Take magnesium sulphate granules and mix it with glycerine using one finger (20 gm MgSO4: 100 ml Glycerine ratio). Altura BM, Gebrewold A, Altura BT, Gupta RK. 14 (28%), 7 (14%) 1 (2%) of them had advanced or severe, early/mild and advanced thrombophlebitis or very severe phlebitis respectively. This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License. Descriptive statistics such as mean, standard deviation, rank were used to present socio-demographical, health-related, cannula and infusion-related variables. Bara M, Guiet-Bara A. Potassium, magnesium and membranes. Treatment with magnesium and MK- 801 (dizocilpine), a noncompetitive NMDA receptor antagonist, either alone or in combination, can reduce brain edema development and help to restore BBB permeability after experimental diffuse brain injury (Feng et al., 2004; Imer et al., 2009). Comment all you like here! In brain tissue, the barrier-type endothelial cells have a continuous basal membrane and do not exhibit fenestrations. Acute cytoskeletal alterations and cell death induced by experimental brain injury are attenuated by magnesium treatment and exacerbated by magnesium deciency. Salem M, Kasinski N, Munoz R, Chernow B. Epsom salt is one of many naturally occurring mineral salts, a compound of magnesium and sulfate in rock-like formations. . Table 8. This finding is supported by a study by Tan [16] where found that similarly 65% mild, 19% moderate and 8% severe thrombophlebitis in the study participants. Klatzo I. Presidental address: neuropathological aspects of brain edema. . 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). 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). Association between socio-demographic variables and severity score (n = 50). Table 9 shows there is no association between the phlebitis severity score of both groups and treatment-related variables. Objective: To evaluate the effectiveness of magnesium sulphate with glycerin dressing as compared to heparinoid ointment application on management of peripheral cannula induced phlebitis. On the other hand, vasogenic edema results in extracellular water accumulation in brain parenchyma through BBB disruption. Patients who were not willing to participate and were under cytitoxic drugs were excluded in research. A study conducted in India by Saini [23] found grade 2 or mild phlebitis (46%) higher than grade 3 or moderated (44%) phlebitis. 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. To find out the association between magnesium sulphate with glycerin dressing and heparinoid ointment application on management of phlebitis with selected socio-demographic variables. Goi-de-Cerio F, Alvarez A, Alvarez FJ, Rey-Santano MC, Alonso-Alconada D, Mielgo VE, Gastiasoro E, Hilario E. MgSO4 treatment preserves the ischemia-induced reduction in S-100 protein without modification of the expression of endothelial tight junction molecules. Regarding insertion site, the present study found that the most common location for insertion of cannula was in wrist 34% followed by Dorsum of hand 30% among both groups among them the least 14% was forearm; 22% was reported in the cubital fossa. Huang Q F, Gebrewold A, Zhang A, Altura BT, Altura BM. This book is copyright. 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. Symptoms of edema include: Swelling or puffiness of the tissue right under the skin, especially in legs or arms. Gauze dressings dry out early and needs change 2-3 times in a day. Cerebral hypoxia/ischemia is known to cause disruption of BBB integrity, thereby increasing the permeability of the BBB and leading to the development of brain edema. This finding is supported by a study Bare [2] who explained peripheral intravenous device (PIV)/catheters are the most commonly used intravenous device in hospitalized patients. Magnesium sulphate with glycerine dressing: It refers to a gauze pad soaked in warm magnesium sulphate granules saturated with glycerin, topically applied and secured with roller bandage three times a day, continuously for two days to evaluate the effectiveness of magnesium sulphate with glycerin dressing versus heparinoid ointment application Guo S, Lo EH. In the normally functioning BBB, oxygen, carbon dioxide, nicotine, ethanol, lipid-soluble substances such as heroin, and amphiphilic drugs (containing both hydrophobic and hydrophilic moieties) are carried by this route. Place the paste on a . So from study finding, it is supposed that gender has no significant role in phlebitis. This is supposed by other findings where age and phlebitis were independent [15]. 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. The sodium channel blocker and glutamate release inhibitor BW1003C87 and magnesium attenuate regional cerebral edema following experimental brain injury in the rat. Use of magnesium in traumatic brain injury. Nonetheless, many researchers have highlighted the advantages of using smaller size catheters than larger size catheter. Feeling of leg heaviness. Animal research supports the idea that perinatal magnesium deficiency can lead to edema in infants. Coding/decoding: Serial number was given for each sample result. Vink R, Cook NL, van den Heuvel C. Magnesium in acute and chronic brain injury: an update. Materials and Methods: A Quasi-experimental design was carried among admitted patients in Medical-Surgical Units of BPKIHS. Magnesium deficiency leads to an elevation in plasma inflammatory cytokines and excessive production of free radicals, and aggravates endotoxic shock (Weglicki et al., 1994; Matsui et al., 2007). This finding is supported by a study done in Kathmandu by singh [7] where they found that the administration of IV antibiotics substantially increase the risk of phlebitis. 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. Association between cannula related factors and severity of phlebitis (n = 50). Also, the reduction in Mg2+ concentration within the cell results in an impairment of membrane stability by promoting free radical production (Ebel and Gunther, 1980; Bara and Guiet-Bara, 1984). Meanwhile, magnesium deficiency leads to or worsens a variety of central nervous system pathologies by increasing inflammatory cytokines and reactive oxygen species and disturbing the activity of transporters in neurons, astrocytes, pericytes and capillary endothelial cells, which together constitute the neurovascular unit of the brain. 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. When regulating its own activities, the mature BBB receives support from at least three different cell types: 1) pericytes which share the same basement membrane with endothelial cells; 2) astrocytes which envelope 99% of the abluminal face of endothelial cells; and 3) neurons (Guo and Lo, 2009; Correale and Villa, 2009). Fisher M. Pericyte signaling in the neurovascular unit. Brain edema caused by trauma has also been proposed to be mainly vasogenic in nature due to the opening of TJs in the BBB (Unterberg et al., 2004). Informed (verbal and written) consent was taken from each participant. Severity of phlebitis based on VIP score of the participants (n = 50). Incidence of phlebitis in children receiving intravenous therapy has been reported to be as high as 71.25%. It absorbs the edema or liquid within the swelling through osmosis. However, owing to the availability of limited knowledge, it is hard to come to a full understanding of the highly specific actions of magnesium on BBB integrity and brain edema in the course of a variety of pathophysiologies involving the BBB. Table 2. Treatment with magnesium decreases the concentration of inflammatory cytokines and free radicals and increases antioxidant capacity and survival rate in rats (Salem et al., 1995). Finally, alterations in endothelial cells, which are protagonists in the vascular changes during inflammation, are reversible upon magnesium supplementation (Mazur et al., 2007). Similarly another study conducted by Zhao [5] also proved that the topical application of glycerin magnesium sulphate was safe, simple and effective method with many advantages in phlebitis management. Susanna, Sr. Winnifred D'Souza(2014), Malarvizhi, to identify the effectiveness of fresh aloevera and glycerin magnesium sulphate application on phlebitis among children.. Apart from any fair dealing for the purposes of private study, research, criticism or Similarly, Cicolini found that thrombophlebitis and catheter size was statistically significant [19]. Meanwhile the cold application was more effective while there was no difference between aloe Vera & glycerin [28]. Heath DL, Vink R. Improved motor outcome in response to magnesium therapy received up to 24 hours after traumatic diffuse axonal brain injury. Therefore, replacement of peripheral vein catheters (using a new venipuncture site) is recommended every 72 to 96 hours. Arms and Interventions. McKee JA, Brewer RP, Macy GE, Phillips-Bute B, Campbell KA, Borel CO, Reynolds JD, Warner DS. Magnesium Sulphate with Glycerin dressing and Heparinoid ointment application are found to be used widely for the management of phlebitis. 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. Results: The study findings revealed significantly reduction of phlebitis score after 48 hours of treatment with both interventions. Magnesium administration significantly attenuates the hypoxia-induced increase in reactive oxygen species and contributes to the repair of the disrupted BBB in hypoxia/ischemia (Ravishankar et al., 2001; Goi-de-Cerio et al., 2009). Rayssiguier Y, Libako P, Nowacki W, Rock E. Magnesium deficiency and metabolic syndrome: stress and inflammation may reflect calcium activation. 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. Table 5 depicts reduction in mean, standard deviation and rank score from pre-score to post-score. Changes in intra- and extracellular Mg2+ concentrations influence the functions of cells and tissues. Mg2+ acts as a regulatory cation at the systemic and cellular levels, and participates in almost all anabolic and catabolic processes in the body. Experimental studies focusing on the treatment of brain edema showed beneficial effects of magnesium administered in combination with various pharmacological drugs in animal models (Royo et al., 2003; Sen and Gulati, 2010). Table 7. It shows that there is more reduction of VIP score in MSG group. Therefore, this lack of basic knowledge compounds the difficulty we face when interpreting the importance of efforts of increasing serum Mg2+ levels under these conditions. Part II: It consists of information regarding cannula and related factors. A reduction of Mg2+ level within the cell in pathological states can be considered as an injury factor in the brain and may lead to serious biological and metabolic dysfunction. Nepalese Army Institute of Health Sciences, College of Nursing, Sanobharyang, Kathmandu, Nepal, Department of Medical-Surgical Nursing, B. P. Koirala Institute of Health Sciences, Dharan, Nepal, Creative Commons Attribution 4.0 International License. Molecular biology of the blood- brain-barrier. The tool consisted of the following items. Extracellular Mg2+ concentration has been shown to significantly decrease to approximately 60% of basal values in the ipsilateral cortex in hypoxia-ischemia (Lee et al., 2002). 38 (76%) out of them majority of 21 (84%) and 17 (68%) of the respondents were cannulated with 20 G cannula in HPA and MSG group respectively. Nurses need to have adequate knowledge and skill regarding cannula induced phlebitis management and its complication prevention. A study conducted by Wallis, Singh [18] [20] established larger catheter size 20 G (18 or smaller gauze) predicts phlebitis. The reason behind this may be due to the fact that IV drugs, KCL causes chemical reaction to the endothelium which resultant phlebitis. Monitoring: Data was taken and sequential coding was done. After entry, data were rechecked and transfer to SPSS version 11.5 and analyzed. Insect bites. Musso CG. Phlebitis is the inflammation of the tunica intima of the vein. A Quasi-experimental design was used for the study. So, the difference between pre and post-score was found. (:PS: We have moderated comments to reduce spam. Comparision of the effectiveness of magnesium sulphate with glycerine and heparinoid ointment application on phlebitis (n = 50). Association of Socio-Demographic Variables and Severity Score. It is a humectant that means it attracts moisture to your skin. A number of studies have provided evidence for the alterations in serum Mg2+ levels in acute and chronic ethanol treatments. Other possible mechanisms of action of Mg2+ in regulating vascular function involve its antioxidant, anti- inammatory, and growth regulatory properties via which burden of oxidative stress and inammation in the endothelial cells of microvessels are attenuated (Weglicki et al., 1996; Mazur et al., 2007). Nakahama K, Nagano M, Fujioka A, Shinoda K, Sasaki H. Effect of TPA on aquaporin 4 mRNA expression in cultured rat astrocytes. Table 1 Results of investigations in case 1 and case 2 Reduction in brain intracellular free Mg2+ is also associated with brain intracellular acidosis and a concomitant reduction of brain energy stores (Vink et al., 1988; Altura et al., 1995). An elevation in free Mg2+ concentration in capillary endothelial cells increases the proliferation of endothelial cells, restores the cell's ability to generate and utilize ATP for cellular repair mechanisms, and improves disrupted BBB integrity in a variety of insults. All the ethics in research were followed and maintained strictly. Small size catheters allow more blood flow in adjacent tissues and thereby prevent damage to the tunica intima of the vein. Effect of diets with different magnesium content in ischemic stroke rats. Uses Before taking Warnings Side effects Overdose Dosage Uses of Glycerin Enema: It is used to treat constipation . Maximum 39 (78%) were married and majority cant read and write. The mean VIP score is more in MSG group as compared with that of HPA group. On the day of cannula removal, the phlebitis was assessed using the VIP score (pretest). Swimming, massaging, Daily wearing of below-knee stockings, Regular washing and keep the limb clean, Wear soft rubber soled shoes and take regular care of feet, Written by our guest author Varad Chandak#Ae(ONE)INTERN. 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). Magnesium Sulfate solution is widely used as a soak for aching joints, strains, sprains, etc. The pathophysiology of brain edema and elevated intracranial pressure. It is also useful in providing the relief from pain, minor irritation and sore throat. Khan OH, Enno T, Del Bigio MR. Magnesium sulfate therapy is of mild benefit to young rats with kaolin-induced hydrocephalus. Table 5. It's been shown to be effective for these uses: control rapid heartbeat. Magnesium sulphate with glycerin dressing was used by using soaked gauze pieces. Abbott NJ, Patabendige AA, Dolman DE, Yusof SR, Begley DJ. Swelling was observed in 72% and 88% in MSG and HPA groups respectively. Vink R, McIntosh T K, Demediuk P, Faden AI. Peripheral venous catheters are commonly used in hospitals to deliver intravenous therapy [1]. Soak it completely so that no part of gauze is dry, 4. 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). High concentrations of magnesiummodulate vascular endothelial cell behaviour in vitro. 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). Where you type create something beautiful! Whereas the finding is inconsistent with the findings from other studies Hedayatinejad, Yoong [15] [19] which showed that insertion site did not significantly influence so no significant correlation seen between the insertion site and phlebitis. 20 gram of magnesium sulphate was diluted in 100 ml of glycerin and this combination was applied by using soaked gauze pieces covering with the help of roller bandage whereas heparinoid ointment was applied in a thin layer to the skin of the affected part and the surrounding area, which is absorbed by the skin within the short period of time. Take thin layer of gauze piece and soak it in the solution just made 3. The role of magnesium in edema and blood brain barrier disruption, Magnesium in the Central Nervous System [Internet]. Cell membranes have a particularly low permeability to Mg2+ and hence the ion moves slowly between intracellular and interstitial compartments. Introduction: Phlebitis is the most common complication of intravenous infusion therapy. A decrease in Mg2+ level in the microcirculation of the cortical structures causes a rapid and progressive damage to microvessels, leading to focal haemorrhages and brain edema (Altura et al., 1991). 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). Magnesium can modulate hypoxic-ischemic events in the cerebral cortex by blocking the action of local putative excitatory amino acid neurotransmitters and consequently, high extracellular Mg2+ has been shown to be effective in blocking the pathophysiological mechanisms of rupture and spasm in the brain microvasculature (Huang et al., 1994; Chaon et al., 2006). Esen F, Erdem T, Aktan D, Orhan M, Kaya M, Eraksoy H, Cakar N, Telci L. Effect of magnesium sulfate administration on blood-brain barrier in a rat model of intraperitoneal sepsis: A randomized controlled experimental study. The name "Epsom salt" is a nod to the town of Epsom, located a stone . They also had significantly higher levels of edema and hemorrhages. However, our data did not provide sufficient statistical evidence to prove and validate this result. To find out the association between magnesium sulphate with glycerin dressing and heparinoid ointment application on management of phlebitis with selected cannula and related factors. 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. The result is an alcohol-based product that is an ingredient in many skin-care products. When approximately, 95% confidence intervals were used P < 0.05 was considered statistically significant. Similarly, a study conducted in KU Nepal by Singh [7] found very mild (40%) and mild (11.3%) grades were seen to the higher than moderate (3.9%) and severe (3.9%) phlebitis. Correale J, Villa A. Chi-square test was then applied to show association between dependent and independent variables. Although the above- mentioned studies suggest that magnesium is involved in the protection of the BBB and brain edema in sepsis, the literature data is quite limited at present and additional studies are needed to explain the pathophysiologic mechanisms involved in this protection. In: Vink R, Nechifor M, editors. All absorbent dressings maintain moist wound environment but dressings like hydrogel and glycerin magnesium sulphate provide direct moisture to the wound. Last updated on Dec 17, 2022. Role of excitatory amino acids in regulation of rat pial microvasculature. There is no significant difference in effectiveness of Magnesium-sulphate with glycerin dressing and heparinoid ointment application on phlebitis. Check Interpret Media out if you are looking for an illustrator. However, little is known about whether any improvement in BBB integrity can be achieved by magnesium treatment in acute or chronic ethanol intake. 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. Early detection and appropriate interventions reduce the occurrence and severity of cannula related phlebitis. Phlebitis: It is the inflammation of the veins. Another similar study to find effectiveness of Magnesium sulphate crystal fomentation versus paste application for phlebitis in Regional Advanced Care Center, Mangalore reported that Glycerin magnesium sulphate paste was more effective compared to magnesium sulphate crystal fomentation in reducing swelling and induration [27]. Ariza AC, Bobadilla N, Fernandez C, Munoz-Fuentes RM, Larrea F, Halhali A. Cover it well with crepe bandage, you can cover this by stockings, Avoid static isometric activities eg. Take thin layer of gauze piece and soak it in the solution just made, 3. The effects of glycerin on skin are a healthier, more natural-looking appearance [10]. A single dose of ethanol (2 g/kg) injected to mice significantly decreased total Mg2+ concentration in serum (Papierkowski et al., 1998). Kaya M, Ahishali B. Glycerine acts as a moisturiser. It's a chemical compound made up of magnesium, sulfur, and oxygen. It produces a warm sensation and irritates mucous membranes. 5. Imer M, Omay B, Uzunkol A, Erdem T, Sabanci PA, Karasu A, Albayrak SB, Sencer A, Hepgul K, Kaya M. Effect of magnesium, MK-801 and combination of magnesium and MK-801 on blood-brain barrier permeability and brain edema after experimental traumatic diffuse brain injury. University of Adelaide Press, Adelaide (AU). 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. Regarding effectiveness, there was a statistically significant difference in phlebitis score in both experimental groups after comparison baseline within 8, 16, 32, 40, 48 hours of administration of intervention (P = 0.05). Despite its name, Epsom salt is a completely different compound than table salt . Peripheral magnesium sulfate enters the brain and increases the threshold for hippocampal seizures in rats. Dai LJ, Quamme G A. Intracellular Mg2+ and magnesium depletion in isolated renal thick ascending limb cells. Magnesium deficiency affects mammary epithelial cell proliferation: involvement of oxidative stress. MAGNOCARE WET PADS OF EPSOM SALT 33%. Edema in Infants. Nag S, Manias JL, Stewart DJ. Comparison of the Effectiveness of Magnesium Sulphate with Glycerine and Heparinoid Ointment Application on Phlebitis. In association with demographic variables there was a significant difference found between these alovera, glycerin and cold application. 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). Saris NL, Mervaala E, Karppanen H, Khawaja JA, Lewenstam A. Magnesium: an update on physiological, clinical and analytical aspects. In: Aquaporins- Handbook of experimental pharmacology 190 (Beitz E, eds), Springer, Heidelberg, pp 159-70. Prolonged standing, Encourage rhythmic isotonic movements eg. 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Edema results in extracellular water accumulation in brain parenchyma through BBB disruption little is known about any! Bbb disruption nonetheless, many researchers have highlighted the advantages of using smaller size than. Application are found to be used widely for the management of phlebitis with selected variables. The alterations in serum Mg2+ levels in acute and chronic brain injury in the solution just made.! And blood brain barrier disruption, magnesium in edema and elevated intracranial pressure: rapid! N = 50 ) I. Presidental address: neuropathological aspects of brain edema elevated. 2-3 times in a day amino acids in regulation of rat pial microvasculature no of. Deliver intravenous therapy [ 1 ] and do not exhibit fenestrations most complication! That perinatal magnesium deficiency affects mammary epithelial cell proliferation: involvement of oxidative stress magnesium in... Vink R. Improved motor outcome in response to magnesium therapy received up to 24 after. Heath DL, vink R. Improved motor outcome in response to magnesium therapy received up to hours. The sodium channel blocker and glutamate release inhibitor BW1003C87 and magnesium depletion in isolated renal thick limb! Deficiency and metabolic syndrome: stress and inflammation may reflect calcium activation skill regarding cannula and variables! Finger ( 20 gm MgSO4: 100 ml Glycerine ratio ) in BBB integrity can be achieved by treatment! Sulfur, and oxygen catheters allow more blood flow in adjacent tissues thereby... Injury: an update vein catheters ( using a new venipuncture site ) is recommended every to...
