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Methods of preventing vinorelbine-induced phlebitis: an experimental study in rabbits.

Kohno E, Murase S, Nishikata M, Okamura N, Matzno S, Kuwahara T, Matsuyama K - Int J Med Sci (2008)

Bottom Line: VNR did not cause obvious loss of venous endothelial cells, the most sensitive and common feature of phlebitis, but VNR infusion led to inflammatory cell infiltration, edema, and epidermal degeneration.Tissue damage was significantly decreased by shortening the administration time and by diluting the VNR solution for infusion from 0.6 mg/mL to 0.3 mg/mL.Rapid infusion and dilution are effective methods of reducing phlebitis caused by the infusion of VNR, but the efficacy of flushing with normal saline or infusion of fat emulsion was not confirmed.

View Article: PubMed Central - PubMed

Affiliation: Department of Hospital Pharmacy, Kansai Medical University Takii Hospital, 10-15 Fumizono-cho, Moriguchi, Osaka 570-8507, Japan. kohnoe@takii.kmu.ac.jp

ABSTRACT

Purpose: In order to identify methods for preventing phlebitis caused by intravenous administration of vinorelbine (VNR), we established a procedure for estimating the severity of phlebitis in an animal model.

Methods: Four different factors (administration rate, dilution, flushing, and infusion of fat emulsion) were evaluated for alleviation of phlebitis caused by VNR infusion. VNR was diluted with normal saline to prepare test solutions with concentrations of 0.6 mg/mL or 0.3 mg/mL for infusion into the auricular veins of rabbits. Two days after VNR infusion, the veins were subjected to histopathological examination.

Results: VNR did not cause obvious loss of venous endothelial cells, the most sensitive and common feature of phlebitis, but VNR infusion led to inflammatory cell infiltration, edema, and epidermal degeneration. Tissue damage was significantly decreased by shortening the administration time and by diluting the VNR solution for infusion from 0.6 mg/mL to 0.3 mg/mL. However, there was no effect of flushing with normal saline after VNR infusion, while treatment with fat emulsion before and after VNR infusion only had a minimal effect.

Conclusion: Rapid infusion and dilution are effective methods of reducing phlebitis caused by the infusion of VNR, but the efficacy of flushing with normal saline or infusion of fat emulsion was not confirmed.

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Related in: MedlinePlus

Typical photomicrographs of an untreated ear vein.
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Figure 2: Typical photomicrographs of an untreated ear vein.

Mentions: Figure 2 shows a representative photomicrograph of a normal vein without exposure to VNR and Table 2 summarizes the histopathological findings after infusion of VNR at a normal or rapid rate. Infusion of a 0.6 mg/mL solution of VNR for 30 min at 5 mL/kg/hr (control) only caused slight loss of venous endothelial cells (Grade 1) in the distal region of the vein in 1 of 8 animals. In addition, there was inflammatory cell infiltration (Grades 2-3) in the proximal and distal regions of the vein in 5 animals each, edema (Grades 1-2) of the proximal vein region in 3 animals and the distal region in 5 animals, and epidermal degeneration (Grades 1-3) at both the proximal and distal regions in all 8 animals (Figure 3). After infusion of the same solution 3 times more rapidly (10 min, 15 mL/kg/hr), there was inflammatory cell infiltration (Grades 1-2) at the proximal vein region in 4 out of 8 animals and at the distal region in 3 animals, but edema (Grade 2) was only found in the proximal region of 1 animal. Epidermal degeneration (Grades 1-3) still occurred at both the proximal and distal regions in 7 out of 8 animals. Edema of the distal region was significantly less severe in the rapid infusion group compared with the control infusion group (p<0.05).


Methods of preventing vinorelbine-induced phlebitis: an experimental study in rabbits.

Kohno E, Murase S, Nishikata M, Okamura N, Matzno S, Kuwahara T, Matsuyama K - Int J Med Sci (2008)

Typical photomicrographs of an untreated ear vein.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2500147&req=5

Figure 2: Typical photomicrographs of an untreated ear vein.
Mentions: Figure 2 shows a representative photomicrograph of a normal vein without exposure to VNR and Table 2 summarizes the histopathological findings after infusion of VNR at a normal or rapid rate. Infusion of a 0.6 mg/mL solution of VNR for 30 min at 5 mL/kg/hr (control) only caused slight loss of venous endothelial cells (Grade 1) in the distal region of the vein in 1 of 8 animals. In addition, there was inflammatory cell infiltration (Grades 2-3) in the proximal and distal regions of the vein in 5 animals each, edema (Grades 1-2) of the proximal vein region in 3 animals and the distal region in 5 animals, and epidermal degeneration (Grades 1-3) at both the proximal and distal regions in all 8 animals (Figure 3). After infusion of the same solution 3 times more rapidly (10 min, 15 mL/kg/hr), there was inflammatory cell infiltration (Grades 1-2) at the proximal vein region in 4 out of 8 animals and at the distal region in 3 animals, but edema (Grade 2) was only found in the proximal region of 1 animal. Epidermal degeneration (Grades 1-3) still occurred at both the proximal and distal regions in 7 out of 8 animals. Edema of the distal region was significantly less severe in the rapid infusion group compared with the control infusion group (p<0.05).

Bottom Line: VNR did not cause obvious loss of venous endothelial cells, the most sensitive and common feature of phlebitis, but VNR infusion led to inflammatory cell infiltration, edema, and epidermal degeneration.Tissue damage was significantly decreased by shortening the administration time and by diluting the VNR solution for infusion from 0.6 mg/mL to 0.3 mg/mL.Rapid infusion and dilution are effective methods of reducing phlebitis caused by the infusion of VNR, but the efficacy of flushing with normal saline or infusion of fat emulsion was not confirmed.

View Article: PubMed Central - PubMed

Affiliation: Department of Hospital Pharmacy, Kansai Medical University Takii Hospital, 10-15 Fumizono-cho, Moriguchi, Osaka 570-8507, Japan. kohnoe@takii.kmu.ac.jp

ABSTRACT

Purpose: In order to identify methods for preventing phlebitis caused by intravenous administration of vinorelbine (VNR), we established a procedure for estimating the severity of phlebitis in an animal model.

Methods: Four different factors (administration rate, dilution, flushing, and infusion of fat emulsion) were evaluated for alleviation of phlebitis caused by VNR infusion. VNR was diluted with normal saline to prepare test solutions with concentrations of 0.6 mg/mL or 0.3 mg/mL for infusion into the auricular veins of rabbits. Two days after VNR infusion, the veins were subjected to histopathological examination.

Results: VNR did not cause obvious loss of venous endothelial cells, the most sensitive and common feature of phlebitis, but VNR infusion led to inflammatory cell infiltration, edema, and epidermal degeneration. Tissue damage was significantly decreased by shortening the administration time and by diluting the VNR solution for infusion from 0.6 mg/mL to 0.3 mg/mL. However, there was no effect of flushing with normal saline after VNR infusion, while treatment with fat emulsion before and after VNR infusion only had a minimal effect.

Conclusion: Rapid infusion and dilution are effective methods of reducing phlebitis caused by the infusion of VNR, but the efficacy of flushing with normal saline or infusion of fat emulsion was not confirmed.

Show MeSH
Related in: MedlinePlus