Thrombophlebitis is the inflammation of the vessel wall due to the formation of blood clot. Clinical signs of phlebitis are localized redness, warmth, swelling and palpable venous cord [1]. In the modern medical practice, up to 80% of the hospitalized patients receive intravenous (IV) therapy at some time during their admission [2]. The peripheral venous catheterization is a commonly done invasive procedure to administer medications, fluids and bio products. The most common complication associated with it is thrombophlebitis with incidence varying according to different settings [3].

Infusion phlebitis, defined as the inflammation of the cannulated vein, is a frequent cause of pain and discomfort to the estimated 25 million patients who receive infusion therapy through peripheral intravenous cannulas each year [4]. Studies over the past two decades have shown that 27% to 70% of patients receiving peripheral intravenous therapy develop phlebitis that requires the removal of the cannula, the insertion of a new cannula in a different site and, often, local treatment and analgesic drugs [5].

A large number of cases of thrombophlebitis is secondary to chemical intimal lesion, by injections of infusions of different solutions, with diagnostic or therapeutic purposes and/or mechanical lesions, such as, for example, venous catheterization. The objective of the study was to estimate the prevalence of superficial thrombophlebitis and assess the clinic-epidemiological profile of the patients admitted in Indira Gandhi Medical College, Shimla.

All adult patients admitted in Medicine wards and requiring intravenous cannulation during the period from Jul 2018 to Jun 2019 were included in this prospective cohort study conducted in Department of Medicine, Indira Gandhi Medical College (IGMC), Shimla, Himachal Pradesh. 

Figure 1: Smoking and Alcohol Consumption Status of the Study Participants (N=269)

Table 1: Epidemiological Profile of the study participants (N=269)

The patients were excluded if already suffering from thrombophlebitis at the time of admission, unconscious patients, patients with pre-existing septicaemia, patients who were hemodynamically unstable, patients who were cannulated in casualty and/or patients who had already been cannulated at periphery. The study was initiated following approval from institute ethics committee at IGMC Shimla. All the study participants were included after they agreed to participate in the study. 

Data was entered in Microsoft Excel spreadsheet and analysed using Epi Info software version 7.2.2. Categorical data were presented as number of patients, their percentage and 95% Confidence Intervals. For quantitative variables, means and standard deviations was calculated. 

A total of 269 patients were included in this study. Out of 269, 111(41.26%) patients were males and 158(58.74) were females. Mean age (± standard deviation) of the patients was 49.85(±17.67). 178(66.17%) were <60 years old and 91 (33.83%) were ≥60 years old. Out of 269 (10.78%) patients were having diabetes and 67(24.91%) patients were suffering from hypertension. 61(22.68%) patients had history of alcohol intake and 68(25.28%) were smoker (Figure 1).

About 42(15.24%) patients included in the study were having hyperlipidemia. Hyperlipidemia was defined as serum Triglycerides levels ≥150.Mean BMI (±standard deviation) of the patients was 24.14(±2.62). out of 269 patients 188 (69.89%) having BMI >22.9, 78(29%) between 18.2-22.9 and only 3 patients were <18.5. Overall, 145(53.90%) out of 269 patients developed different grades of thrombophlebitis at variable time periods (Table 1).

The females were found to be affected more by thrombophlebitis in our study as compared to males. Similar results were found in the study conducted by Singh et al. [6] on 230 patients admitted in the Intensive Care Unit, medical, surgical, obstetrics and gynaecology wards of Dhulikhel Hospital. Salma et al. [7] also found out that the incidence waws higher in the male patients but Comely et al. [8] found that the incidence of thrombophlebitis was more in females, hence this study is in concordance with our findings. In our study, phlebitis was more common in patient group of less than 60 years than the patients above 60 years of age. This result coincides with the result of other studies [7-8]. This may attributed to the fact that as the inflammatory response in the elderly is often impaired, signs and symptoms of phlebitis may be stable. 

One of the most striking findings of our study was that phlebitis was found in only 10% of the diabetic patients. This result of our study does not coincide with the result of the study conducted by Salma et al. [7] at Dhaka National Medical College Institute Hospital [7]. In this study, the prevalence of diabetics was 25%. A higher proportion of phlebitis in these patients may be due to the endothelial damage induced by diabetes mellitus, that predisposes patients to phlebitis. Good control of diabetes mellitus, greater attention and care during insertion and changing catheters within 72 hours may reduce the rate of phlebitis in these patients [5].

In our study, there were nearly one-fourth of the study participants who were hypertensive. This is in contrast to the result of the study conducted by Maki et al. [9]. In their study the proportion of patients with HTN was nearly one-third of the study population.

In our study, dyslipidemia was found in approximately 15% of the study particpants. This is similar to the result found in the study done by Monreal et al. [10]. In addition, they also found that the rate of thrombophlebitis was significantly higher in hyperlipidemia group (17.11%) compared to group without hyperlipidemia.

The prevalence of thrombophlebitis was high among the study participants. This is comparable with the other studies [11,12].

In our study, the prevalence of thrombophlebitis was quite high. Several variables were found in our study such as diabetes, old age, hypertension that might contribute towards the incidence of thrombophlebitis. Further studies are, therefore, desired to determine an association among the factors responsible for thrombophlebitis.

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