To the Editor:

I wish to commend authors Mazzola, Schott-Baer, and Addy for their fine contribution to the understanding of phlebitis associated with peripherally inserted central catheters (PICCs). 1

I cannot, however, refrain from remarking that two recent and pertinent studies have been omitted from their review. The first, a 1997 prospective hospital-based study of peripheral intravenous catheter outcomes, demonstrated an 81% reduction in "phlebitis/infiltration" in consequences of using a catheter securement device instead of tape and transparent dressing. 2 The second demonstrated a 59% reduction in phlebitis when a securement device was used instead of a standard technique to secure PICCs and midline catheters. 3 Theses omitted studies, from the intravenous nursing literature, clearly demonstrate what authors Mazzola et al seem to have unexpectedly discovered. Their study, while it did target "insertion-related factors," did not initially focus upon catheter movement or migration post-insertion. In fact, the study incompletely reports the securement technique in both the experimental and control groups. Nevertheless, the authors report that "when other PICC complications were evaluated," (we are not told when or how this was done) "retraction from the vein was a significant factor in the development of phlebitis [horizontal ellipsis], indicating that clients whose PICCs retract or migrate from the insertion site could be at risk for phlebitis." 1 The data supporting this comment are not presented. Nevertheless, the authors conclude:

1. "[horizontal ellipsis]Every attempt should be used to avoid any unnecessary movement in or out of the vein during insertion or under the insertion site dressing[horizontal ellipsis]" [italics mine.]

2. Future research to identify better methods of catheter fixation to limit catheter movement should be encouraged.

Fortunately, such future research was featured in the May/June 1999 issue of Journal of Intravenous Nursing [pp. 151-156]. Sheppard et al report the longest average dwell-time of a short peripheral Teflon catheter ever recorded. In addition, they demonstrate a 100% reduction in phlebitis. Both results follow from use of a catheter securement device (StatLock IV, Venetec International, Mission Viejo, CA).

It appears that whether it is movement during insertion or after insertion, the vascular endothelium reacts with an inflammatory cascade that often eventuates in clinical phlebitis. Stop catheter movement with improved fixation and, as the evidence now shows, phlebitis is reduced.

Steven Bierman MD

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