Understanding Phlebitis: Causes, Risks, and Prevention in IV Therapy
Phlebitis, an inflammation of a vein, is a common complication associated with intravenous (IV) therapy, particularly with peripheral venous catheters. This condition can cause noticeable symptoms such as redness, pain, and swelling at the catheter insertion site. Understanding its causes, risk factors, and prevention methods is crucial for both healthcare providers and patients.
Phlebitis occurs when a vein becomes inflamed due to the presence of a catheter. This inflammation can lead to symptoms like redness, pain, and swelling at the site where the catheter is inserted. It can affect the quality of care and cause discomfort for the patient.
Causes and Risk Factors
Several factors contribute to the development of phlebitis:
- Mechanical Damage: Movement of the catheter inside the vein can create friction and irritation, damaging the vessel wall and leading to inflammation.
- Chemical Irritation: Infusing fluids or medications with extreme pH levels or high osmolarity can irritate the vascular tissue, causing phlebitis.
- Infection: Poor aseptic technique during catheter insertion or maintenance can introduce bacteria, leading to infectious phlebitis.
- Post-Infusion: Phlebitis can also develop up to 48 hours after the catheter has been removed.
Staging and Treatment
Phlebitis is typically graded on a scale from 0 to 4, with higher grades indicating more severe symptoms.
- Early-Stage: Slight redness and pain.
- Advanced Stages: Includes swelling and a palpable venous cord.
Treatment Options:
- Catheter Removal: If phlebitis is detected early, removing the catheter and re-inserting it at a different site can be effective.
- Topical Treatments: Nonsteroidal anti-inflammatory drugs (NSAIDs) or heparinoid creams can reduce inflammation and swelling.
- Anticoagulants: In severe cases, especially with thrombophlebitis, anticoagulants may be prescribed.
Proper education and training of healthcare professionals in catheter insertion and maintenance are essential to reducing the risk of phlebitis.
Best Practices for Minimizing Phlebitis Risk
To prevent phlebitis when inserting a peripheral venous catheter (PIVC), follow these best practices:
- Aseptic Technique: Strict aseptic techniques during insertion are crucial. This includes proper hand hygiene and the use of sterile gloves and equipment to prevent infections.
- Site Selection: Choose a suitable site for catheter insertion. Avoid areas prone to movement, such as the wrist or antecubital fossa, and prefer the forearm to minimize mechanical irritation.
- Catheter Size: Use the smallest gauge catheter appropriate for the therapy to reduce trauma to the vein.
- Proper Insertion Technique: Ensure that healthcare professionals are well-trained in insertion techniques to minimize mechanical damage.
- Securement: Secure the catheter properly to prevent movement that can cause irritation and lead to phlebitis.
- Monitoring and Maintenance: Regularly check the insertion site for signs of phlebitis and maintain the catheter according to protocols, including changing dressings and flushing as needed.
- Education and Training: Continuously educate and train healthcare staff on the latest guidelines and techniques for PIVC insertion and maintenance to reduce phlebitis risk.
By adhering to these practices, healthcare providers can significantly lower the incidence of phlebitis associated with peripheral venous catheters, improving patient outcomes and comfort.
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Reference:
Nickel, B. et al., (2024, January/ February) Infusion Therapy Standards of Practice 9th edition. Journal of Infusion Nursing. https://www.ins1.org/publications/infusion-therapy-standards-of-practice/
West, M. (2023, February 13) What to know about the stages of catheter-related phlebitis. Medical News Today. https://www.medicalnewstoday.com/articles/stages-of-phlebitis
Zingg, W. et al., (2023, February 3) Best practice in the use of peripheral venous catheters: A scoping review and expert consensus. National Library of Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9995289/
Noronha, A. et al., (2022, June 10) Risk factors for peripheral intravenous catheter-related phlebitis in adult patients. National Library of Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10111391/