Phlebitis

“VENIFACTS” NEWSLETTER

June 2, 2003

 TYPES OF PHLEBITIS

Phlebitis is a common complication of IV therapy which can lead to further damage of the vein and the limb. Review the following points to prepare yourself to provide your patient with the best possible care in case a phlebitis develops. Phlebitis can occur with ANY type of catheter, whether peripheral or central, single lumen or multi-lumen, PICC or midline.

TYPE AND CHARACTERISITICS OF PHLEBITIS

Mechanical (Also called Sterile Phlebitis)

Commonly seen during first week of PICC placement. Needs treatment - not removal.

·         Redness starting at the insertion site and traveling up the vein path.

·         No drainage or irritation of insertion site.

·         Irritation caused by catheter manipulation either during insertion and/or while indwelling.

Chemical

·         Redness starting at the tip of the catheter and traveling up the vein path.

·         Irritation caused by the solution being infused.

Bacterial (Must be removed. Culture insertion site and catheter tip)

·         Redness in the area of the insertion site which is usually accompanied by purulent drainage.

·         Irritation caused by bacteria.

CAUSES:

·         Traumatic insertion, internal vein wall irritation, manipulation of catheter (mechanical).

·         Catheters not well secured and allowed to move while indwelling (mechanical).

·         TPN, irritating IV solutions and medications (chemical).

·         Poor site preparation, insertion technique, and improper dressing care (bacterial).

CONCERNS:

·         Inflamed veins can lead to venous thrombosis, venous scarring, and vein stripping.

·         Bacterial phlebitis can lead to sepsis.

All phlebitis can be painful to the patient and lead to serious vein trauma and scarring.

TREATMENT:

·         Immediately discontinue the catheter, except with sterile phlebitis with a PICC or midline..

·         Remember: This is not a suitable vein for further IV infusions.

·         Promote hemodilution of the vein by applying WET heat to the affected area.

·         Start another site above the red area or in the other limb.

·         Consider placing a PICC instead of continuing peripheral sites.

DOCUMENTATION:

Should include:

·         Explanation of the appearance of the insertion site including the redness and drainage.

·         Patient comments about how the site feels.

·         Treatment provided.

·         Plans for prevention of further phlebitis, i.e., request PICC order.

·        Incident reports are required when bacterial phlebitis is discovered.

·        Arm circumference when a PICC/midline is removed.

DID YOU KNOW?

Standards for documentation of phlebitis are provided by the Intravenous Nurses Society. Using these standards provides thorough explanation of the condition of the site and simplifies what you need to write. Since these abbreviations are part of national standards it is appropriate to use them in your documentation (P – phlebitis). Keep them handy for quick reference.