Phlebitis is a complication that is frequently associated with IV therapy. And is defined as the acute inflammation of the internal lining of the vein . Phlebitis is characterized by pain and tenderness along the course of the vein, redness and swelling and warmth can be felt at the insertion site.
There are a number of factors that can contribute to and increase the risk of phlebitis.
These factors include:
- The infusion of drugs or solutions that are acidic or alkaline or have a high osmolarity
- Trauma to the vein during insertion
- Insertion into a vein that is too small
- Using a vascular access device that is too big for the vein
- Extended dwell time of the same IV site
- Type of catheter material used
- Patients history and present condition
- Condition of the veins
- Cannula stabilization
- Skin preparation/infection control
- Frequency of dressing change
Phlebitis can be classified into three categories:
- Mechanical
- Chemical or infusion
- Bacterial
Chemical phlebitis is most commonly seen with peripheral IV devices when medications or solutions irritate the endothelial lining of the small peripheral vessel wall. The lower or higher the Ph of the medication or solution, the greater the risk of phlebitis occurring. The same occurs if there is an increase in the tonicity of a medication or solution. Chemical phlebitis is a rare occurrence in central venous catheters due to the larger size of the vessel and the increased blood volume through these vessels. Medications which have been incorrectly diluted or mixed result in particulate matter being infused; particulate matter is also another factor which increases the risk of chemical phlebitis.
Bacterial phlebitis is usually a precursor to an infection at the insertion site. It occurs due to contamination of the IV system allowing bacteria to enter the solution and then the patient. Contamination can be caused by compromised aseptic technique during mixing of medications or solutions, improper cleaning of connection ports and hubs during connecting of IV equipment and inadequate skin preparation during insertion.
An interesting point to make about phlebitis and PICC lines is that research has shown that female patients have a higher risk of phlebitis than male patients; Caucasians have also shown to have a higher incidence although the reason for the increased risk has not been determined (Maki and Ringer, 1991).
Prevention
Prevention of phlebitis involves many factors and the nurse should consider these factors the moment the patient receives an IV device.
Prevention measures include:
* Adhering to aseptic technique during insertion, dressing changes, mixing or drawing up of solutions or
medications, accessing ports or hubs on IV equipment
* Cannula site rotation
* Using the smallest gauge cannula in the largest vein
* Adequate securement of the IV device
* Close and regular monitoring of the IV site
* Patient education of the signs and symptoms of phlebitis
* IV device selection – When to Pick a PICC!
* Following guidelines on dilution of solutions to prevent particulate matter and to ensure that the medication or solution doesn’t have too high or too low a pH or tonicity.
Jackson (1998) states that peripheral intravenous cannulation is one of the most prevalent invasive procedures in health care today. Problems such as phlebitis continue to affect patient care. Having an awareness of the types of phlebitis and the causes can improve patient care by preventing unnecessary and often expensive intravenous interventions.
Source: Google
Prevention measures include:
* Adhering to aseptic technique during insertion, dressing changes, mixing or drawing up of solutions or
medications, accessing ports or hubs on IV equipment
* Cannula site rotation
* Using the smallest gauge cannula in the largest vein
* Adequate securement of the IV device
* Close and regular monitoring of the IV site
* Patient education of the signs and symptoms of phlebitis
* IV device selection – When to Pick a PICC!
* Following guidelines on dilution of solutions to prevent particulate matter and to ensure that the medication or solution doesn’t have too high or too low a pH or tonicity.
Jackson (1998) states that peripheral intravenous cannulation is one of the most prevalent invasive procedures in health care today. Problems such as phlebitis continue to affect patient care. Having an awareness of the types of phlebitis and the causes can improve patient care by preventing unnecessary and often expensive intravenous interventions.
