According to this study:

* Phlebitis was more likely when infusion pumps were used, catheters were inserted near the elbow, and drugs were administered more than three times daily.

Phlebitis is a common complication of intravenous therapy and results in undue pain in patients and increases in costs to the health care system. A new study (conducted by nurses) investigated the factors that most frequently led to phlebitis and identified how advanced practice nurses could encourage prevention of the problem.

The authors evaluated 568 intravenous catheter sites on 355 patients on a general surgery unit at a university hospital in Turkey. To determine possible factors related to phlebitis, the authors collected data on patients' age; sex; diagnosis; catheter size, location, and site; and types of fluids and medications infused. A phlebitis evaluation scale developed by the Infusion Nurses Society was used to categorize the degree of phlebitis observed, ranging from 0 (no phlebitis) to 4th degree (redness, pain, edema, red line, a cord-like vein more than 2.5 cm in length, and purulent discharge).

More than half (54.5%) of the catheter sites had phlebitis. First-degree phlebitis (redness or pain at the site, or both) accounted for the majority (44.5%) of these cases. The most common site for phlebitis was the antecubital area, and phlebitis was observed more often when the same arm was used for subsequent catheter placements. Catheters inserted for less than 24 hours were less likely to cause phlebitis, as were isotonic fluid infusions. The authors also found that phlebitis was more likely to occur when medications were delivered through the catheter, especially four or more times a day, and when an infusion pump was used.

Nurses should be vigilant about assessing patients with IV catheterization for phlebitis on a daily basis and educating staff on the potential risk factors. Based on these study results, site rotation, use of isotonic solutions when appropriate, and avoidance of the elbow area may be used as preventive strategies.

AK

Uslusoy E, Mete S. J Am Acad Nurse Pract 2008;20(4):172-80.