A Multiple Case Study Examining the Risk Factors Contributing to Amiodarone Infusion Related Phlebitis in a New Zealand Cardiac Care Centre

Song, Tiqing
Mowat, Rebecca
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Master of Health Science in Advanced Nuring Practice
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Auckland University of Technology

Aim: This study aimed to investigate amiodarone infusion related phlebitis in a local cardiac centre in a large metropolitan hospital within Te Whatu Ora- Health New Zealand, focusing on assessing its incidence, identifying contributing factors, evaluating treatment practices and uncovering policy gaps.

Background: In hospitals, amiodarone, a widely used antiarrhythmic drug, is mostly administered intravenously via peripheral catheters. However, the incidence of amiodarone infusion related phlebitis, which may lead to severe complications, still needs to be studied more in the context of New Zealand healthcare.

Methods: Yin’s case analysis methodology was used to analyse two cases: a seven- year clinical audit from March 2016 to June 2023 in the local cardiac centre and four local policies. Cross case analysis examined the two cases using triangulation to determine the gaps between practice reality and policy and to discover how and why amiodarone infusions occur.

Results: The incidence of amiodarone infusion related phlebitis was 8.4%. Contributing factors revealed that intravenous catheter locations were predominantly in the antecubital fossa (63%), and participants had a size 20 or larger cannula in situ (90%). There was a lack of use of the visual infusion phlebitis scores for assessment. Other findings revealed that 45% of phlebitis cases occurred during the amiodarone infusion, and 55% occurred after infusion. Seventy percent of the patients were seen by a doctor and 54% were charted oral antibiotics as treatment.

Conclusion: To improve patient outcomes and align with best evidenced guidelines, it is recommended that local policies are updated to address the identified gaps. There is a need to promote nurses’ awareness of amiodarone related phlebitis prevention, especially in relation to which site and gauge cannula should be used, increasing assessment frequency and scoring to assess phlebitis severity. There is a need for monitoring post infusion, alternating warm and cold compresses and arranging timely medical reviews. Other recommendations include using dedicated IV cannulas and inline filters for continuous amiodarone infusions.

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