Review of literature is a key step in research process. A researcher analyses existing knowledge before dealing into a new area of study while conducting a study when interpreting the result of the study and when making judgment about applications of a new knowledge in nursing practice. Research literature were reviewed and organized under the following sections.
Section A : Studies related to incidence and prevalence of thrombophlebitis.
Section B : Studies related to anti inflammatory action of alovera gel.
Section C : Studies related effect of aloevera gel in reducing thrombophlebitis.
Section A: Studies Related To Incidence And Prevalance of Thrombophlebitis.
Villacampa (2008) reviewed a national multicentric epidemiological study having the institutional participation of 10 centers in Spanish. In the study 381 complications appeared in the 2701 peripheral catheters studied, which represents an incidence level of 14.11% they reviewed 8700 treatment records. This study proved that the implementation strategy to improve the quality care reduces non instrumental complications. (persistent pain at the entrance point, extravasations or edema, first, second or third degree phlebitis and infections associated with catheters).
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Powell (2008) conducted a retrospective study to determine the relationship between peripheral intravenous catheters, indwell time and the incidence of thrombophlebitis. Thrombophlebitis rating site and tubing labels was performed on 1161 sites. Only 679 had documented indwell time to use. Average indwell time was 2 days and overall phlebitis rate was 3.7%, however asymptomatic peripheral IV may not need to be removed by regular intervals because they were healthy.
Jackie Hart (2007) conducted a study in identifying intravenous infusion site phlebitis in British Internal medicine, Department of a tertiary teaching hospital, with 308 short lines and 307 midsized lines and 151 long lines. The overall phlebitis rate was 39%. Phlebitis developed in 53% of patients with short lines, 41% of patients with midsized lines, and 10% of patients with long lines, and these catheters remained in place an average (± SD) of 3.0 ± 2.4 days, 4.6 ± 3.4 days, and 7.8 ± 6.6 days, respectively.
Benin.V. Chacko (2007) conducted a comparative study in identifying the complications of catheters in an University affliated hospital in England .In the study three-hundred and fifty-three intravascular catheters were implanted in 315 patients of a total number of 1,838 hospitalized patients. Out of the 353 intravascular catheters, 26 (7.3%) were intra-arterial, 273 (77.3%) were peripheral, and 54 (15.3%) were central. The median (range) duration of the catheterization was 3 days for arterial catheters, 1day for peripheral catheters, and 5 days for central catheters. Fifty-three showed signs of infection. Independent risk factors associated with the presence of infection located elsewhere (odds ratio [OR] = 8.7, CI = 4.13-18.3, p<.0001), inappropriate catheter care (OR = 5.3, CI = 2.511.2, p<.0001), inappropriate length of catheter use (OR= 3.5, CI= 1.4-9.02, p<.01), and duration of hospitalization exceeding 14 days.
Stavros Kakkos, George Lampropoulos, Spyros Papadoulas, Ioannis Ntouvas & Ioannis Tsolakis (2007) conducted an observational study to identify the position of peripheral venous cannulae and the incidence of thrombophlebitis in the University of Patras Medical School, Italy among 427 patients. The variables evaluated were based on age, gender, cannula size and site of cannula location , and the tool used was structured observation protocol. Chi-square or Student t tests, and the adjusted odds ratios were used to analyze the data. The result showed that the frequency of peripheral intravenous cannulae thrombophlebitis was higher in females (OR:1·91;CI:1·20-3·03;P < 0·006). The highest incidence was found in patients with cannulae inserted in the dorsal side of the hand veins compared to those with cannulae inserted in cubital fossa veins (OR:3·33;CI:1·37-8·07; P < 0·001 ) respectively.
Stephen Berger (2007) conducted a comparative study on incidence of phlebitis due to buffered cephalothin, cephapirin and cefamandole. Three drugs were compared with respect to their tendency to produce phlebitis. Two grams of each agent’s were administered every 6 hours for 4days to 12 healthy volunteers. Approximately 50% of intravenous sites developed mild phlebitis and 25% developed moderate phlebitis .
Singh .R, Bhgandry.S, Punk. D & Kathmandu (2007) carried out a study on peripheral Intravenous Catheter related thrombophlebitis on 230 patients in University School of Medical Sciences Nepal. The incidence rate of phlebitis rise sharply after 36 hours of catheter insertion. The sites were examined using Jackson Standard of visual Phlebitis scale once a day .Thrombophlebitis developed on 136 patients per 230 patients ie. 59%.Increase incidence rates of infusion related phlebitis were associated with males compared with females.
Tripathi (2008) conducted a randomized controlled trial covering all the aspects associated with vascular access to identify the factors affecting peripheral intravenous. This prospective interventional study was conducted over a period of 6 months. This sample was composed of 88 patients from neonate to 12 years old who were admitted to the pediatric ward, on whom a total of 377 catheters were started.Intravenous cannulation was randomized for heparin flushes (1:100 dilution) and splints. Prospective data were collected regarding duration and complication. The incidence of phlebitis increased with heparin flushes. Shorter patency duration and increased complications were associated with younger age, wrist and scalp insertions with 24 gauge catheters.
Juyaly Biswas (2006) conducted a prospective study in peripheral intravenous cannula(PIC). In this study total of 123 in patients on the surgical wards had a peripheral intravenous cannula(PIC) inserted during the third day 17 patients out of 123 patients (13.8%) had a peripheral intravenous cannula inserted for more than the recommended maximum of 72 hours. Peripheral intravenous cannula sites assessed using visual phlebitis scale. The result showed that 19 were scored 1, and 9 of them scored 2(pain at peripheral intravenous site with erythema).Totally 28 patients who had inflammation at the peripheral intravenous cannula site ie, 46.4%, of these 10.7% of cannula site appears to be inflamed which has kept more than 72hours.
Manuel Monreal , Francisco Quilez , Celestino Rey-Joly ,Soledad Rodriguez & Nieves Sopena (1999) conducted a prospective non randomized study in Joseph Roca Hospital University , Spain to assess the relative risk for thrombophlebitis in a series of consecutive patients with pneumonia, and to identify risk factors that predict an increased risk for phlebitis. Seven hundred and sixty-six consecutive patients with acute pneumonia receiving IV therapy were selected for the study. They were 308 short lines (51-mm, 18-gauge Teflon catheter), 307 midsized lines (28-cm, 16-gauge polyvinyl chloride catheter); and 151 long lines (71-cm, 14-gauge plain polyurethane catheter). Eighteen variables were prospectively evaluated for their contribution to the occurrence of thrombophlebitis. The overall phlebitis rate was 39%. Phlebitis developed in 53% of patients with short lines. In 41% of patients with midsized lines, and in 10% of patients with long lines, and these catheters remained in place of an average (± SD) of 3.0 ± 2.4 days, 4.6 ± 3.4 days, and 7.8 ± 6.6 days, respectively.
Huang Haping, Chen Zhuoming, Yang Junhuactal (2005) conducted a comparative study to discuss the effect of dexamethsone and Lidocaine normal saline on reducing phlebitis caused by Navelbine (NVB) Chemotherapy. The dexamethasone and lidocaine to venous was given in experimental group, while the control group with intravenous dripped physiological saline 0.9% and dexamethasone 5 mg on reduction of phlebitis. The experimental group′s phlebitis incidence was 13.33%; the pain′s degree was 3.71±0.49; the average duration of pain was 4.4±0.42 days. The phlebitis incidence in the control group was 36.67%, the pain′s degree was 6.68±0.76, and the average duration of pain was 6.68±0.76 days.
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Berrazueta Poveda, Ochoteco, AmadoF.Puebla, Salas & Sarabia (1999) carried out a prospective double-blind randomized study among forty patients with infusion-related thrombophlebitis in the department of Cardiology, Spain. Twenty-two patients were included in the glyceryltrinitrate (GTN) ointment group and 18 patients in the control heparinoid group. Pain was assessed by an analogue scale. At 48 hours the analgesic index was 84.6 +/- 18 units with glyceryltrinitrate and 49 +/- 45 units with heparinoid ointment (P < 0.01). Faster relief of edema was also observed in the glyceryltrinitrate treated group. All signs of thrombophlebitis were relieved in less than 4 days in the glyceryltrinitrate group compared with 9 days in the controls (P < 0.005). We conclude that transdermal glyceryltrinitrate is useful therapy for infusion-related thrombophlebitis showing evidence of anti-inflammatory and analgesic effect.
Section B: Studies Related To Anti Inflammatory Action Of Aloevera Gel.
Jocher (2008) conducted a randomized double blind placebo controlled study to investigate about the anti inflammatory effect of aloevera gel in erythema. Forty patients were included and treated occlusively on two subsequent days with aloevera gel. Erythema values were determined after 24 and 48 hours. Aloevera gel significantly reducing erythema (97.5%) after 48hours than placebo (1% hydrocortisone). The aloevera gel is useful for the treatment of inflammatory reaction as topical application.
Choonhakarn, Busaracome., Sripanidkulchai , Sarakarn (2007) conducted a randomized, double-blind, placebo-controlled trial in Srinagarind Hospital Medical School ,Thailand to compare the efficacy of alovera gel and placebo in the topical management of Oral lichen planus ( OLP) . Fifty-four patients were randomized into two groups to receive alovera gel or placebo for 8 weeks in which erosive and ulcerative lesions in 83% and 17% respectively. The most common site of Oral lichen planus was the lower lip. Twenty-two of 27 patients treated with alovera gel (81%) had a good response after treatment, while one of 27 placebo-treated patients (4%) had a similar response (P<0.001). Furthermore, two patients treated with alovera gel (7%) had a complete clinical remission. Burning pain completely disappeared in nine patients treated with aloevera gel (33%) and in one treated with placebo (4%) (P=0.005). Symptomatology improved by at least 50% (good response) in 17 patients treated with aloevera gel (63%) and in two treated with placebo (7%) (P<0.001).
Sayed (1996) conducted a double blind placebo controlled study to evaluate the clinical efficacy and tolerability of topical alovera extract for erythema patients. The sample size was sixty patients, thirty in experimental and thirty in control group between the age group of 18-50yrs at Sweden. Here the investigator applied alovera extract 3 times for a period of 5days. The result showed that alovera extract had cured 25/30 patients, 83% compared to the placebo (precoded 100g tube) cure rate of 2/30(6.6%). Hence the researcher suggested that topically applied alovera extract was more effective than placebo.
Davis (1994) conducted a study to evaluate the effect of anti-inflammatory action of alovera in a hospital at Philadelphia. The anti-inflammatory activity was found in the supernatant fraction .The supernatant fraction decreased inflammation when applied topically by 29.2% over the swelling and the precipitate decreased inflammation by 12.1%, Alovera appears to act as a modulatory system towards inflammation and is potentially valuable tool for managing inflammatory condition.
Kenneth H. Falchuk, Lynn Peterson, and Barbara J. Mc Neil (1985) conducted a study on intravenous infusion in 541 patients at a hospital in England. A total of 277 patients received infusions through intravenous sets with 0.22-μm IVEX-HP filters, and 264 received infusions without filters. Each infusion was evaluated daily for a maximum of three days. The incidence of phlebitis on Days 1, 2, and 3 of the study was 14.3, 31.1, and 27 per cent for patients receiving infusions without filters and 6.8, 9.7, and 11.3 per cent for those receiving infusions through filters (P<0.001). Thus the incidence was reduced by approximately two thirds in the patients who received infusions through the IVEX-HP filters. They conclude that the infusion-related phlebitis was pervasive problem in hospitalized patients.
Section C: Studies Related To Alovera Gel In Thrombophlebitis.
Kang Kaew (2007) conducted a systematic review to determine the efficacy of topical alovera for the treatment of thrombophlebitis in a Thailand hospital among 371 patients. The alovera gel was applied for a period of 5days .Based on an analysis using duration of healing as an outcome, the healing time in alovera group was faster than the control group (P=0.006). Hence the researcher concluded that alovera gel was effective intervention used in thrombophlebitis.
Hu Huali et al (2006) conducted a study to assess the effectiveness of fresh alovera to prevent phlebitis in malignant patients receiving chemotherapy in the department of tumor Jinghua Guagfu hospital, China.1510 cases were standardized in experimental and control group, experimental 1000 patients ,control group 510 patients, fresh alovera was placed 2 cm above the infusion site and fixed with plaster, every 2 hours it is replaced. The incidence of phlebitis was 3.50% in experimental group and in control group 28.53 %( p0.01) significantly higher than that of experimental group. Applying fresh aloevera was effective in prevention of phlebitis.
Winchers (2005) conducted a prospective study in Netherland hospital for treatment of superficial thrombophlebitis with alovera gel in relieving the local pain, swelling and redness. In this 116 patients were selected with thrombophlebitis and alovera gel was applied for a period of 3 days. The efficacy of alovera was recorded. There was a drastic improvement in patient received alovera gel as treatment than the control group.
According to Quatrin (2003) conducted a double blind evaluation of an alovera gel topical effect to reduce pain and edema on inflammatory conditions like thrombophlebitis, who were on intravenous infusions. In this study 56 patients were selected who receives intravenous infusion. Assessment was done with the visual infusion phlebitis score. Alovera gel was applied to the experimental group, for a period of 3 days then the post test score was taken ,statistical analysis showed that pain, edema and severity of inflammation was (P=0.01) for the experimental group it was statistically significant.
Chowchen (1995) conducted a comparative study on effect of alovera to reduce pain and edema due to thrombophlebitis. Twenty seven patients with thrombophlebitis were selected in experimental group; they were treated with alovera gel compared with twenty seven with Vaseline gauze. In experimental group statistical analysis by using ‘t’ test and the value of p 0.001 was statistically significant. This study shows the effectiveness of alovera gel on inflammatory conditions were greater than the control group who received Vaseline gauze.
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