Factores de riesgo de flebitis en un hospital de cuarto nivel en Bogotá-Colombia: estudio de casos y controles

Constanza Dennys Villalba; Ginna Marcela Prieto Castillo; Mauricio Andrés Murillo Moreno; Diego Enrique Prieto Alvarado

Factores de riesgo de flebitis en un hospital de cuarto nivel en Bogotá-Colombia: estudio de casos y controles

Constanza Dennys Villalba, Ginna Marcela Prieto Castillo, Mauricio Andrés Murillo Moreno, Diego Enrique Prieto Alvarado

Resumen

Introducción: La flebitis se define como la presencia de dolor, sensibilidad, induración, inflamación, eritema, calor y cordón palpable en el sitio de inserción, ocasionando complicaciones como infección o trombosis (1). Se clasifica como un evento adverso prevenible, por lo cual, las instituciones hospitalarias deben conocer los factores de riesgo asociados a su presentación.

Objetivo: Establecer los factores asociados al desarrollo de flebitis en pacientes adultos atendidos en una institución hospitalaria de cuarto nivel en la ciudad de Bogotá-Colombia, en el año 2017.

Conclusiones: La administración de antibióticos endovenosos como el cefepime, la claritromicina y la vancomicina, así como el antecedente de diabetes mellitus, incrementan el riesgo de flebitis. Por otra parte, la curación y el uso de apósito de lámina transparente demostraron ser factores protectores de esta condición.

Palabras clave

Flebitis, factores de riesgo, catéter venoso periférico, enfermería.

Texto completo:

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Referencias

Amin NH, Speirs JN, Simmons MJ, Lermen OZ, Cushner FD, Scuderi GR. Total Knee Arthroplasty Wound Complication Treatment Algorithm: Current Soft Tissue Coverage Options. J Arthroplasty. 2019;34(4):735–42.

Kurtz SM, Ong KL, Lau E, Bozic KJ. Impact of the economic downturn on total joint replacement demand in the United States: Updated projections to 2021. J Bone Jt Surg. 2014;96(8):624–30.

Nedza SM, Fry DE, DesHarnais S, Spencer E, Yep P. Emergency Department Visits Following Joint Replacement Surgery in an Era of Mandatory Bundled Payments. Acad Emerg Med. 2017;24(2):236–45.

Jones RE, Russell RD, Huo MH. Wound healing in total joint replacement.The bone & joint journal. 2013;95-B(11 Suppl A):144-7.

Vince KG, Abdeen A. Wound problems in total knee arthroplasty.Clinical Orthopaedics and Related Research. 2006;452:88-90.

Zhang W, Li N, Chen S, Tan Y, Al-Aidaros M, Chen L. The effects of a tourniquet used in total knee arthroplasty: a meta-analysis. Journal of orthopaedic surgery and research. BioMed Central. 2014;9(1):13.

Belmont PJ, Goodman GP, Waterman BR, Bader JO, Schoenfeld AJ. Thirty-day postoperative complications and mortality following total knee arthroplasty : Incidence and risk factors among a national sample of 15,321 patients.Journal of Bone and Joint Surgery 2014;96(1):20-6.

Taylor GI, Pan WR. Angiosomes of the leg: Anatomic study and clinical implications. Plast Reconstr Surg. 1998;102(3):599–616.

Osei DA, Rebehn KA, Boyer MI. Soft-tissue Defects after Total Knee Arthroplasty: Management and Reconstruction. Journal of the American Academy of Orthopaedic. 2016;24(11):769-779.

Reference-Pricing Policy for Hip/Knee Replacements Generates Significant Savings by Encouraging Enrollees To Choose High-Value Facilities | AHRQ Health Care Innovations Exchange [Internet]. [cited 2020 Feb 13]. Available from: https://www.innovations.ahrq.gov/profiles/reference-pricing-policy-hipknee-replacements-generates-significant-savings-encouraging

Cram P, Lu X, Kates SL, Singh JA, Li Y, Wolf BR. Total knee arthroplasty volume, utilization, and outcomes among medicare beneficiaries, 1991-2010.J Am Med Assoc. 2012;308(12):1227–36.

Mahomed NN, Barrett J, Katz JN, Baron JA, Wright J, Losina E. Epidemiology of total knee replacement in the United States medicare population. J Bone Jt Surg. 2005;87(6):1222-8.

Cordtz RL, Hawley S, Prieto-Alhambra D, Højgaard P, Zobbe K, Overgaard S, et al. Incidence of hip and knee replacement in patients with rheumatoid arthritis following the introduction of biological DMARDs: An interrupted time-series analysis using nationwide Danish healthcare registers. Ann Rheum Dis. 2018;77(5):684-689.

Misra A, Niranjan NS. Fasciocutaneous flaps based on fascial feeder and perforator vessels for defects in the patellar and peripatellar regions. Plast Reconstr Surg. 2005;115(6):1625–32.

Economides JM, DeFazio M V, Golshani K, Cinque M, Anghel EL, Lakhiani C, et al. Soft Tissue Coverage of Complex Periprosthetic Defects in Patients With Total Knee Arthroplasty: Analysis of Factors That Influence Reconstructive and Functional Outcomes. Wounds a Compend Clin Res Pract. 2018;30(10):283–289.

Panni AS, Vasso M, Cerciello S, Salgarello M. Wound complications in total knee arthroplasty. Which flap is to be used? With or without retention of prosthesis?.Knee Surgery, Sports Traumatology, Arthroscopy. 2011;19(7):1060-8.

Gad B, Styron J, Goergy M, Klika A, Barsoum W, Higuera C. Patient Factors Associated with Failure of Flap Coverage Used during Revision Total Knee Arthroplasty. J Knee Surg. 2018;31(08):723–9.

Bedair H, Ting N, Jacovides C, Saxena A, Moric M, Parvizi J, et al. The mark coventry award: Diagnosis of early postoperative TKA infection using synovial fluid analysis. Clinical Orthopaedics and Related Research. 2011;469(1):34-40.

Casey WJ, Rebecca AM, Krochmal DJ, Kim HY, Hemminger BJ, Clarke HD, et al. Prophylactic flap reconstruction of the knee prior to total knee arthroplasty in high-risk patients. Ann Plast Surg. 2011;66(4):381-7.

Young K, Chummun S, Wright T, Darley E, Chapman TW, Porteous AJ, et al. Management of the exposed total knee prosthesis, a six-year review. Knee. 2016;23(4):736–9.

Nahabedian MY, Orlando JC, Delanois RE, Mont MA, Hungerford DS. Salvage procedures for complex soft tissue defects of the knee. Clinical Orthopaedics and Related Research. 1998. p. 119–24.

Tiengo C, Macchi V, Vigato E, Porzionato A, Stecco C, Azzena B, et al. Reversed gracilis pedicle flap for coverage of a total knee prosthesis. Journal of Bone and Joint Surgery. Journal of Bone and Joint Surgery Inc. 2010;92(7):1640-6.

Shen Y, Han D, Qin F. Management of skin necrosis around incision following total knee arthroplasty. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2014;28(8):985-7.

Donaldson DQ, Torkington M, Anthony IC, Wheelwright EF, Blyth MJ, Jones BG. Influence of skin incision position on physiological and biochemical changes in tissue after primary total knee replacement - A prospective randomised controlled trial. BMC Surg. 2015;15(1):44.

Lazaro LE, Cross MB, Lorich DG. Vascular anatomy of the patella: Implications for total knee arthroplasty surgical approaches. Knee. 2014;21(3):655–60.

Rao AJ, Kempton SJ, Erickson BJ, Levine BR, Rao VK. Soft Tissue Reconstruction and Flap Coverage for Revision Total Knee Arthroplasty .Journal of Arthroplasty. 2016;31(7):1529-38.

Harvin WH, Stannard JP. Negative-Pressure Wound Therapy in Acute Traumatic and Surgical Wounds in Orthopaedics. JBJS Rev. 2014;2(4):1.

Calderon W, Chang N, Mathes SJ. Comparison of the effect of bacterial inoculation in musculocutaneous and fasciocutaneous flaps. Plast Reconstr Surg. 1986;77(5):785-94.

Rodriguez ED, Bluebond-Langner R, Copeland C, Grim TN, Singh NK, Scalea T. Functional outcomes of posttraumatic lower limb salvage: A pilot study of anterolateral thigh perforator flaps versus muscle flaps. J Trauma - Inj Infect Crit Care. 2009;66(5):1311–4.

Yazar S, Lin CH, Lin Y Te, Ulusal AE, Wei FC. Outcome comparison between free muscle and free fasciocutaneous flaps for reconstruction of distal third and ankle traumatic open tibial fractures. Plast Reconstr Surg. 2006;117(7):2468–75.

Corten K, Struelens B, Evans B, Graham E, Bourne RB, MacDonald SJ. Gastrocnemius flap reconstruction of softtissue defects following infected total knee replacement. Bone Jt J. 2013 Sep;95 B(9):1217–21.

Ries MD, Bozic KJ. Medial gastrocnemius flap coverage for treatment of skin necrosis after total knee arthroplasty. Clinical Orthopaedics and Related Research 2006;446:186-92.

Papaioannou K, Lallos S, Mavrogenis A, Vasiliadis E, Savvidou O, Efstathopoulos N. Unilateral or bilateral V-Y fasciocutaneous flaps for the coverage of soft tissue defects following total knee arthroplasty. J Orthop Surg Res. 2010;5(1):82.

Sahin I, Guzey S, Aykan A, Nisanci M. The Reverse Fasciocutaneous ALT Flap Harvested From Deeply Wounded and Scarred Area for Reconstruction of the Knee: A Case Report. Int J Low Extrem Wounds.2016;15(2):136–8.

Hallock GG. Salvage of total knee arthroplasty with local fasciocutaneous flaps. J Bone Joint Surg Am . 1990;72(8):1236–9.

Fang T, Zhang EW, Lineaweaver WC, Zhang F. Recipient vessels in the free flap reconstruction around the knee .Annals of Plastic Surgery. 2013;71(4):429-33.

Saint-Cyr M, Wong C, Schaverien M, Mojallal A, Rohrich RJ. The perforasome theory: Vascular anatomy and clinical implications. Plast Reconstr Surg. 2009;124(5):1529–44.

Haertsch P. The blood supply to the skin of the leg: a post-mortem investigation. Br J Plast Surg.1981t;34(4):470–7.

Walton RL, Bunkis J. The Posterior Calf Fasciocutaneous Free Flap. Plast Reconstr Surg. 1984;74(1):76–85.

Acland RD, Schusterman M, Godina M, Eder E, Taylor GI, Carlisle I. The Saphenous Neurovascular Free Flap. Plast Reconstr Surg. 1981;67(6):763–74.

Pozzobon LR, Helito CP, Guimarães TM, Gobbi RG, Pécora JR, Camanho GL. Rotation flaps for coverage after total knee arthroplasty. Acta Ortop Bras. 2013;21(4):219–22.

Ng SW, Fong HC, Tan BK. Two sequential free flaps for coverage of a total knee implant. Arch Plast Surg. 2018;45(3):280–3.

Wettstein R, Largo RD, Raffoul W, Schumacher R, Schaefer DJ, Kalbermatten DF. Laser scanning evaluation of atrophy after autologous free muscle transfer. Ann Plast Surg. 2014;72(SUPPL. 2):680–4.

Venkatramani H, Sabapathy SR, Nayak S. Free-flap cover of complex defects around the knee using the descending genicular artery as the recipient pedicle. J Plast Reconstr Aesthetic Surg. 2014;67(1):93–8.