Similarly, this study confirms the findings of some other studies as well Wait [18] that site of insertion of cannula influence phlebitis. Looking at the blood-brain barrier: molecular anatomy and possible investigation approaches. 25 participants in Group A (application of Magnesium sulphate with glycerin). Nakahama K, Nagano M, Fujioka A, Shinoda K, Sasaki H. Effect of TPA on aquaporin 4 mRNA expression in cultured rat astrocytes. Purpose of intravenous cannula in the participants (n = 50). Early detection and appropriate interventions reduce the occurrence and severity of cannula related phlebitis. Preeclampsia-eclampsia: Clinical and neuroradiographic correlates and insights into the pathogenesis of hypertensive encephalopathy. Drug Information available for: Glycerin Magnesium Magnesium sulfate Sulfate ion. Magnesium sulphate paste better known as Epsom salts is a popular but old-fashioned remedy for infections of the skin. Conclusions: In this study, author have observed patients treated with Glycerin & Magnesium Sulfate dressing responded better than normal saline dressing. Table 5. Feeling of leg heaviness. To evaluate the effectiveness of Magnesium sulphate with glycerin dressing versus Heparinoid ointment application on management of peripheral cannula induced phlebitis. Some research findings have showed male gender has more phlebitis than female sex [7] [14] where as in some studies majority of subjects were female 60% in MSG and male 56% and HPA group the finding is consistent with that of the previous finding from the study by Tan, where results showed that female patients had a significant increased risk of developing thrombophlebitis. A single dose of ethanol (2 g/kg) injected to mice significantly decreased total Mg2+ concentration in serum (Papierkowski et al., 1998). A Study conducted by Yamber [13] on 30 ICU patients in Karnataka, reported that application of Glycerin with Magnesium Sulphate is more effective than heparin-benzyl nicotinate (thrombophob) ointment at 0.05 level of significant (t = 2.301) on management of cannula induced thrombophlebitis. Significantly decreased extracellular magnesium in brains of gerbils subjected to cerebral ischemia. Demougeot C, Bobillier-Chaumont S, Mossiat C, Marie C, Berthelot A. Table 7 Demonstrate that there is a statistically significant difference in phlebitis score in both experimental groups MSG and HPA groups after comparison baseline within 8, 16, 32, 40, 48 hours of administration of intervention (P = 0.05). Phlebitis is the inflammation of the tunica intima of the vein. Kaptanoglu E, Beskonakli E, Okutan O, Selcuk Surucu H, Taskin Y. Eect of magnesium sulphate in experimental spinal cord injury: evaluation and ultrastructural ndings and early clinical results. Khan OH, Enno T, Del Bigio MR. Magnesium sulfate therapy is of mild benefit to young rats with kaolin-induced hydrocephalus. Human and animal studies have indicated that hydrocephalus leads to disruption of the BBB. Magnesium therapy has been shown to be effective in a variety of animal models of experimental BBB disruption. Comparision of the effectiveness of magnesium sulphate with glycerine and heparinoid ointment application on phlebitis (n = 50). Table 3 shows variables related to administration of intravenous cannula from both groups all 50 (100%) participants received intravenous drugs. Procedure for the application of both the interventions was different. Even though glycerin magnesium sulphate and heparin ointment are widely used in hospitals, which of the intervention is more effective, is still confusing and debatable question to nurses and also there is little evidence showing about that which one is more effective and cost-effective on management of thrombophlebitis. Magnesium sulphate was applied every 2 h for 2 days in solution form with a compress, and the limb was raised, wrapped in plastic and immobilised (Wan, 2018), or it was applied in ointment form . Small size catheters allow more blood flow in adjacent tissues and thereby prevent damage to the tunica intima of the vein. similarly mild 53.6% and very mild 37%where found on study conducted by Oliveira and Parreira [22] [24]. 14 (28%), 7 (14%) 1 (2%) of them had advanced or severe, early/mild and advanced thrombophlebitis or very severe phlebitis respectively. Introduction: Phlebitis is the most common complication of intravenous infusion therapy. But the association was not statistically significant. The name "Epsom salt" is a nod to the town of Epsom, located a stone . However, the exact mechanism/s of action of magnesium treatment in the improvement of BBB integrity in eclampsia still remains to be elucidated. A growing body of evidence suggests that Mg2+ plays a pivotal role in ameliorating BBB disruption via a number of mechanisms during certain neurological diseases. These cells contain many mitochondria, but harbour very few caveola (pinocytotic vesicles) in their luminal surfaces. It's a quick and effective first aid for boils, carbuncles and whitlows. The present study shows that majority of 16% and 80% participants had pain along the pathway in MSG and HPA groups respectively, followed by 44% and 20% pain in cannula insertion site in MSG and HPA groups respectively. In addition, treatment of human endothelial cells with magnesium has induced reduction of cellular pro-oxidant levels and diminished the release of pro-inammatory cytokines (Wolf et al., 2008). Take magnesium sulphate granules and mix it with glycerine using one finger (20 gm MgSO4: 100 ml Glycerine ratio). Aquaporin (AQP)-4, a bidirectional transmembrane water channel expressed mainly in astrocytes and to a lesser extent in barrier type of endothelial cells and pial membranes, may play a crucial role in the pathogenesis of cytotoxic and vasogenic brain edema and aggravation/resolution of ischemic and traumatic brain edema (Amiry- Moghaddam et al., 2003; Zador et al., 2009). Epsom salt is one of many naturally occurring mineral salts, a compound of magnesium and sulfate in rock-like formations. The impairment of BBB integrity during sepsis has been shown in several studies, and magnesium administration in the early stages of sepsis reduced BBB permeability and brain edema (Papadopoulos et al., 2005; Esen et al., 2005). It is also useful in providing the relief from pain, minor irritation and sore throat. The passage of many circulating substances from the capillary bed into the brain parenchyma is tightly controlled by physical and enzymatic barriers provided by the endothelial cells of capillaries in the brain parenchyma (Abbott et al., 2010; Cardoso et al., 2010). In pathological conditions with BBB impairment, Mg2+ passes into the extracellular compartment of the brain in significantly higher concentrations and plays an important role in the pathophysiological processes that follow BBB disruption. Feng DF, Zhu ZA, Lu YC. A study conducted in India by Saini [23] found grade 2 or mild phlebitis (46%) higher than grade 3 or moderated (44%) phlebitis. More studies could be conducted on the large sample and using other forms of products. Guo S, Lo EH. Libien J, Sacktor TC, Kass IS. All absorbent dressings maintain moist wound environment but dressings like hydrogel and glycerin magnesium sulphate provide direct moisture to the wound. Effect of magnesium given 1 hour after head trauma on brain edema and neurological outcome. Effectiveness of Magnesium Sulphate with Glycerin Dressing versus Heparinoid Ointment Application on Management of Phlebitis among Patients Admitted in Selected Wards of BPKIHS. ALL comments that are not spam will be published on the website. Role of excitatory amino acids in regulation of rat pial microvasculature. The average score was reduced on post-treatment score in both groups. Papierkowski A, Pasternak K. The effect of a single dose of morphine and ethanol on magnesium level in blood serum and tissues in mice. Mg2+ acts as a regulatory cation at the systemic and cellular levels, and participates in almost all anabolic and catabolic processes in the body. Table 7. A study conducted by Cicoloni33 also found first degree thrombophlebitis to be the highest (84.4%). In addition, a number of molecules are transported across the BBB by other mechanisms including carrier- and receptor-mediated transport, adsorptive-mediated endocytosis and fluid phase-mediated endo- cytosis (Loscher and Potschka, 2005; Pardridge, 2007). Magnesium as a regulatory cation: criteria and evaluation. She was managed conservatively with analgesics, limb elevation, and glycerin magnesium sulfate dressing. Phlebitis is the most common complication of intravenous therapy. Chi-square test was then applied to show association between dependent and independent variables. However, a variety of pathological conditions, such as sepsis, multiple sclerosis and epilepsia disrupt the BBB integrity and lead to the development of brain edema. Data was entered in MS Excel with the help of concerned people, guide and co-guide. After every application of intervention the posttest level of phlebitis was assessed by using the VIP scale. In this study, the instruments baseline performa and observation scale were used. Liu X, Hunter C, Weiss HR, Chi OZ. Can Help Improve Blood Sugar . Regulation of cellular magnesium. In glycerine magnesium sulphate group after the initial assessment a dressing with glycerine magnesium sulphate paste soaked on a sterile gauze pad was applied over the site The finding of the study is consistent with others studies. groups. a = Mann-Whitney U Test; b = Kruskal Wallis Test. Bruises, and sprains associated with muscle and joint injuries. The reason behind this may be due to the fact that IV drugs, KCL causes chemical reaction to the endothelium which resultant phlebitis. Background: Phlebitis is the inflammation of the tunica intima of the vein. Ageing, hippocampal synaptic activity and magnesium. Glycerin can be made from natural products such as vegetable oil, or can be synthesized from propylene alcohol. Dysfunctional cell-cell signaling in the neurovascular unit as a paradigm for central nervous system disease. Key Ingredients: Dried magnesium sulfate Topical glycerine Topical phenol Key Benefits: [. in Christian Medical College and Hospital, Ludhiana, Punjab among 60 subjects (30 with Heparinoid and 30 with Ichthammol Glycerine applications with matching age, gender and type of disease condition) reported that both the applications were effective in reducing IV induced phlebitis [11]. However there are no more studies to support this finding. Finally, alterations in endothelial cells, which are protagonists in the vascular changes during inflammation, are reversible upon magnesium supplementation (Mazur et al., 2007). along the nein and swelling. If left untreated may lead to infection or thrombus formation. Although the effects of magnesium on BBB characteristics and the formation of brain edema in various pathophysiological conditions has not been thoroughly elucidated, the studies mentioned above suggest that magnesium provides protective effects on BBB integrity and reduces brain edema by more than one mechanism (Figure 1). Out of 100 hospitalized patients at any given time, 7 in developed and 10 in developing countries will acquire at least one health care-associated infection [6]. The average score has been reduced on post r score in both groups score. A Study conducted by Yamber on 30 ICU patients in Karnataka, reported that application of Glycerin with magnesium sulphate is more effective than heparinbenzyl nicotinate (thrombophob) ointment at 0.05 level of significant (t = 2.301) on management of cannula induced thrombophlebitis [13]. Among the other events associated with Mg2+ deficiency in brain are opening of Ca2+ channels, cellular entry of Ca2+, release of certain neurotransmitters, activ- ation of NMDA receptors, membrane oxidation and activation of nuclear factor kappa B (NFKB) (Weglicki et al., 1994; Altura et al., 2003; Billard, 2006; Rayssiguier et al., 2010). Magnesium sulphate treatment decreases blood brain barrier permeability during acute hypertension in pregnant rats. In a study involving a total of 21 patients with normal- pressure hydrocephalus, a slight plasma-like protein pattern has been demonstrated in CSF in 38% of the patients prior to surgical intervention, indicating BBB dysfunction (Wikkels and Blomstrand, 1982). Approximately 90% participants among both groups cannula were inserted frequently which was more than twice among them majority of 92% and 84% in MSG and HPA groups respectively. 1. Besides, the alterations in the Mg2+ concentration in intra- and extracellular fluids are associated with development or aggravation of BBB disruption and brain edema in various clinical disorders and experimental settings. This topic discusses on the main findings of the present study and these are discussed with regards to findings of other relevant studies. Edema in foot and ankle. Another similar study conducted by Thomas [26] to evaluate the prevalence of Phlebitis and Comparison of the Effectiveness of Topical Ichthammol Glycerin and Heparinoid application on Phlebitis among 90 patients in Christian Medical College, Vellore reported that the prevalence of phlebitis was 26.07% for the time period of six weeks whereas Ichthammol glycerin was more effective than Heparinoid application based on the observation at 12 hours and 24 hours, both were found to be equally effective at 48 hours of the observation. Lee MS, Wu YS, Yang DY, Lee JB, Cheng FC. Table 8 shows there is no association between the phlebitis severity score of the both groups and demographical variables. Glycerin Enema Generic name: Glycerin Enema [ GLIS-er-in ] Brand names: Fleet, Fleet Babylax Drug class: Laxatives Medically reviewed by Drugs.com. Ravishankar S, Ashraf QM, Fritz K, Mishra OP, Delivoria-Papadopoulos M. Expression of Bax and Bcl-2 proteins during hypoxia in cerebral cortical neuronal nuclei of newborn piglets: effect of administration of magnesium sulfate. Musso CG. Edema and brain trauma. Based on the findings of the study, both magnesium sulphate with glycerin dressing and heparinoid ointment application were effective in management of peripheral cannula induced phlebitis (p < 0.001) but among them the mean VIP score is more in MSG group as compared with that of HPA group so magnesium sulphate with glycerin was more effective. Take thin layer of gauze piece and soak it in the solution just made 3. In animal models, magnesium treatment has been shown to contribute to the protection of the BBB during eclampsia, to decrease the increased BBB permeability, and to prevent the development of brain edema in certain experimental settings, including acute hypertension and hypoglycemia- induced seizures (Kaya et al., 2001 and 2004; Euser et al., 2008). to be significant. The blood-brain barrier (BBB) is composed mainly of brain capillary endothelial cells and represents a dynamic structure that regulates the trafficking of molecules between blood and brain tissue. Results: The study findings revealed significantly reduction of phlebitis score after 48 hours of treatment with both interventions. In contrast to the animal studies mentioned above, McKee and colleagues (McKee et al., 2005) described the functional characteristics of the BBB in patients with TBI by using MgSO4 infusions initiated at an average of 5 days after injury. Magnesium sulphate decreases the limb edema. Magnesium in the Central Nervous System [Internet]. Ionized magnesium (Mg2+) is a crucial cofactor that plays an essential role within the cell and regulates a variety of biochemical reactions. Magnesium sulphate with glycerin dressing was used by using soaked gauze pieces. The grading of severity of phlebitis was done based on scores obtained by using VIP scale. Informed (verbal and written) consent was taken from each participant. Decline in intracellular free Mg2+ concentration reduces ATP synthesis, and utilization in the maintenance of ion gradients via the Na+-K+ ATPase (Grubbs and Maguire, 1987). The guideline for the prevention of catheter-related infections has been developed for practitioners who insert catheters and for those who are responsible for surveillance and control of infections in the hospital, the outpatient, and home healthcare settings [8]. Susanna, Sr. Winnifred D'Souza(2014), Malarvizhi, to identify the effectiveness of fresh aloevera and glycerin magnesium sulphate application on phlebitis among children.. Further the study demonstrates that there is a statistically significant difference in phlebitis score (VIP score) in both experimental groups MSG and HPA groups after comparison baseline within 8,16,32,40, 48 hours of administration of intervention (P = 0.05). Similarly, Cicolini found that thrombophlebitis and catheter size was statistically significant [19]. Acute and chronic ethanol treatment gives rise to significant increases in BBB permeability to a variety of molecules that do not normally cross the BBB. Transient receptor potential melastatin 6 and 7 channels, magnesium transport, and vascular biology: implications in hypertension. Cytokines, neuropeptides, and reperfusion injury during magnesium deficiency. Table 1 shows surprisingly 47 years was the mean age of respondents in both. Passive diffusion across the BBB mainly depends on the lipid solubility and molecular weight of molecules. The tool consisted of the following items. Rayssiguier Y, Libako P, Nowacki W, Rock E. Magnesium deficiency and metabolic syndrome: stress and inflammation may reflect calcium activation. Hoane MR. Assessment of cognitive function following magnesium therapy in the traumatically injured brain. review as permitted under the Copyright Act, no part may be reproduced, stored in a retrieval system, or Peripheral magnesium sulfate enters the brain and increases the threshold for hippocampal seizures in rats. No complication was observed, healing was faster and reduced hospital stay. Where you type create something beautiful! Nonetheless, many researchers have highlighted the advantages of using smaller size catheters than larger size catheter. Fisher M. Pericyte signaling in the neurovascular unit. Salem M, Kasinski N, Munoz R, Chernow B. Part I: It consists of socio-demographic characteristics of the participants. The finding is consistent with the study by da Shiva32 where they found that, phlebitis incidence was more frequent in the veins of small calibers on the dorsum of the hand and in the median anti-brachial vein. Hallak M, Berman RF, Irtenkauf SM, Evans MI, Cotton DB. Matsui T, Kobayashi H, Hirai S, Kawachi H, Yano H. Magnesium deficiency stimulated mRNA expression of tumor necrosis factor-a in skeletal muscle of rats. Most 38 (76%) of the participants were cannulated with less than and equal to 20 G cannula Frequency of cannula insertion was more than and equal to second time of nearly 90% among both groups. Effects of blockade of ionotropic glutamate receptors on blood- brain barrier disruption in focal cerebral ischemia. They identified that the higher frequency for complication was found in the age group of 30 to 60 years old [15]. The latter can be the water absorption paper towel, gauze, or medical using dressing. Nevertheless, under normal conditions, BBB function is regulated primarily by capillary endothelial cells (Fisher, 2009; Abbott et al., 2010). without the prior written permission. Despite its name, Epsom salt is a completely different compound than table salt . The present study demonstrates that there is a statistically significant difference in VIP score among the participants in magnesium sulphate with glycerin group and heparinoid ointment groups after each intervention (P < 0.05). Table 6 demonstrates that there is a statistically significant difference in VIP score among the participants in magnesium sulphate with glycerin group and heparinoid ointment groups after each intervention (P < 0.05). They also had significantly higher levels of edema and hemorrhages. Romani AM. Molecular biology of the blood- brain-barrier. Similarly, medium stage or moderate phlebitis was observed in 28 (56%) of the participants as scored by 3 among both groups out of them 44% and 68% in MSG and HPA groups respectively. About 95% of the microvessels in the brain display BBB properties, and almost every neuron is estimated to be nourished by a distinct capillary vessel (Pardridge, 2005). In both physiological and pathological conditions, Mg2+ can directly influence BBB properties. Vink R, McIntosh TK, Demediuk P, Weiner MW, Faden AI. Upreg- ulation of AQP-4 in brain injury leads to an increase in brain water content, resulting in brain edema (Taniguchi et al., 2000; Papadopoulos and Verkman, 2005) and treatment with magnesium causes the down-regulation of AQP-4 (Ghabriel et al., 2006) and thereby attenuates brain edema (Okiyama et al., 1995). Mg2+ has also been shown to reduce brain edema and protect brain morphology in experimental cold-injury by inhibition of lipid peroxidation (Turkoglu et al., 2008). Take magnesium sulphate granules and mix it with glycerine using one finger (20 gm MgSO4: 100 ml Glycerine ratio), 2. Taniguchi M, Yamashita T, Kumura E, Tamatani M, Kobayashi A, Yokawa T, Maruno M, Kato A, Ohnishi T, Kohmura E, Tohyama M, Yoshimine T. Induction of aquaporin-4 water channel mRNA after focal cerebral ischemia in rat. Role of brain [Mg2+]i in alcohol-induced hemorrhagic stroke in a rat model: a 31P-NMR in vivo study. Association between socio-demographic variables and severity score (n = 50). Directions for administration Directions for administration For glycerol with magnesium sulfate and phenol. Weglicki WB, Mak IT, Kramer JH, Dickens BF, Cassidy MM, Staord RE, Phillips TM. Meanwhile, magnesium decient rats are more susceptible to cerebral hypoxia/ ischemia than rats fed with a normal or high magnesium diet (Demougeot et al., 2004). An alpha- syntrophin-dependent pool of AQP4 in astroglial end- feet confers bidirectional water flow between blood and brain. Add your e-mail address to receive free newsletters from SCIRP. Under certain pathological conditions, such as traumatic brain injury (TBI), cerebral ischemia and acute hypertension, thebrain edema, which is initially cytotoxic, acquires a vasogenic character in the following stages. Types of illness, days of hospital stay, cannula insertion site, size of cannula and frequency of insertion shows no statistical significance so both groups are homogenously significant with P-value of (0.05). Brain intracellular and extracellular Mg2+ concentrations, as well as serum Mg2+ levels, are decreased following central nervous system injury and a decline of Mg2+ concentration in brain can further increase the severity of BBB disruption and be a critical factor in the development of irreversible tissue damage (Vink et al., 1987; Vink and Cernak, 2000; Vink et al., 2009). It is also used as a soaking solution to relieve minor sprains, bruises, muscle aches or discomfort, joint stiffness or soreness, and tired feet. Frequent monitoring of cannula site, early identification of cannula induced phlebitis and prompt intervention is essential for treatment and prevention of further complication. The present study shows there is no association between socio-demographic variables which included age, gender, marital education and educational level with severity score which include after complete interventions scores (8, 16, 24, 32, 40, 48 hours) of participants in both experimental groups. However this finding is contradictory to the finding of other studies. Last updated on Dec 17, 2022. Comment all you like here! But finally after comparison, Ichthammol glycerin was found as more effective for the management of phlebitis. However, many pathological conditions alter the functional and structural characteristics of the BBB impairing the maintenance of neural homeostasis. . Apart from any fair dealing for the purposes of private study, research, criticism or It shows that there is more reduction of VIP score in Magnesium Sulphate with Glycerin (MSG) group. Authors: Kondireddy Suhas No full-text available Impact of isotonic and hypertonic saline. Syndrome: stress and inflammation may reflect calcium activation level of phlebitis was assessed using! ; Epsom salt is a crucial cofactor that plays an essential role within the and..., Dickens BF, Cassidy MM, Staord RE, Phillips TM of! Old-Fashioned remedy for infections of the tunica intima of the BBB mainly depends the! Lee JB, Cheng FC hour after head trauma on brain edema and hemorrhages age of respondents both... Gauze, or can be the highest ( 84.4 % ) participants received intravenous drugs Kramer JH, Dickens,! 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Score ( n = 50 ) sulfate therapy is of mild benefit to young rats with kaolin-induced hydrocephalus exact of!, magnesium transport, and glycerin magnesium magnesium sulfate and phenol glycerin magnesium sulphate dressing for edema it. Better known as Epsom salts is a completely different compound than table salt tissues and thereby prevent to... A = Mann-Whitney U Test ; b = Kruskal Wallis Test help of concerned people, guide and.!