What is the treatment for phlebitis and infiltration?

Treatment for Phlebitis and Infiltration

For peripheral venous catheter-related phlebitis and infiltration, the primary treatment is immediate removal of the affected catheter and application of warm compresses to the site. 1

Diagnosis and Assessment

• Signs of phlebitis requiring intervention include:

  • Warmth
  • Tenderness
  • Erythema (redness)
  • Palpable venous cord
  • Pain at insertion site 1

• Signs of infiltration requiring intervention include:

  • Swelling
  • Coolness at site
  • Blanching
  • Pain
  • Leaking of fluid 2

Treatment Algorithm

Step 1: Immediate Interventions

1. Remove the affected catheter immediately if signs of phlebitis or infiltration are present 1
2. Apply warm compresses to the affected area:
   • Apply for 20 minutes, 3-4 times daily
   • Warm water compresses are as effective as saline compresses and more cost-effective 3

Step 2: Topical Treatments

1. Apply topical anti-inflammatory agents:
   • Heparinoid creams (e.g., Hirudoid) can shorten duration of symptoms 4
   • Topical NSAIDs may help control local pain and inflammation 4

Step 3: Systemic Management

1. Analgesics for pain management as needed
2. Elastic compression to reduce swelling and improve venous return 4
3. Encourage mobility and exercise to reduce pain and prevent deep vein thrombosis 4

Step 4: Replacement of IV Access (if needed)

1. Select a new site in an upper extremity (for adults) 1
2. Choose appropriate catheter type based on:
   • Intended purpose and duration of use
   • Known complications
   • Experience of catheter operator 1
3. Consider a midline catheter or PICC if IV therapy will likely exceed 6 days 1, 5

Special Considerations

For Severe Cases

• Monitor for signs of systemic infection or progression to suppurative thrombophlebitis
• Consider blood cultures if fever or signs of systemic infection develop 1
• Antibiotics are generally not indicated unless there is documented infection 4

Prevention Strategies

• Evaluate catheter insertion sites daily 1
• Replace peripheral venous catheters every 72-96 hours in adults 1
• Use proper aseptic technique during insertion and maintenance 1
• Consider using sutureless securement devices with transparent dressings 5

Common Pitfalls to Avoid

1. Do not leave catheters in place when signs of phlebitis or infiltration are present
2. Avoid bed rest unless pain is severe, as mobility helps reduce complications 4
3. Do not routinely use antibiotics for uncomplicated phlebitis 4
4. Avoid using steel needles for administration of fluids that might cause tissue necrosis if extravasation occurs 1

Early recognition and prompt treatment of phlebitis and infiltration are essential to prevent complications such as tissue damage, infection, and patient discomfort. The incidence of these complications can be significantly reduced through proper staff education and implementation of evidence-based protocols 2, 6.