What is the management of intravenous (IV) phlebitis?

Management of Intravenous Phlebitis

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, 2

Assessment and Immediate Management

• Remove the peripheral venous catheter immediately if the patient develops signs of phlebitis including warmth, tenderness, erythema, or palpable venous cord 1, 2
• Visually inspect the site after catheter removal to assess the extent of inflammation 2
• If exudate is present at the insertion site, submit samples for Gram staining and culture, particularly in immunocompromised patients 1, 3
• 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
• Apply warm moist compresses to the affected area (at approximately 28°C for 15 minutes, three times daily) to reduce inflammation, redness, edema, and pain 4, 5
• For severe cases, consider using topical diclofenac gel and oral anti-inflammatory medicines to alleviate symptoms 6
• Antibiotics should only be used when definite signs of infection develop, not routinely for simple phlebitis 6, 7
• Elevate the affected limb to reduce swelling and promote comfort 7
• Encourage early ambulation to minimize phlebitis symptoms 6

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
• Avoid steel needles for administration of fluids and medications that might cause tissue necrosis if extravasation occurs 1
• Rotate IV catheter sites every three days 6
• Infuse irritating medications (like amphotericin B) over a longer period (e.g., 4 hours) 6
• Ensure proper dilution of irritating medications (e.g., vancomycin should be administered as a dilute solution of 2.5 to 5 g/L) 8
• Provide adequate hydration after administration of irritating medications 6

Common Pitfalls to Avoid

• Do not delay removal of the catheter if phlebitis is suspected 1, 2
• 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, 2
• Do not submerge the affected area in water until healing is complete 1, 2
• Avoid using antibiotics unless there are clear signs of infection, as phlebitis is primarily an inflammatory rather than infectious process 6, 7
• Do not ignore phlebitis, as untreated septic phlebitis can lead to serious complications including septicemia 7

Special Considerations

• In pediatric patients, peripheral venous catheters can be left in place until IV therapy is completed, unless complications like phlebitis occur 1
• The incidence of phlebitis is higher in female patients (odds ratio = 1.42), so extra vigilance may be needed 9
• Patients receiving antibiotics, those with longer catheter dwelling times, and those with catheters placed in the forearm are at higher risk for developing phlebitis 9