Evaluation of Antiseptics and the Microbiological Environment Regarding Complications of Phlebitis Caused by Peripheral Cannulas

OBJECTIVES: Our aim was to demonstrate which of the different antiseptics is more effective in reducing phlebitis occurrence and to analyse the microbiological environment on the skin surface around the puncture point of the cannula.

METHODS: An experimental, qualitative, quantitative study was performed between July and October of 2021 by collecting samples weekly at the Departments of the University of Pécs Clinical Centre. Patients included in our study gave written consent, had a peripheral cannula for more than 24 hours, and did not receive oncology treatment. We took, cultured microbiological samples from the skin area around the puncture, and kept survey sheet about cannulas as well. Data were analysed with SPSS 25.0, descriptive statistics, correlation analysis, χ² test, ANOVA, and independent samples t-test were calculated (p<0.05).

RESULTS: 70% isopropyl alcohol (according to descriptive statistics) is most effective in preventing phlebitis. There were no differences between antiseptics with different agents, such as: 72.9% ethanol (n=29), 70% isopropyl alcohol (n=3), octenidine dihydrochloride / phenoxyethanol (n=9), 2% chlorhexidine digluconate (n=3), and the incidence of phlebitis (p=0.798). Microorganisms were cultured in 47.2% of skin inoculations (n=51). Cannulas placed into the elbow flexions (n=14) had significantly more microbes than those in the forearms (n=55) and hands (n=35) (p=0.036). Cannulas were in the vasculature for an average of 86.55±58.00 hours (min=7, max=316). There was no significant difference in the incidence of phlebitis between cannulas used for ≤96 hours (n=30) and cannulas used for ≥97 hours (n=14; p=0.247).

CONCLUSIONS: During peripheral short cannula usage, Cutasept disinfectant should be preferred if possible, however, other formulations tested could be used as well and areas of elbow flexion should be avoided to prevent phlebitis development. Based on our study, phlebitis as a complication can be traced back to mechanical or chemical causes in addition to microbial infection.