What are the management and prevention strategies for intravenous (IV) phlebitis?

Management and Prevention Strategies for IV Phlebitis

Immediate removal of the peripheral venous catheter is the primary management strategy for IV phlebitis when signs such as 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 2, 1
• Visually inspect the site after catheter removal to assess the extent of inflammation 1
• If exudate is present, collect samples for Gram staining and culture, particularly in immunocompromised patients 1
• Clean the area with an appropriate antiseptic (preferably 2% chlorhexidine-based preparation or 70% alcohol) 2, 1
• Apply appropriate sterile dressing:
  • Use sterile gauze for weeping or oozing sites 2, 1
  • Use transparent semi-permeable dressing for dry sites 2, 1

Treatment Options

• Apply warm moist compresses (28°C for 15 minutes three times daily) to reduce redness, edema width, and pain intensity at the phlebitis site 3
• Monitor the site daily for signs of improvement or deterioration 1, 4
• Do not submerge the affected area in water until healing is complete 2, 1
• Avoid placing new catheters in the same area where phlebitis has occurred 1

Prevention Strategies

• Select catheters based on intended purpose and duration of use, known complications, and experience of individual catheter operators 2, 1
• For adults, use upper extremity sites rather than lower extremity sites for catheter insertion 2, 1
• Replace peripheral venous catheters at least every 72-96 hours in adults to reduce the risk of phlebitis 2
• Consider using a midline catheter or PICC when IV therapy is expected to exceed 6 days 2, 1
• Avoid steel needles for administration of fluids and medications that might cause tissue necrosis if extravasation occurs 2, 1
• Evaluate catheter insertion sites daily through visual inspection if transparent dressing is used or by palpation if opaque dressing is used 2, 4
• Clean injection ports with 70% alcohol or an iodophor before accessing the system 2
• Cap all stopcocks when not in use 2
• Designate trained personnel for the insertion and maintenance of intravascular catheters 2

Risk Factors to Consider

• Female gender is associated with higher risk of phlebitis (odds ratio 1.50) 5
• Patients with diabetes mellitus (odds ratio 7.78), infectious diseases (odds ratio 6.21), and burns (odds ratio 3.96) require closer monitoring 5
• Teflon catheters are associated with higher phlebitis rates (33%) compared to Vialon catheters (27%) 6
• Longer dwelling time and antibiotics infusion are important risk factors for phlebitis development 6, 5

Common Pitfalls to Avoid

• Do not delay removal of the catheter if phlebitis is suspected 2, 1
• Do not routinely apply prophylactic topical antimicrobial or antiseptic ointment to insertion sites of peripheral venous catheters 2, 1
• Do not administer intranasal or systemic antimicrobial prophylaxis routinely before insertion or during use of an intravascular catheter 2
• Do not use filters routinely for infection-control purposes 2
• Avoid using the same vein for reinsertion when phlebitis has occurred 1, 4

Cost and Quality of Life Considerations

• Clinically indicated removal (versus routine replacement) of peripheral venous catheters may reduce device-related costs by approximately AUD 7.00 per patient 7
• Complications arising from phlebitis can have long-term effects on patient care, satisfaction, and length of hospital stay 8
• Routine IV site observation and the use of phlebitis severity measurement scales can reduce the incidence and severity of phlebitis 8