How to prevent phlebitis at IV site
Intravenous infusion of medication through peripheral pathways is one of the most common practices in hospitals. Although its advantages are numerous, like all invasive therapies, it is not without complications. As such, it is important to be aware of these complications and know how to prevent them. Show The most common complication (despite this, it only affects a minimum percentage of patients treated) is acute post-puncture phlebitis. It is the inflammation of the vein area closest to the catheter insertion point, and may be caused by improper asepsis (bacterian phlebitis), poor catheter insertion (mechanical phlebitis), or the very nature of infused drugs (chemical phlebitis), which may sometimes have vesicant effects, which may affect the internal epithelium of the vein and cause it to become inflamed. In severe cases, it can cause a blood clot that partially or completely obstructs blood circulation, which can lead to thrombosis. The appearance of phlebitis is an adverse effect that has negative consequences for both the patient and the health system, as it may cause an unwanted prolongation of hospital admission time. Therefore, carefully following asepsis protocols before inserting the catheter, being well aware of the patient’s clinical history, as there are both genetic factors and concomitant pathologies that can predispose a patient to phlebitis, adequately verifying the patency of the pathway and periodically monitoring the patient’s condition are fundamental precautions that must be taken to prevent phlebitis. In addition to rigorous asepsis, it is advisable to use a transparent dressing to visually verify the condition of the canalized vein, as well as to re-disinfect and change the dressing frequently. Washing the pathway with physiological serum is also a good practice. It is important to assess the risks of phlebitis at the time of choosing the vein in which the catheter is to be inserted. Veins that appear hard upon palpation or ones that we are not sure can be canalized must be discarded. While in the emergency services it is usually preferred to canalize veins in the elbow flexion, when a patient is going to spend time in the hospital it is important to assess their comfort and mobility, so veins on the back of the hand are more preferable in these cases. In any case, changes in the appearance of the canalized vein, the presence of swelling, redness, or the appearance of pain, are warning signs that should prompt us to change the peripheral pathway to avoid more serious consequences. Note: This guideline is currently under review. Introduction Aim Definition of terms Assessment Management Companion Documents References Evidence Table IntroductionPeripheral intravenous catheters (PIVC) are the most commonly used intravenous device in hospitalised patients. They are primarily used for therapeutic purposes such as administration
of medications, fluids and/or blood products as well as blood sampling. AimThe aim of this guideline is to provide an outline of the ongoing maintenance and management of the PIVC for patients in hospital, outpatient, and home healthcare settings. For information related to insertion of PIVC, please refer to
intravenous access guideline . Nurses who are deemed competent in IV insertion could continue to insert PIVC in consultation with NUM/CSN’s. Definition of terms
AssessmentPatient and IV site assessments should be done on a regular basis. PIVC assessment includes:
ManagementAdministration of intravenous fluid, drug infusions or blood products a) Continuous infusion of IV fluids
Infusion Pump Pressure
If pump pressure exceeds the recommended limits, check the patency of the PIVC. b) Administration of bolus/loading doses: Administering drugs: Drugs administered via PIVC may be
The most appropriate method should be selected depending on volume of diluent required, patient condition, fluid balance and intended rate of delivery. Drugs administered via:
Attach
a completed drug label detailing the drug, dose, diluent, volume of diluent, date, time and signature of the nurse and the staff who double checked. Access PIVC only after cleaning the access port and scrub the hub. For intermittent infusions, IV lines which are disconnected are to be discarded between infusions. Ensure the cannula is flushed with normal saline once the giving set is disconnected from the cannula. For Opioid infusion bolus refer to the specific
guidelines: Children’s Pain Management Service (CPMS)(opioid infusion guideline) Administering blood products:
Flushing of PIVC’s
Change of PIVC dressing and securement of cannula:
Change of Extension sets
IV Fluid Considerations via Peripheral IV line Which Fluids and how much fluids to use
Labeling infusions:
Fluid bag and infusion changes:
Line changes
Table 1.Changing IV bags and lines
Removal of PIVCs: There is no evidence for routine replacement of PIVC unless clinically indicated. PIVC’s should be maintained with regular assessment and documentation of complications.
Management of complications There are a range of complications that could
occur with the presence of a PIVC in insitu. Some of these complications can be prevented by the correct use of aseptic technique for insertion and maintenance as well as assessing the device as indicated.
Companion Documents
References
Evidence Table The evidence table can be found here. The development of this nursing guideline was coordinated by Mercy Thomas, Nursing Educator, and approved by the Nursing Clinical Effectiveness Committee. Updated December 2018. How can phlebitis be prevented?For the prevention of phlebitis, the highest rated evidence regarding asepsis include the topical use of >0.5% chlorhexidine preparation with 70% alcohol or 2% aqueous chlorhexidine, a proper hygienic hand washing, and the use clean gloves to handle connections and devices.
What helps IV phlebitis?If you have a catheter or IV line, it will likely be removed if it is the cause of the thrombophlebitis. Medicines called NSAIDs, such as ibuprofen, may be prescribed to reduce pain and swelling. If clots in the deeper veins are also present, your provider may prescribe medicines to thin your blood.
What should a nurse do for phlebitis?Whatever the reason for phlebitis, your nursing care should include promptly removing the I.V. cannula as soon as the patient complains of discomfort, monitoring vital signs and the infusion site, notifying the patient's health care provider, and applying heat from a continuous, regulated source.
How do you prevent IV complications?Select an appropriate I.V. site, avoiding areas of flexion.. Use proper venipuncture technique.. Follow your facility policy for securing the I.V. catheter.. Observe the I.V. site frequently.. Advise the patient to report any swelling or tenderness at the I.V. site.. |