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Journal of Semnan University of Medical Sciences

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Cover image of the article: Comparison of topical Rosemary and Nitroglycerine ointment effects on the incidence of phlebitis due to peripheral catheterization in hospitalized children (AI-generated illustration)

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Outline

https://doi.org/10.69107/koomesh-158690

Comparison of topical Rosemary and Nitroglycerine ointment effects on the incidence of phlebitis due to peripheral catheterization in hospitalized children

Authors

Fatemeh Ahmadi Fakhrabadi1, Majid KazemiMajid Kazemi ORCID2,*, Hadi HasaniHadi Hasani ORCID3, Hamid Ostadebrahimi4, Somayeh NejadbagheriSomayeh Nejadbagheri ORCID5
1Department of Medical Surgical Nursing, School of Nursing and Midwifery, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
2Non-communicable Disease Research Center,, Faculty of Nursing and Midwifery, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
3Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
4School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
55Department of Nursing, School of Nursing and Midwifery, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
*Corresponding Author: Faculty of Nursing and Midwifery, Non-Communicable Disease Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran Email: maj_kaz@yahoo.com
Koomesh:Vol. 28, issue 3; e158690
Published online:Sep 08, 2026
Article type:Research Article
How to Cite:Ahmadi Fakhrabadi F, Kazemi M, Hasani H, Ostadebrahimi H, Nejadbagheri S. Comparison of topical Rosemary and Nitroglycerine ointment effects on the incidence of phlebitis due to peripheral catheterization in hospitalized children. Koomesh. 2026;28(3):e158690. doi: https://doi.org/10.69107/koomesh-158690

Abstract

Background and aim: Phlebitis is a common complication associated with the use of intravenous catheters in children. This study aimed to compare the topical effects of rosemary ointment and nitroglycerin ointment on the time to onset of phlebitis caused by intravenous cannulation in children in 2020. Materials and Methods: This prospective double-blind randomized clinical trial was conducted on 144 pediatric patients hospitalized in the pediatric ward of Shahid Sadoughi Hospital. Based on the inclusion criteria, participants were selected and randomly assigned to intervention and control groups using block randomization. After catheter insertion, the intervention groups received either 0.5 cc of rosemary ointment or nitroglycerin ointment (2.5 mg), while the control group received 0.5 cc of Eucerin ointment applied to the proximal site of the catheter. The catheter insertion site was monitored every 12 hours for up to 72 hours for signs of phlebitis, and ointments were cleaned and reapplied every 24 hours. The maximum catheter retention time in all groups was 72 hours. Phlebitis was diagnosed and the catheter was removed if at least two signs were present or if a minimum of grade 2 was reached on the Visual Infusion Phlebitis Assessment Scale (VIPAS). Results: Catheter survival time significantly differed between the intervention and control groups. The mean time to phlebitis occurrence was 29.14 hours in the control group, 40.10 hours in the rosemary group, and 41.06 hours in the nitroglycerin group. This indicates that the mean phlebitis onset was delayed by 10.96 hours in the rosemary group and 11.92 hours in the nitroglycerin group compared to the control group. The incidence of phlebitis after 72 hours was 87.5% in the rosemary group, 89.6% in the nitroglycerin group, and 97.9% in the control group. Fisher’s exact test showed no significant differences in phlebitis frequency among the three groups at 72 hours (P = 0.154). Conclusion: The findings indicated that the use of rosemary and nitroglycerin significantly prolonged the onset time of phlebitis, thereby delaying its occurrence compared to the control group, while no statistically significant difference was observed between the two interventions.

 

KeywordsPhlebitisLength of StayRosmarinusChildNitroglycerinCatheterization

References

  • 1.
    Naik VM, Mantha SSP, Rayani BK. Vascular access in children. Indian J Anaesth. 2019;63(9):737–45. [PubMed ID:31571687]. [PubMed Central ID:PMC6761776]. https://doi.org/10.4103/ija.IJA_489_19.
  • 2.
    Sarafzadeh F, Sepehri G, Yazdizadeh M. [Evaluation of the severity of peripheral intravenous catheter related phlebitis during one year period in an Iranian educational hospital, Kerman, Iran]. Annals Biol Res. 2012;3:4741–6. Persian.
  • 3.
    Al Sofyani K, Julia G, Abdulaziz B, Yves CJ, Sylvain R. Ultrasound guidance for central vascular access in the neonatal and pediatric intensive care unit. Saudi J Anaesth. 2012;6(2):120–4. [PubMed ID:22754436]. [PubMed Central ID:PMC3385252]. https://doi.org/10.4103/1658-354X.97023.
  • 4.
    Tork-Torabi M, Namnabati M, Allameh Z, Talakoub S. Vancomycin Infusion Methods on Phlebitis Prevention in Children. Iran J Nurs Midwifery Res. 2019;24(6):432–6. [PubMed ID:31772917]. [PubMed Central ID:PMC6875886]. https://doi.org/10.4103/ijnmr.IJNMR_149_18.
  • 5.
    Andriyani R, Satari HI, Amalia P. Duration of peripheral intravenous catheter use and development of phlebitis. Paediatrica Indonesiana. 2013;53(2). https://doi.org/10.14238/pi53.2.2013.117-20.
  • 6.
    Bahramsari J, Kazemi M, Nasrollah nezahad A, Sadeghi T. [Effect of topical rosemary ointment on the phlebitis and peripheral vascular catheter infection in children]. Koomesh J. 2021;23(5):665–71. Persian. https://doi.org/10.52547/koomesh.23.5.665.
  • 7.
    Akbari H, Raufi S, Anbari K. [Comparaing the effect of nitroglycerin and clobetazol ointments on prevention of superficial intravenous catheter induced phlebitis]. Evidence Based Care. 2014;4(1):71–80. Persian.
  • 8.
    Webster J, McGrail M, Marsh N, Wallis MC, Ray-Barruel G, Rickard CM. Postinfusion Phlebitis: Incidence and Risk Factors. Nurs Res Pract. 2015;2015:691934. [PubMed ID:26075092]. [PubMed Central ID:PMC4446485]. https://doi.org/10.1155/2015/691934.
  • 9.
    Hedayatinejad M, Fayazi S, Jahani S, Sakimalehi A, Hedayatinejad E. Survey of Complications of Peripheral Venous Catheterization at an Intensive Care Unit of (ICU) of Susa City. Jentashapir J Health Res. 2016;7(5). https://doi.org/10.17795/jjhr-33783.
  • 10.
    Palese A, Ambrosi E, Fabris F, Guarnier A, Barelli P, Zambiasi P, et al. Nursing care as a predictor of phlebitis related to insertion of a peripheral venous cannula in emergency departments: findings from a prospective study. J Hosp Infect. 2016;92(3):280–6. [PubMed ID:26792683]. https://doi.org/10.1016/j.jhin.2015.10.021.
  • 11.
    Nascimento J, Silva MGd, Fernandes JIDS, Galvão VTLS, Messias CM. Nursing Care in Peripheral Intravenous Catheterization in Hospitalized Children: Integrative Review. Texto Contexto - Enfermagem. 2022;31. https://doi.org/10.1590/1980-265x-tce-2021-0300.
  • 12.
    Karaoglan N, Sari HY, Devrim I. Complications of peripheral intravenous catheters and risk factors for infiltration and phlebitis in children. Br J Nurs. 2022;31(8):S14–S23. [PubMed ID:35439080]. https://doi.org/10.12968/bjon.2022.31.8.S14.
  • 13.
    Yasuda H, Rickard CM, Marsh N, Yamamoto R, Kotani Y, Kishihara Y, et al. Risk factors for peripheral intravascular catheter-related phlebitis in critically ill patients: analysis of 3429 catheters from 23 Japanese intensive care units. Ann Intensive Care. 2022;12(1):33. [PubMed ID:35394571]. [PubMed Central ID:PMC8994002]. https://doi.org/10.1186/s13613-022-01009-5.
  • 14.
    Garcia-Exposito J, Sanchez-Meca J, Almenta-Saavedra JA, Llubes-Arria L, Torne-Ruiz A, Roca J. Peripheral venous catheter-related phlebitis: A meta-analysis of topical treatment. Nurs Open. 2023;10(3):1270–80. [PubMed ID:36335576]. [PubMed Central ID:PMC9912403]. https://doi.org/10.1002/nop2.1449.
  • 15.
    Guanche-Sicilia A, Sanchez-Gomez MB, Castro-Peraza ME, Rodriguez-Gomez JA, Gomez-Salgado J, Duarte-Climents G. Prevention and Treatment of Phlebitis Secondary to the Insertion of a Peripheral Venous Catheter: A Scoping Review from a Nursing Perspective. Healthcare (Basel). 2021;9(5). [PubMed ID:34069674]. [PubMed Central ID:PMC8160666]. https://doi.org/10.3390/healthcare9050611.
  • 16.
    Sarani Ali Abadi P, Etemadi S, Abed Saeedi Z. [Investigating role of mechanical and chemical factors in the creation of peripheral vein in flammarion in hospitalization patients in hospital in Zahedan, Iran]. Life Sci J. 2013;10(1s). Persian.
  • 17.
    Mihala G, Ray-Barruel G, Chopra V, Webster J, Wallis M, Marsh N, et al. Phlebitis Signs and Symptoms With Peripheral Intravenous Catheters: Incidence and Correlation Study. J Infus Nurs. 2018;41(4):260–3. [PubMed ID:29958263]. https://doi.org/10.1097/NAN.0000000000000288.
  • 18.
    Suliman M, Saleh W, Al-Shiekh H, Taan W, AlBashtawy M. The Incidence of Peripheral Intravenous Catheter Phlebitis and Risk Factors among Pediatric Patients. J Pediatr Nurs. 2020;50:89–93. [PubMed ID:31785409]. https://doi.org/10.1016/j.pedn.2019.11.006.
  • 19.
    Goff DA, Larsen P, Brinkley J, Eldridge D, Newton D, Hartzog T, et al. Resource utilization and cost of inserting peripheral intravenous catheters in hospitalized children. Hosp Pediatr. 2013;3(3):185–91. [PubMed ID:24313085]. https://doi.org/10.1542/hpeds.2012-0089.
  • 20.
    Liu C, Chen L, Kong D, Lyu F, Luan L, Yang L. Incidence, risk factors and medical cost of peripheral intravenous catheter-related complications in hospitalised adult patients. J Vasc Access. 2022;23(1):57–66. [PubMed ID:33302797]. https://doi.org/10.1177/1129729820978124.
  • 21.
    Marsh N, Larsen EN, Ullman AJ, Mihala G, Cooke M, Chopra V, et al. Peripheral intravenous catheter infection and failure: A systematic review and meta-analysis. Int J Nurs Stud. 2024;151:104673. [PubMed ID:38142634]. https://doi.org/10.1016/j.ijnurstu.2023.104673.
  • 22.
    Kazemi M, Sabzevari S, Mohamad Alizadeh S, Razavi SE. [Survey of effectiveness of nitroglycerine ointment on onset of phlebitis due to peripheral catheterization in hospitalized patients at internal and surgical wards]. J Kerman Univ Med Sci. 1996;3(3):123–8.
  • 23.
    Wagh D, Pawale D, Tan JKG, Rao SC. Local nitroglycerin to facilitate peripheral arterial cannulation in children: systematic review and meta-analysis. Arch Dis Child. 2022;107(10):890–5. [PubMed ID:35595521]. https://doi.org/10.1136/archdischild-2021-323757.
  • 24.
    Borges RS, Ortiz BLS, Pereira ACM, Keita H, Carvalho JCT. Rosmarinus officinalis essential oil: A review of its phytochemistry, anti-inflammatory activity, and mechanisms of action involved. J Ethnopharmacol. 2019;229:29–45. [PubMed ID:30287195]. https://doi.org/10.1016/j.jep.2018.09.038.
  • 25.
    Yarmohammadi F, Ghasemzadeh Rahbardar M, Hosseinzadeh H. Effect of eggplant (Solanum melongena) on the metabolic syndrome: A review. Iran J Basic Med Sci. 2021;24(4):420–7. [PubMed ID:34094022]. [PubMed Central ID:PMC8143715]. https://doi.org/10.22038/ijbms.2021.50276.11452.
  • 26.
    Sheikhi A, Asadizaker M, Jahani S, Koochak M, Shamloo MBB, Zadeh MHH. [The effect of rosemary topical ointment on phlebitis caused by antibiotic therapy in intensive care units]. J Int J Pharm Re. 2018;45:5–11. Persian.
  • 27.
    Mohammadyan S, Seidi J, Nouri B, Fathi M. A Comparative Study on the Effect of Aloe Vera and Nitroglycerin Ointment on the Incidence and Severity of Phlebitis Caused by the Peripheral Catheter. Sci J Kurdistan Univ Med Sci. 2020;25(2):44–53. https://doi.org/10.52547/sjku.25.2.44.
  • 28.
    Dornhofer P, McMahon K KJIVASTIFSP. Intraosseous Vascular Access. Treasure Island (FL): StatPearls; 2025.
  • 29.
    Annisa L, Hanifah S, Setiani P. Correlation Between the Use of Vesicant Medications and The Incidence of Phlebitis in Pediatric Ward. J Pharm Bioallied. 2024;16(Suppl 4)::S4103–S6. [PubMed ID:39926814]. [PubMed Central ID:PMC11805223]. https://doi.org/10.4103/jpbs.jpbs_1062_24.
  • 30.
    Pasalioglu KB, Kaya H. Catheter indwell time and phlebitis development during peripheral intravenous catheter administration. Pak J Med Sci. 2014;30(4):725–30. [PubMed ID:25097505]. [PubMed Central ID:PMC4121686].
  • 31.
    Bagheri- Nesami M, Khodadadian-Miri J, Khodadadian-Miri J, Tabiban S, Ala S. [The Comparison of 2% Nitroglycerin Ointment and 2% Chlorhexidine Solution Effect in Preventing Catheter-Related Phlebitis]. J Babol Univ Med Sci. 2014;16(6):7–15. https://doi.org/10.18869/acadpub.jbums.16.6.7.
  • 32.
    Yousefi M, Barikbin B, Kamalinejad M, Abolhasani E, Ebadi A, Younespour S, et al. Comparison of therapeutic effect of topical Nigella with Betamethasone and Eucerin in hand eczema. J Eur Acad Dermatol Venereol. 2013;27(12):1498–504. [PubMed ID:23198836]. https://doi.org/10.1111/jdv.12033.
  • 33.
    Ulbricht C, Abrams TR, Brigham A, Ceurvels J, Clubb J, Curtiss W, et al. An evidence-based systematic review of rosemary (Rosmarinus officinalis) by the Natural Standard Research Collaboration. J Diet Suppl. 2010;7(4):351–413. [PubMed ID:22432564]. https://doi.org/10.3109/19390211.2010.525049.
  • 34.
    Raziani Y, Othman BS. Ointment therapy and prevention of cannulation-induced superficial phlebitis. Veins Lymphatics. 2021;10(2). https://doi.org/10.4081/vl.2021.9800.
  • 35.
    Helm RE, Klausner JD, Klemperer JD, Flint LM, Huang E. Accepted but unacceptable: peripheral IV catheter failure. J Infus Nurs. 2015;38(3):189–203. [PubMed ID:25871866]. https://doi.org/10.1097/NAN.0000000000000100.
  • 36.
    Miliani K, Taravella R, Thillard D, Chauvin V, Martin E, Edouard S, et al. Peripheral Venous Catheter-Related Adverse Events: Evaluation from a Multicentre Epidemiological Study in France (the CATHEVAL Project). PLoS One. 2017;12(1):e0168637. [PubMed ID:28045921]. [PubMed Central ID:PMC5207628]. https://doi.org/10.1371/journal.pone.0168637.
  • 37.
    Jeong IS, Jeon GR, Lee MS, Shin BJ, Kim YJ, Park SM, et al. Intravenous Infiltration Risk by Catheter Dwell Time Among Hospitalized Children. J Pediatr Nurs. 2017;32:47–51. [PubMed ID:27651032]. https://doi.org/10.1016/j.pedn.2016.08.008.
  • 38.
    Çökmez A, Gür S, Genç H, Deniz S, Tarcan E. Effect of transdermal glyceryl trinitrate and anti‐inflammatory gel in infusion phlebitis. ANZ Journal of Surgery. 2003;73(10):794–6. [PubMed ID:14525568]. https://doi.org/10.1046/j.1445-2197.2003.02791.x.
  • 39.
    Unbeck M, Förberg U, Ygge BM, Ehrenberg A, Petzold M, Johansson E. Peripheral venous catheter related complications are common among paediatric and neonatal patients. Acta Paediatrica. 2015;104(6):566–74. [PubMed ID:25655941]. https://doi.org/10.1111/apa.12963.

Copyright

© 2026, Author(s). This open-access article is available under the Creative Commons Attribution 4.0 (CC BY 4.0) International License (https://creativecommons.org/licenses/by/4.0/), which allows for unrestricted use, distribution, and reproduction in any medium, provided that the original work is properly cited.

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