Phlebitis The first three complications, infection, embolism and hematoma are easily differentiated because they have unique characteristics. The initial treatment for any form of phlebitis is to stop the infusion and remove the PVC (Webster et al, 2010). Anaesthesia; 57: 921-925. Questions: The round to the nearest whole number). Calculate the flow rate you will program the infusion pump. For example, a large-bore cannula would be appropriate for rapid fluid resuscitation while a cannula with a smaller bore would suffice for sliding scale insulin therapy. Ray Higginson is chartered biologist and senior lecturer in critical care, and Andrew Parry is senior lecturer in critical care; both at the Faculty of Health, Sport and Science, University of Glamorgan, Wales. Infective phlebitis can have significant ramifications for the patient due to the potential development of systemic sepsis. Cool skin and blanching. These findings may indicate phlebitis. They can help reduce the progression of phlebitis through early detection. In turn, early recognition will enable prompt intervention, minimising disruption to treatment. I would like recommendations for the treatment of an infiltrated IV consisting of D5 1/3ns with 40 MEQ KCL that was running at 125cc/hr. Uslusoy E, Mete S (2008) Predisposing factors to phlebitis in patients with peripheral intravenous catheter: a descriptive study. Likewise, central access is required if cytotoxic and/or hypertonic solutions are to be intravenously administered (RCN, 2010). Peripheral catheter-related phlebitis is caused by the inflammation of the tunica intima of a superficial vein. In addition, aseptic technique can help prevent the transmission of micro-organisms to wounds and other susceptible sites (such as intravenous cannula ports), and reduce the risk of cross-infection (Hart, 2007). Creed F, Spiers C (2010) Care of the Acutely Ill Adult: an Essential Guide for Nurses. As the sound waves tr… 21 Although appropriate researcher training was offered, with the aim of reducing judge-related bias, some inaccuracies may have threatened the findings. Start studying BN Ch 22 Care of pt with alterations in health. By observing good practice both during and after peripheral catheter insertion, complication rates of phlebitis can be reduced and patient care improved. Phlebitis is one of the local complications related to intravenous therapy, which must be managed by the nursing team. A patient with phlebitis with a VIP score of 2 or more will require their cannula to be removed or resited. What are the recommended nursing interventions when phlebitis is noted? Notify the patient's health care provider. When the inflammation is caused by a blood clot or thrombus, it is called thrombophlebitis. Nursing Times; 107: 36, early online publication. A urine culture C& S is ordered. Decreased or stopped flow rate. Phlebitis - Nursing considerations. ... * Document your patient's condition and interventions. CONCLUSIONS: Missed nursing care and expertise of the nurses caring for the patient after PVC insertion affected the incidence of phlebitis; receiving more nursing care and being in a specialized hospital were associated with lower risk of PVC-related phlebitis. This article discusses in detail the predisposing factors, symptomatology, and specific nursing interventions for these two com mon IV-related complications. _____mL/h (The client states she has pain to her left forearm four (4) hours after the start of the infusion. BMC Medicine; 8: 53 doi:10.1186/1741-7015-8-53. A new app, developed by Abbott’s UK-based nutrition business, has already seen…, Please remember that the submission of any material is governed by our, EMAP Publishing Limited Company number 7880758 (England & Wales) Registered address: 7th Floor, Vantage London, Great West Road, Brentford, United Kingdom, TW8 9AG, We use cookies to personalize and improve your experience on our site. 4. DOI: 10.1002/14651858.CD007798.pub2. ... Phlebitis, or inflammation of a vein, is a common complication of peripheral I.V. Any exudate oozing from the insertion site would also be suggestive of phlebitis, in particular infective phlebitis (Macklin, 2003). To avoid chemical phlebitis, the possibility of bringing drug pH or osmolarity in line with physiological ranges should be explored (Kuwahara et al, 1999). Symptoms may appear when you are receiving an IV medication, or 48 to 96 hours after you receive the medicine. Follow up with your healthcare provider as directed: Write down your questions so you remember to ask them during your visits. It may start as an inflammatory response to cannula insertion, allowing bacteria to colonise the “inflammatory debris” (Malach et al, 2006). IV will need to be discontinued and restarted ... 14. For example, patients undergoing antibiotic or potassium therapy have a higher phlebitis risk due to the low pH of these solutions and neutralising such solutions may help prevent phlebitis (Kuwahara et al, 1999), although this is not usually done by nurses. How would the nurse obtain a … Available for Android and iOS devices. Royal College of Nursing (2010) Standards for Infusion Therapy. Journal of Infusion Nursing; 32: 3, 145–155. The purpose of this study is to determine the effects of sesame oil on the prevention of amiodarone-induced phlebitis. New England Journal of Medicine; 364: 4, 380. A-NO, b/c it is recomended to remove catheters as soon as they are no longer clinically indicated to eliminate a portal of entry for pathogens or bacteria. A number of phlebitis scales and assessment tools have been developed to assist this, and the two most commonly used in the UK are the Phlebitis Scale and the Visual Infusion Phlebitis (VIP) scale. The treatment of phlebitis will depend to some extent on the severity of inflammation and presence of a thrombus. Objective. Journal of Infusion Nursing; Supplement 34: 1s. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or IBM Watson Health. Moderate phlebitis will usually resolve itself. Notify primary care provider if phlebitis is suspected. In addition, a poor standard of infection control has a part to play and infection control and hygiene standards are essential in the treatment and prevention of the condition (Uslusoy and Mete, 2008). Microorganisms gain access to new hosts via a variety of methods, with some microbes using more than one method of transmission. Phlebitis Prevention. Jackson A (1998) Infection control: a battle in vein infusion phlebitis. Dougherty L, Lister S (2008) The Royal Marsden Hospital Manual of Clinical Nursing Procedures. Phlebitis or venitis is the inflammation of a vein, usually in the legs.It most commonly occurs in superficial veins. With a large proportion of hospitalised patients receiving IV antibiotics, nurses need to be vigilant when administering this therapy. B-NO, b/c it is recommended to use a sterile needle/catheter for each insertion attempt for clients safety & prevention of infection. Peripheral venous cannulation (PVC) is a common procedure carried out in hospital to allow rapid and accurate administration of medication (Endacott et al, 2009). 5. Symptoms include pain, redness, and swelling near the vein. American Journal of Infection Control; 34: 5, 308-312. Clinical staff, especially those in close physical contact with patients, can act as a portal for disease-causing organisms, facilitating their spread between patients and the clinical environment. Nursing care plan goals for a client with postpartum thrombophlebitis include enhance tissue perfusion, facilitate resolution of thrombus, promote optimal comfort, prevent complications and provide information and emotional support. Phlebitis has been linked with inappropriate catheter insertion sites and inappropriate catheter usage. Einstein; 6 (4), 459-462. Another risk factor is poor skin cleansing technique before cannula insertion. To whom can the nurse delegate the task of taking the urine sample to the labatory? Webster J et al (2010) Clinically-indicated replacement versus routine replacement of peripheral venous catheters. Infective phlebitis is caused by the introduction of bacteria into the vein. The commonest symptoms of any form of phlebitis are erythema and swelling along the venous track, leading to hardened, cord -like veins (Endacott et al, 2009). However, the placement of a… Keywords Phlebitis, Venous catheter, Infection control. Phlebitis is the most common complication of this solution, the management of which is quite necessary. This standard of practice must continue to the administration phase, with particular attention paid to cannula sites of patients on frequent intravenous therapy, as regular use of the cannula site increases the risk of bacterial phlebitis (Uslusoy and Mete, 2008). LaRue G, Peterson M (2011) The impact of dilution on intravenous therapy. Treatment for phlebitis. The patient was 85 years old, non-responsive in an emaciated condition. The appropriate cannula should be selected for the vein. Phlebitis is commonly treated by discontinuing the IV line and applying a moist warm compress over the area. For infiltration you should always consult your agency's policy for treatment and it usually involves discontinuing the IV and elevating the extremity some policies may also recommend applying … Inflammation may be caused by damage to or infection of your vein. Swelling, discomfort, burning, and/or tightness. Journal of Toxicological Sciences; 24: 2, 113-121. D/C infusion stat Apply warm/moist compresses to the affected site Avoid further use of the vein Restart infusion in another vein. Good clinical practice must be observed when administering intravenous drugs, starting at the point of reconstituting and drawing up the drug. Regarding this, the present study aimed to compare the effect of warm moist compress and Calendula ointment on the severity of phlebitis caused by 50% dextrose infusion.Methods: This … Intravenous therapy is indicated for many reasons. Nursing Standard; 21: 47, 43-48. Your IV catheter will be removed. Good infection control techniques are also vital in preventing the condition. Ultrasound. London: Royal College of Nursing. [24] Another study has found that … The clinician’s hands should be thoroughly washed, gloves worn and the patient’s skin adequately cleansed. It can have a mechanical, chemical or infectious cause. What are the recommended nursing interventions when phlebitis is noted? Superficial Thrombophlebitis means there is a blood clot in the vein just under the skin (thrombosis or thromboembolism), that causes swelling and pain. Older people with dementia often have other health comorbidities resulting in the need for a … The Phlebitis Scale was developed by the Infusion Nurses Society (2006). The VIP scale has been shown to be a valid and reliable measure for determining when an intravenous catheter should be removed (Gallant and Schultz, 2006). A recognised associated risk factor is phlebitis. Materials and methods: This is a double-blind randomized controlled trial. Consideration must also be given to the nature of the intended IV therapy and optimum cannula size for drug delivery. The quality of life of individuals, their families and friends is impacted by dementia. Oxford: Blackwell Publications. Good practice during insertion will also extend the life of the cannula. Recommended Citation Mindo, ... noted a high incidence rate of phlebitis related to amiodarone infusion even when the current ... a high incidence of amiodarone-related phlebitis has also been noted, prompting three major nursing journals in the … It often occurs when the size of the cannula is too big for the selected vein (Martinho and Rodrigues, 2008). For example, peripheral venous cannulas are indicated for short-term use only (Dougherty and Lister, 2008). This will help decrease swelling and pain. Prevention. 10-41F), may also be seen focally. Isotonic fluids have been found to lower rates of phlebitis, while hypertonic fluids increase the incidence of phlebitis by initiating the inflammatory response (Uslusoy and Mete, 2008). Missed nursing care increased the incidence of PVC-related phlebitis by approximately 4% (HR 1.038, 95% CI 1.001-1.077). Receiving intravenous therapy Intravenous therapy is indicated for many Oxford: Oxford University Press. It is estimated that in the UK 20-80% of patients with a PVC develop phlebitis (Pandero et al, 2002). What are the recommended nursing interventions when an IV becomes infiltrated? Visit our, Phlebitis: treatment, care and prevention, 100 years: Centenary of the nursing register, 2020: International Year of the Nurse and Midwife, Nursing Times Workforce Summit and Awards, print-friendly PDF file of the complete article, An initiative for student nurses to practise clinical skills at home, Don’t miss your latest monthly issue of Nursing Times, Nursing Times survey reveals extent of Covid-19 workforce pressures, Improving patient care as the use of telemedicine rises, Spire Healthcare steps up to support the NHS, Reducing the cognitive load on nursing staff, Creating an electronic solution for early warning scores, How best to meet the complex needs of people with interstitial lung disease, New blended learning nursing degree offers real flexibility, NHS reform plan promises clearer nurse staffing accountability, Tributes paid to nurses who have died in latest surge of Covid-19, Kent theatre nurse described as ‘one of the best’ dies with Covid-19, Call for nurses to join Covid-19 vaccine side effects study, City emergency department ‘four or five nurses short every shift’, finds CQC, Jersey to launch first on-island mental health nursing degree, Gallery: Paramedic’s photographs show nursing over four decades, Covid-19 vaccines: Nurse volunteer draws on 40-year career to support programme, Senior Manager – Local Authority Inspection / Uwch-reolwr – Arolygu Awdurdodau Lleol, Join our Outstanding Ophthalmology team in Yorkshire, Team Manager – Adult Services Inspection / Rheolwr Tîm – Arolygu Gwasanaethau Oedolion, This content is for health professionals only, Peripheral venous cannulation is a common procedure used in hospital to deliver fluid and medicine, Phlebitis (inflamation of the vein) can be caused by chemical, mechanical or infectious irritation, Good practice with cannula insertion and infection control should help to prevent the condition, Peripheral venous cannulation is a common procedure, Phlebitis – or inflammation of the vein – can be caused by mechanical, chemical or infectious irritation at the cannula site, Careful placement and good hygiene can help to prevent phlebitis, There are two assessment tools to identify early signs of the condition, Vigilance can help to prevent rare but potentially severe complications such as sepsis. What are the recommended nursing interventions when phlebitis is noted 1 A from WINDSOR 101 at CDI College of Business, Technology and Health Care The site should also be carefully selected, to avoid any bony prominences, joints and venous valves that would cause the cannula to move within the vein lumen. Phlebitis -- Nursing Interventions-Stop infusion and DC IV line-Start new IV line in other extremity or promal to orevious insertion site if continued IV therapy is necessary.-Apply warm moist compress or contact IV therapy team or health care provider if area needs additional treatment. Thrombus. Journal of Infusion Nursing; 32: 2, 74-79. Malach et al (2006) found the bacterial growth on removed cannula tips were those commonly associated with normal skin flora. The diagnosis of PVC-related phlebitis was based on clinical signs, which were assessed using VIPS. It is not intended as medical advice for individual conditions or treatments. Cochrane Database of Systematic Reviews; Issue 3, Art No: CD007798. TPN is hypertonic but its osmolarity can be adjusted without affecting the pharmacodynamics of the solution, which, alongside the addition of drugs such as heparin, has been shown to increase the life of a fine bore midline cannula (Catton et al, 2006). Nurses have a crucial role in the prevention and management of complications as explained below. Disposing of contaminated or soiled equipment and linen appropriately, Grade 1    Erythema at access site with or without pain, Grade 2    Pain at access site with erythema and/or oedema, Grade 3    Pain at access site with erythema and/or oedema, streak formation, palpable venous cord, Grade 4    Pain at access site with erythema and/or oedema, streak formation, palpable venous cord, greater than one inch in length and purulent drainage. It may look swollen and red. Infusion Nurses Society (2006) Infusion Nursing Standards of Practice. Dementia poses a significant challenge for health and social policy in Australia. Missed nursing care was measured with a validated tool assessing the perceptions of the RNs. Phlebitis (fle-BYE-tis) is a condition in which a vein becomes inflamed (phleb=vein + it is=inflammation). Many patients in hospital require PVC as part of their medical management and care. This material must not be used for commercial purposes, or in any hospital or medical facility. Gallant P, Schultz AA (2006) Evaluation of a visual infusion phlebitis scale for determining appropriate discontinuation of peripheral intravenous catheters. The type of intravenous delivery device used depends on the type of fluid administered and the length of time intravenous therapy will last. Journal of the American Academy of Nurse Practitioners; 20: 172-180. HCP ordered 1 Liter of LR to infuse over 6 hours. Your arm or leg feels warm, tender, and painful. Monitor the patient's vital signs and the I.V. 86 Enterocolic phlebitis has also been reported in association with lymphocytic enteritis and colitis. Learn more about the causes, symptoms, diagnosis and treatment from the number one heart center, Cleveland Clinic. Oxford: Oxford University Press. These include intravenous antibiotic administration, intravenous fluids, intravenous pain relief and/or total parenteral nutrition (TPN). Loewenstein R (2011) Treatment of superficial thrombophlebitis. © Copyright IBM Corporation 2020 Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. Follow your facility policy for securing the … The inflammation may cause pain and swelling. What are the recommended nursing interventions when an IV becomes infiltrated? Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. A urine culture C& S is ordered. Anti-inflammatory analgesics can be prescribed to treat both the inflammation and the pain associated with phlebitis. Use proper venipuncture technique. Difficulty in injecting or regular infusion pump occlusion would also indicate phlebitis. The incidence of phlebitis can be reduced by use of simple measures. Hart S (2007) Using an aseptic technique to reduce the risk of infection. The VIP score is recommended in the Infusion Nursing Standards of Practice (INS, 2011). Analysis of existing data set from a large randomized controlled trial, the primary purpose of which was to compare routine peripheral intravascular catheter changes with changing catheters only on clinical indication. Learn vocabulary, terms, and more with flashcards, games, and other study tools. However, the placement of an intravenous cannula can have undesirable effects, the most common of which is phlebitis. Infusion Nurses Society (2011) Infusion nursing standards of practice. Oxford: Oxford University Press. Early phlebitis at an intravenous site usually resolves after a cannula is removed or resited (Rickard et al, 2010). Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. An affected limb should be elevated to minimise inflammation and an anti-inflammatory cream or gel can be directly applied to the area (Reis et al, 2009). A blood clot An unhygienic environment can harbour micro-organisms and facilitate their contamination and spread (Randle et al, 2009). Journal of Infusion Nursing: 34, 2, 117–123. What are the recommended nursing interventions when phlebitis is noted? Background: One of the important hypertonic solutions is 50% dextrose. Granulomatous phlebitis, in which the mural infiltrate contains histiocytes and giant cells associated with damage to the walls of veins (see Fig. If intravenous therapy is indicated for longer periods, central venous access will be required. This study analyzed the knowledge of the nursing team about phlebitis … The affected arm was swollen from … Martinho RFS, Rodrigues AB (2008) Occurrence of phlebitis in patients on intravenous amiodarione. Endacott R et al (2009) Clinical Nursing Skills, Core and Advanced. Clinical Nutrition; 25: 394-399. However, with the two latter – infiltration and phlebitis can be quite difficult to discern because they share the same signs and symptoms which, if you are not careful enough you might render the wrong treatment and …