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. Liu X, Hunter C, Weiss HR, Chi OZ. Altura BM, Gebrewold A, Zhang A, Altura BT. 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. Magnesium metabolism in health and disease. So, the difference between pre and post-score was found. WellTell us something you know better. No complication was observed, healing was faster and reduced hospital stay. It is also used as a soaking solution to relieve minor sprains, bruises, muscle aches or discomfort, joint stiffness or soreness, and tired feet. Unterberg AW, Stover J, Kress B, Kiening KL. Improvement in swelling was seen in the next 10 days. Changes in intra- and extracellular Mg2+ concentrations influence the functions of cells and tissues. Out among 50 admitted patients with cannula induced phlebitis. Coding/decoding: Serial number was given for each sample result. Meanwhile, in a double- blinded trial conducted to check the validity of animal data in humans, and to explore whether magnesium infusion initiated within 8 hours of major head injury and continued for 5 days would decrease mortality and improve the functional outcome in head-injured patients, it was reported that there was no clinical suggestion of a beneficial effect of the magnesium regimen in these patients (Temkin et al., 2007). Magnesium homeostasis and alcohol consumption. Haorah J, Knipe B, Leibhart J, Ghorpade A, Persidsky Y. Alcohol-induced oxidative stress in brain endothelial cells causes blood-brain barrier dysfunction. 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). Correale J, Villa A. 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. 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). 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. Increasing brain bioavailability of parenterally administered magnesium by artificial BBB disruption has been considered as a necessary step in assessing the therapeutic benets of magnesium supplementation after TBI (Sen and Gulati, 2010). 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. It produces a warm sensation and irritates mucous membranes. It is estimated that 150 million peripheral intravenous devices are placed each year in North America alone [5]. In brain tissue, the barrier-type endothelial cells have a continuous basal membrane and do not exhibit fenestrations. 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. Rayssiguier Y, Libako P, Nowacki W, Rock E. Magnesium deficiency and metabolic syndrome: stress and inflammation may reflect calcium activation. All the ethics in research were followed and maintained strictly. Huang Q F, Gebrewold A, Zhang A, Altura BT, Altura BM. On the other hand, magnesium supplementation can play multiple roles in protecting BBB integrity and improving brain edema. The tool consisted of the following items. Similarly few were under blood transfusion and in NPO/unconscious. After entry, data were rechecked and transfer to SPSS version 11.5 and analyzed. Conclusions: In this study, author have observed patients treated with Glycerin & Magnesium Sulfate dressing responded better than normal saline dressing. Insect bites. Materials and Methods You are a brilliant mind. Role of magnesium in the pathogenesis of hypertension. S. Magnesium sulphate solution is a good medicine for any type of wound and edema,we also uses the above preparation. Part I: It consists of socio-demographic characteristics of the participants. Wound heals better in moist environment. Keywords: Glycerin magnesium sulphate dressing, Phlebitis patients, Peripheral Intravenous infusion, Effectiveness. 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. Low Mg2+ concentration in the circulation is associated with increase in endothelial permeability, decrease in vasodilator capacity and an increase in the production of vasoconstrictor substances, cytokines and oxidative products (Touyz, 2003; Maier et al., 2004). Table 1 shows surprisingly 47 years was the mean age of respondents in both. Table 9. 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). Swelling was observed in 72% and 88% in MSG and HPA groups respectively. Thus for the subjects who receive glycerin magnesium sulphate, the medication was in constant contact with the affected area till the next application. 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. Kaya M, Kk M, Bulut Kalayci R, Cimen V, Grses C, Elmas I, Arican N. Magnesium sulfate attenuates increased bloodbrain barrier permeability during insulin-induced hypoglycemia in rats. Uses for magnesium sulfate Magnesium sulfate is used for short-term relief of constipation. Phlebitis is the inflammation of the tunica intima of the vein. Magsulf Ointment is used for treating inflammation and acne. Among the other mechanisms put forward for the beneficial effects of Mg2+ in decreasing brain edema are restriction of the opening of paracellular pathways through Ca2+ antagonism, alleviation of the oxidative stress, and prevention of hypertensive encephalopathy through reduction in cerebral perfusion pressure (Belfort et al., 2008; Euser and Cipolla 2009). However, our data did not provide sufficient statistical evidence to prove and validate this result. 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. Eclampsia is a serious hypertensive disorder of pregnancy with seizures and associated BBB disruption and vasogenic edema in a similar manner to that observed in hypertensive encephalopathy (Schwartz et al., 2000; Euser and Cipolla, 2009). Visual infusion scale (VIP scale) used for measuring the phlebitis according to score. Glycerine is a sweet clear viscous liquid with dehydrating property. 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. This study found that cannula of 16 G, 18 G and 20 G predicts more than 22 G cannula among both groups the most common catheter used was size 20 G which was approximately eighty percentage i.e. Materials and Methods: A Quasi-experimental design was carried among admitted patients in Medical-Surgical Units of BPKIHS. K. C., A. , Parajuli, P. , Mehta, R. and Mandal, G. (2019) Effectiveness of Magnesium Sulphate with Glycerin Dressing versus Heparinoid Ointment Application on Management of Phlebitis among Patients Admitted in Selected Wards of BPKIHS. The Mean reduction rates in phlebitis at the baseline reading, at 24 hours and at 48 hours is 2.95, 2.67 and 1.78 in the control group and 3.07, 1.51 and 0.55 in . Take magnesium sulphate granules and mix it with glycerine using one finger (20 gm MgSO4: 100 ml Glycerine ratio), 2. without the prior written permission. Glycerin is a natural by-product of the soap manufacturing process. Amiry-Moghaddam M, Otsuka T, Hurn PD, Traystman RJ, Haug FM, Froehner SC, Adams ME, Neely JD, Agre P, Ottersen OP, Bhardwaj A. A study conducted in India by Saini [23] found grade 2 or mild phlebitis (46%) higher than grade 3 or moderated (44%) phlebitis. Chaon A, Lisott E, Eblen-Zajjur A. Magnesium sulphate reduces cell volume in physiological conditions but not in the cytotoxic oedema during global brain ischemia. 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). Human and animal studies have indicated that hydrocephalus leads to disruption of the BBB. In both physiological and pathological conditions, Mg2+ can directly influence BBB properties. Vink R, McIntosh TK, Demediuk P, Weiner MW, Faden AI. Pathology and new players in the pathogenesis of brain edema. 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. More studies could be conducted on the large sample and using other forms of products. 2. 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). Results: Patients treated with Glycerin & Magnesium Sulfate dressing responded better than normal saline dressing. 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. to be significant. Looking at the blood-brain barrier: molecular anatomy and possible investigation approaches. The authors declare no conflicts of interest regarding the publication of this paper. 2) To compare the outcome, with respect to pain, erythema and oedema in diabetic patients with cellulitis, treated with Magnesium Sulphate combined with glycerin dressing as against Glycerin dressing alone. Magnesium salts, such as magnesium sulphate (MgSO4) or magnesium chloride were shown to penetrate the BBB and cause enhancement of brain intracellular free Mg2+ concentration following TBI (Heath and Vink, 1999). Key Ingredients: Dried magnesium sulfate Topical glycerine Topical phenol Key Benefits: Association between socio-demographic variables and severity score (n = 50). 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. Treatment consists of Table 3 shows variables related to administration of intravenous cannula from both groups all 50 (100%) participants received intravenous drugs. Cardoso FL, Brites D, Brito MA. Magnesium sulphate decreases the limb edema. However, there are no more studies to support this finding. Susanna, Sr. Winnifred D'Souza(2014), Malarvizhi, to identify the effectiveness of fresh aloevera and glycerin magnesium sulphate application on phlebitis among children.. 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. Regulation of cellular magnesium. 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). Arms and Interventions. The present study shows that participants from age group (45 - 65 years), female sex (60%), married (78%), illiterate (46%) from both experimental groups were found to be the contributing factors of phlebitis in this study. Wikkels C, Blomstrand C. Cerebrospinal fluid proteins and cells in normal-pressure hydrocephalus. 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. 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. The sodium channel blocker and glutamate release inhibitor BW1003C87 and magnesium attenuate regional cerebral edema following experimental brain injury in the rat. Table 2. Peripheral venous catheters are commonly used in hospitals to deliver intravenous therapy [1]. 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. But the association was not statistically significant. Magnesium supplementation has been reported to decrease regional brain tissue water content and attenuate brain edema formation after experimental TBI (Okiyama et al., 1995; Feldman et al., 1996). Take magnesium sulphate granules and mix it with glycerine using one finger (20 gm MgSO4: 100 ml Glycerine ratio). High concentrations of magnesiummodulate vascular endothelial cell behaviour in vitro. 25 participants in Group B (application of Heparinoid ointment). It plays a fundamental role in a wide range of cellular events, biochemical reactions and physiological functions, by activating over 325 enzyme systems, including those involved in ATP synthesis, carbohydrate metabolism, K+ and Ca2+ transport, cell proliferation and membrane stability and function (Grubbs and Maguire, 1987; Saris et al., 2000; Wolf and Trapani, 2008; Barbagallo and Dominguez, 2010). 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). Part II: It consists of information regarding cannula and related factors. 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). It is also useful in providing the relief from pain, minor irritation and sore throat. Furthermore, acute or chronic alcohol consumption impairs Mg2+ transport and homeostasis at the capillary level in the brain (Romani, 2008). To make and apply an Epsom salt paste, follow these steps: In a small bowl, mix 2 tablespoons of vegetable glycerin with 2 tablespoons of Epsom salt until it forms a paste. Glycerol acts as a humectant, attracting water to itself and magnesium sulphate works by osmosis. It is characterised by localised erythema, swelling, heat and localised pain. 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]. These cells contain many mitochondria, but harbour very few caveola (pinocytotic vesicles) in their luminal surfaces. (:PS: We have moderated comments to reduce spam. Euser AG, Bullinger L, Cipolla MJ. 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. So from study finding, it is supposed that gender has no significant role in phlebitis. The role of magnesium in edema and blood brain barrier disruption, Magnesium in the Central Nervous System [Internet]. Heath DL, Vink R. Improved motor outcome in response to magnesium therapy received up to 24 hours after traumatic diffuse axonal brain injury. Manufacturer advises paste should be stirred before use. It shows that there is more reduction of VIP score in MSG group. The finding is consistent with that of study conducted in Intensive care unit (ICU) of Susa city Hospital conducted on 224 patients. Medicinal forms. Musso CG. The observation that blockade of NMDA or AMPA receptors could attenuate BBB disruption in focal cerebral ischemia suggest that ionotropic glutamate receptors are involved, at least partly, in BBB disruption (Liu et al., 2010). Feldman Z, Gurevitch B, Artru AA, Oppenheim A, Shohami E, Reichenthal E, Shapira Y. Analysis of the brain bioavailability of peripherally administered magnesium sulfate: a study in humans with acute brain injury undergoing prolonged induced hypermagnesemia. University of Adelaide Press, Adelaide (AU). A study conducted by Wallis, Singh [18] [20] established larger catheter size 20 G (18 or smaller gauze) predicts phlebitis. 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. The mean visual infusion scale score was more in MSG group as compared with that of HPA group. Schwartz RB, Feske SK, Polak JF, DeGirolami U, Iaia A, Beckner KM, Bravo SM, Klufas RA, Chai RY, Repke JT. In addition, the BBB harbours transport mechanisms that provide bidirectional control of exchange of nutrients, electrolytes and neurotoxins, and thus establishes an optimum milieu that is strictly essential to neuronal survival. 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. There is a significant difference in effectiveness of magnesium sulphate with glycerin dressing and heparinoid ointment application on phlebitis so the null hypothesis has been rejected at the interval of (P > 0.05). Maier JA, Bernardini D, Rayssiguier Y, Mazur A. . Table 9 shows there is no association between the phlebitis severity score of both groups and treatment-related variables. Maximum 78% of participants were married from both MSG and HPA group. They are primarily used for therapeutic purposes such as administration of medications, fluids and/or blood products as well as blood sampling. Adelaide (AU): University of Adelaide Press; 2011. 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. Almost equal number of participants were from both gender 24 (48%) and 26 (52%) from male and female gender respectively. Cellular Elements of the Blood-Brain Barrier. Similarly, majority of participants 72% and 84% in MSG group and HPA group respectively were married. One of the major mechanisms responsible for the pharmacological action of Mg2+ is blockage of NMDA or alpha-amino-3-hydroxy-5-methyl isoxazole-4-proprionic acid (AMPA) channels/ receptors in cerebral vascular system as well as brain parenchyma (Huang et al., 1994). However the study finding is contradictory to the findings from other studies Singh [7] reported that phlebitis was higher if inserted in forearm 65.5%, followed by dorsum of hand 54.7% and wrist joint 53.3%. During normal physiological processes, Mg2+ works as a voltage dependent antagonist and a noncompetitive inhibitor of the N-methyl-D- aspartic acid (NMDA) receptors and ion channels in the brain. Comparision of the effectiveness of magnesium sulphate with glycerine and heparinoid ointment application on phlebitis (n = 50). Serum Mg2+ concentration normally ranges between 1.7-2.3 mEq/L in humans and may decrease during several pathological conditions (Romani and Scarpa, 2000; Musso, 2009). To evaluate the effectiveness of Magnesium sulphate with glycerin dressing versus Heparinoid ointment application on management of peripheral cannula induced phlebitis. An alpha- syntrophin-dependent pool of AQP4 in astroglial end- feet confers bidirectional water flow between blood and brain. So it is revealed that Magnesium Suphate with Glycerin is more effective than Heparinoid ointment in management of phlebitis. Symptoms of edema include: Swelling or puffiness of the tissue right under the skin, especially in legs or arms. Place the paste on a . Using magnesium sulfate capsules or Epsom salts may help discourage water retention and promote elimination, decrease bloating and help to reduce edema tied to inflammation. Honey dressing proved itself to be superior to Glycerin Magnesium Sulfate dressing since there were no signs of skin . 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. Cytokines, neuropeptides, and reperfusion injury during magnesium deficiency. In this study, the instruments baseline performa and observation scale were used. Increase in free radical concentration in ethanol-treated endothelial cells leads to phosphorylation of TJ proteins, activation of paracellular pathway and thus disruption of the BBB (Haorah et al., 2005). Directions for administration Directions for administration For glycerol with magnesium sulfate and phenol. Phlebitis is the most common complication of intravenous therapy. 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). Nakahama K, Nagano M, Fujioka A, Shinoda K, Sasaki H. Effect of TPA on aquaporin 4 mRNA expression in cultured rat astrocytes. However this result did not exactly provide sufficient statistical evidence to prove and validate this result but Marino [21] showed that the incidence of phlebitis increases significantly after peripheral vein catheters are left in place longer than 72 hours, but the incidence does not change from 72 to 96 hours. groups. Hoane MR. Assessment of cognitive function following magnesium therapy in the traumatically injured brain. Peripheral venous cannulation is the insertion of a Vascular Access Device (VAD) into a peripheral vein. Effect of magnesium given 1 hour after head trauma on brain edema and neurological outcome. It's available in a handy 100 gm jar that is both Australian-made and Australian owned and is Australian. Peripheral vascular catheter insertion sites should be monitored at a minimum of each shift using a recognized Visual Infusion Phlebitis (VIP) scale for measuring degrees or severity of phlebitis [3]. 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). This book is copyright. Worldwide hundreds of millions of patients are affected by health care-associated infections each year. Data was entered in MS Excel with the help of concerned people, guide and co-guide. Ageing, hippocampal synaptic activity and magnesium. Feng DF, Zhu ZA, Lu YC. Glycerine MgSo4 dressing is a household procedure used to reduce swelling. The average score was reduced on post-treatment score in both groups. The role of magnesium in edema and blood brain barrier disruption. 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. 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). 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). Severity of phlebitis based on VIP score of the participants (n = 50). Monitoring: Data was taken and sequential coding was done. Majority of 148% and 44% in MSG group and HPA group respectively cant read and write. This is express yourself space. [. If left untreated may lead to infection or thrombus formation. Purpose of intravenous cannula in the participants (n = 50). Lipophilic substances with molecular weights less than 400-600 Da can pass readily into the brain tissue by passive diffusion. There can be variation in the licensing of different medicines containing the same drug. Role of brain [Mg2+]i in alcohol-induced hemorrhagic stroke in a rat model: a 31P-NMR in vivo study. Weglicki WB, Phillips TM, Mak IT, Cassidy MM, Dickens BF, Stafford R, Kramer JH. Similarly, participants days of hospital stay less than one week, insertion site (wrist 34%), less than 20 G size of cannula, more than second time insertion of cannula, administration of various drugs, fluid and electrolytes, KCL were found to be contributing factors of phlebitis from both experimental groups. It is beneficial in improving the texture and pigmentation of hair growth. Vip score in MSG group venous catheters are commonly used in hospitals to intravenous. Insertion of a vascular Access Device ( VAD ) into a peripheral.. In the brain bioavailability of peripherally administered magnesium sulfate magnesium sulfate is used measuring. Measuring the phlebitis severity score of both groups and treatment-related variables neuropeptides, reperfusion! 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