Treatment of IV Phlebitis
Remove the peripheral venous catheter immediately upon identifying any signs of phlebitis—this is mandatory, not optional. 1, 2
Immediate Management
Catheter Removal
- Remove the catheter as soon as phlebitis is identified, characterized by warmth, tenderness, erythema, palpable venous cord, or swelling 1, 2
- Do not leave the catheter in place hoping symptoms will resolve with treatment alone—this significantly increases risk of progression and infection 2, 3
- The CDC explicitly states this is a Category IB recommendation, meaning it is strongly supported by well-designed studies 1
Site Care After Removal
- Clean the affected area with 2% chlorhexidine-based preparation, or alternatively 70% alcohol 3
- Apply sterile gauze dressing if the site is weeping or oozing; use transparent semi-permeable dressing for dry sites 3
Symptomatic Treatment
Warm Compress Application
- Apply warm water compresses at 28°C for 15 minutes, three times daily for three days to reduce pain, redness, and edema 4, 5
- This intervention significantly decreases pain intensity, redness, and edema width compared to routine care alone 5
- Warm water compresses are as effective as 0.9% NaCl compresses but more cost-effective 4
Monitoring Requirements
- Evaluate the phlebitis site daily for progression of tenderness, erythema, warmth, and swelling 2, 3
- Monitor for signs of infection including fever, purulent drainage, and systemic symptoms 2, 3
- If symptoms worsen or persist beyond 3 days despite catheter removal, consider septic thrombophlebitis and evaluate for systemic infection 1
Placement of New IV Access
- Use upper extremity sites only for subsequent IV therapy 2, 3
- Avoid placing new catheters in the same area where phlebitis occurred 3
- Consider a midline catheter or PICC if IV therapy will likely exceed 6 days 1, 3
- Avoid lower extremity placement entirely in adults 1
Critical Pitfalls to Avoid
- Do NOT apply topical antimicrobial ointments or creams to the phlebitis site—this provides no benefit and is not recommended 2, 3
- Do not attempt to salvage the catheter once phlebitis develops 2, 3
- Do not use steel needles for subsequent access, especially for medications that could cause tissue necrosis if extravasation occurs 1
When to Escalate Care
Septic Thrombophlebitis (Rare but Serious)
- If bacteremia or fungemia persists for 3 days after catheter removal, treat presumptively for endovascular infection with 4 weeks of antimicrobial therapy 1
- Surgical exploration is needed when infection extends beyond the vein into surrounding tissue 1
- Consider heparin anticoagulation for septic thrombosis of great central veins, but not for routine peripheral vein phlebitis 1
Prevention for Future Insertions
- Replace peripheral catheters every 72-96 hours in adults to prevent phlebitis 6
- Select catheter material carefully—polyetherurethane (Vialon) has lower phlebitis rates than Teflon 7, 8
- Avoid forearm insertion sites when possible, as they carry higher phlebitis risk 7
- Be aware that female patients, those receiving antibiotics, and those with longer dwelling times have significantly higher phlebitis risk 7, 8