Thrombophlebitis associated with peripheral amiodarone infusions

Purpose: Like most IV medications, amiodarone can be administered via peripheral venous catheter or via a peripherally inserted central catheter (PICC). Thrombophlebitis is associated with a variety of IV medications of which IV amiodarone is a culprit.  The primary purpose of this study was to evaluate the incidence of thrombophlebitis with IV amiodarone based on IV site.

Methods: This was a prospective observational study involving patients receiving IV amiodarone via a PICC line or peripheral venous catheter. Eligible patients included patients >18 years of age, receiving intravenous amiodarone and admitted to cardiovascular units.   Patients were evaluated daily for phlebitis until IV amiodarone was converted to oral formulation or discontinued. 

Results: One hundred and thirty-nine patients completed the study, of which 33% (46) were peripheral venous catheter patients and 67% (93) were PICC line patients. Thrombophlebitis occurred in 13% of the peripheral venous catheter patients vs. 1.1% of the PICC line patients (p=0.0054). The median length of infusion in the peripheral venous catheter arm was 47.6 hours vs. 63 hours in the PICC line arm. Forty-one percent in the peripheral venous catheter arm had other IV medication co-administered with amiodarone vs. 75.3% in the PICC line arm. The median total dose in the peripheral venous catheter arm was 1680 mg vs. 2910 mg in the PICC line arm.

Conclusion: This study associated that the incidence of thrombophlebitis is higher among patients who received IV amiodarone via peripheral venous catheter than patients who received the drug via a PICC line.  Thrombophlebitis not only causes patient discomfort, but can increase complications (i.e. bacteremia), length of stay and hospital costs. Based on this study, we have recommended to our hospital medication outcome management subcommittee and pharmacy therapeutics committee that amiodarone infusions greater than 24 hour infusion would require a central line catheter such as a PICC line.