What is the management of phlebitis caused by IV (Intravenous) insertion?

Management of Phlebitis Caused by IV Insertion

The primary management of phlebitis caused by IV insertion is to immediately remove the peripheral venous catheter when signs of phlebitis (warmth, tenderness, erythema, or palpable venous cord) develop. 1

Assessment and Immediate Management

• Remove the peripheral venous catheter immediately upon identification of phlebitis signs including warmth, tenderness, erythema, or palpable venous cord 1
• Inspect the site visually after removal of the catheter to assess the extent of inflammation 1
• If exudate is present, submit samples for Gram staining and culture, particularly in immunocompromised patients 2
• Clean the area with an appropriate antiseptic (preferably 2% chlorhexidine-based preparation or 70% alcohol) 1, 2

Treatment Based on Severity

• Apply appropriate sterile dressing:
  • Use sterile gauze for weeping or oozing sites 1, 2
  • Use transparent semi-permeable dressing for dry sites 1, 2
• For mild phlebitis:
  • Elevate the affected limb to reduce swelling 3
  • Apply warm compresses to improve circulation and reduce discomfort 3
• For more severe phlebitis or signs of infection:
  • Monitor for signs of systemic infection (fever, increased white blood cell count) 3
  • Consider antibiotic therapy if there are signs of infection spreading beyond the insertion site 3

Prevention Strategies for Future IV Insertions

• Select catheters based on intended purpose and duration of use 1
• For adults, use upper extremity sites rather than lower extremity sites for catheter insertion 1
• Replace peripheral venous catheters at least every 72-96 hours in adults to reduce the risk of phlebitis 1
• Consider using a midline catheter or PICC when IV therapy is expected to exceed 6 days 1, 4
• Avoid steel needles for administration of fluids and medications that might cause tissue necrosis if extravasation occurs 1

Risk Factors to Consider

• Higher risk of phlebitis is associated with:
  • Female gender (42% higher odds) 5
  • Forearm insertion sites compared to hand or upper arm 6, 5
  • Smaller catheter size (20 gauge) 6
  • IV drug administration, particularly antibiotics 5, 7
  • Blood product transfusions 6
  • Catheter dwell time exceeding 36 hours 6
  • Underlying conditions such as diabetes mellitus and infectious diseases 7

Common Pitfalls to Avoid

• Do not delay removal of the catheter if phlebitis is suspected 1
• Avoid placing new catheters in the same area where phlebitis has occurred 2
• Do not routinely apply prophylactic topical antimicrobial or antiseptic ointment to insertion sites of peripheral venous catheters 1
• Do not submerge the affected area in water until healing is complete 1
• Do not ignore early signs of phlebitis as complications can lead to extended hospital stays (average 14 days) 3

Special Considerations

• In patients with diabetes mellitus or infectious diseases, more vigilant monitoring is required as they have significantly higher risk of developing phlebitis (OR 7.78 and 6.21 respectively) 7
• For patients requiring long-term IV therapy with history of phlebitis, consider PICC lines which have been shown to reduce phlebitis rates from 16.5% to 2.4% 4
• The incidence of phlebitis rises sharply after 36 hours of catheter insertion, suggesting this as a critical timepoint for assessment 6