From the Guidelines
Phlebitis from an IV is a strong indicator of inflammation of a vein, which may be caused by mechanical, chemical, or infectious factors, and requires prompt removal of the IV catheter to prevent further complications, as recommended by the Infectious Diseases Society of America 1. Phlebitis from an IV can manifest as redness, warmth, swelling, pain, or tenderness along the vein where the IV is inserted. The risk of catheter-related bloodstream infection (CRBSI) with or without suppurative thrombophlebitis from short-term, peripheral intravenous catheters is very low 1. However, phlebitis can still cause significant morbidity and impact quality of life. Key factors that contribute to the development of phlebitis include:
- Prolonged IV placement
- Larger catheter size
- Poor insertion technique
- Certain medications (particularly those with high or low pH or high osmolarity)
- Patient factors such as poor vein quality or compromised immune status Management of phlebitis typically involves:
- Removing the IV catheter, as recommended by the Clinical Infectious Diseases guidelines 1
- Applying warm compresses to the affected area
- Elevating the limb
- Administering anti-inflammatory medications like ibuprofen for pain and inflammation Prevention strategies include:
- Regular site rotation (every 72-96 hours)
- Using the smallest appropriate catheter size
- Proper insertion technique
- Vigilant monitoring of the IV site for early signs of irritation, as recommended by the Clinical Infectious Diseases guidelines 1
From the Research
Phlebitis Indications
Phlebitis from IV can indicate several conditions, including:
- Mechanical, chemical, or infectious causes of inflammation to the vein at a cannula access site 2
- Venous thromboembolism, which can lead to deep vein thromosis, pulmonary embolism, and stroke 3
- Pylephlebitis, or suppurative thrombophlebitis of the portal vein, typically occurring in the context of an intraabdominal infection or abdominal sepsis 4
- Arterial thrombosis, which can be treated with anticoagulants and antiplatelet agents 5
Underlying Conditions
Phlebitis can be a sign of underlying conditions such as:
- Vascular injury, inflammation, venous stasis, and hypercoagulable states 3
- Intraabdominal infection or abdominal sepsis 4
- Atherosclerotic disease, which can be progressed by platelet activity 5
Treatment Implications
The presence of phlebitis can imply the need for:
- Anticoagulant medications to prevent and treat venous thromboembolism 3
- Systemic anticoagulation to improve the rate of portal vein thrombosis resolution and reduce the rate of chronic symptomatic portal hypertension in patients with pylephlebitis 4
- Antiplatelet agents and anticoagulants to treat arterial thrombosis 5