Research Article: Detection of intravenous infiltration using impedance parameters in patients in a long-term care hospital

Date Published: March 21, 2019

Publisher: Public Library of Science

Author(s): Ihn Sook Jeong, Eun-Joo Lee, Jae Hyung Kim, Gun Ho Kim, Young Jun Hwang, Gye Rok Jeon, Raffaele Serra.

http://doi.org/10.1371/journal.pone.0213585

Abstract

This study was aimed to evaluate the changes of impedance parameters of patients who were admitted to a long-term care hospital by measuring bioelectrical impedance. The subjects were 18 patients who had infusion therapy through peripheral intravenous (IV) catheters and had at least an infiltration. The impedance parameters were measured with a multi-channel impedance measuring instrument (Vector Impedance Meter) twice; at starting IV infusion after catheter insertion and infiltration detected. As results, the resistance (R) after infiltration significantly decreased compared to the initial resistance. At 50 kHz, the resistances were 498.2±79.3 [Ω] before infiltration and 369.4±85.6 [Ω] after infiltration. The magnitude of the reactance (XC) decreased after infiltration. At 50 kHz, the measured reactance was -31.1±8.3 [Ω] before infiltration and -24.5±5.9 [Ω] after infiltration. The data points plotted in the R-XC graph shifted from the first quadrant before infiltration to third quadrant after infiltration. Our findings suggest that bioelectrical impedance is an effective method for detection of infiltration in a noninvasive and quantitative manner.

Partial Text

Infiltration is one of the most common health complications in infusion therapy involving a peripheral intravenous (PIV) catheter [1]. Patients with infiltration often experience pain and skin damage, and can even a persistent disability of the arm [2]. Thus, infiltration can significantly impact the patient’s wellbeing and must be carefully monitored at an early stage [3]. Infiltration is known to be difficult to detect particularly during its initial stages. To date, infiltration has relied primarily on clinical and visual methods to examine skin and tissues surrounding the IV catheter site for factors such as tissue pressure, color, edema, swelling and temperature. However, these methods are disadvantageous because infiltration can only be confirmed well after infiltration has progressed considerably or tissue damage has occurred in subcutaneous tissue. As recognition of early signs and symptoms of infiltration can effectively limit the amount of fluid that leaks from the vein into the subcutaneous tissue [4], several infiltration detection systems have been introduced.

Impedance indicators have been proposed to detect detection of infiltration of IV solutions that accumulate in the extracellular fluid (ECF) and affect the cell membrane function. In previous experiments that studied infiltration in the rabbit’s ears and the human’s forearms, impedance parameters showed a significant difference within 2–3 minutes after infiltration in rabbits, whereas impedance parameters gradually changed over 15 minutes after infiltration in humans [18]. In this human study, impedance parameters before and after infiltration in hospitalized subjects were analyzed using BIA, and infiltration phenomena were quantitatively explained by using infiltration mechanism and equivalent circuit of human cells. Impedance parameters (R, XC, Cm) showed significant differences in the impedance parameters before and after infiltration.

The resistance (R) after infiltration significantly decreased compared to the initial resistance, the absolute magnitude of the reactance (XC) decreased after infiltration, and the data points plotted in the R-XC graph were distributed on the upper right before infiltration but on the lower left after infiltration. And, body capacitance of the cell membrane decreased almost inversely as frequency increased after infiltration. Our findings suggest that bioelectrical impedance is an effective method for detection of infiltration in a noninvasive and quantitative manner. Repeated studies with different age groups of subjects are recommended to increase the generalizability of the results. And we also recommend further studies to identify the smallest infiltration size that impedance parameters can detect the infiltration, which needs to confirmed whether impedance parameter can use a method for early detection of infiltration.

 

Source:

http://doi.org/10.1371/journal.pone.0213585

 

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