Treatment of Peripheral IV Phlebitis
Remove the IV catheter immediately and apply warm compresses to the affected area three times daily for symptomatic relief. 1
Immediate Management Steps
Catheter Removal
- Remove the peripheral venous catheter as soon as phlebitis is identified (warmth, tenderness, erythema, palpable venous cord, or swelling). 1
- Do not leave the catheter in place once signs of phlebitis develop, as this increases risk of progression and infection. 1
Symptomatic Treatment
Warm compress application is the primary evidence-based intervention:
- Apply warm water compresses at 28°C (approximately 82°F) for 15 minutes, three times daily for three days. 2
- Warm compresses effectively reduce redness, edema width, and pain intensity compared to routine care alone. 2
- Both warm water and 0.9% NaCl compresses are equally effective at reducing phlebitis grade (p=0.18 between groups), making warm water the more cost-effective choice. 3
Pain Management
- NSAIDs or acetaminophen can be used for pain control, though this is based on standard clinical practice rather than specific guideline recommendations for phlebitis.
Monitoring Requirements
Daily assessment of the phlebitis site:
- Evaluate for progression of tenderness, erythema, warmth, and swelling. 1
- Monitor for signs of infection (fever, purulent drainage, systemic symptoms). 1
- Continue monitoring for 48 hours after IV discontinuation to detect delayed complications. 4
When to Escalate Care
Consider further evaluation if:
- Symptoms worsen despite conservative management after 48-72 hours
- Signs of infection develop (fever, purulent drainage, ascending erythema)
- The hardened vein extends proximally or involves deeper structures
- Severe pain persists despite treatment
Rule Out Deep Vein Thrombosis
- If the phlebitis involves the basilic or cephalic vein extending proximally, or if there are high-risk features (history of DVT, severe symptoms, length >5 cm), obtain ultrasound imaging to exclude concurrent DVT. 5
- Approximately 25% of patients with superficial phlebitis have underlying DVT. 5
Prevention for Future IV Access
For subsequent IV therapy:
- Use upper extremity sites only; avoid lower extremity placement. 1
- Replace short peripheral catheters every 72-96 hours in adults to reduce phlebitis risk. 1
- Consider midline catheters if IV therapy duration will exceed 6 days, as they have significantly lower phlebitis rates (0.3%) compared to peripheral catheters. 6
- Avoid insertion sites around the elbow, as these increase phlebitis risk. 4
Common Pitfalls to Avoid
- Do not apply topical antimicrobial ointments or creams to the phlebitis site, as this is not recommended and provides no benefit. 1
- Do not leave the catheter in place hoping the phlebitis will resolve with treatment alone. 1
- Do not ignore progression - if symptoms worsen or systemic signs develop, escalate care promptly to rule out septic thrombophlebitis.