Management of Phlebitis Caused by IV Insertion

Assessment and Immediate Management

• The primary management of phlebitis caused by IV insertion is to immediately remove the peripheral venous catheter when signs of phlebitis (warmth, tenderness, erythema, or palpable venous cord) develop, as recommended by the Centers for Disease Control and Prevention 1, 2
• Remove the peripheral venous catheter immediately upon identification of phlebitis signs including warmth, tenderness, erythema, or palpable venous cord, according to the Centers for Disease Control and Prevention 1, 2
• Inspect the site visually after removal of the catheter to assess the extent of inflammation, as suggested by the Centers for Disease Control and Prevention 2
• If exudate is present, submit samples for Gram staining and culture, particularly in immunocompromised patients, as recommended by the Praxis Medical Insights 3
• Clean the area with an appropriate antiseptic (preferably 2% chlorhexidine-based preparation or 70% alcohol), as recommended by the Centers for Disease Control and Prevention 4, 3

Treatment Based on Severity

• Apply appropriate sterile dressing:
  • Use sterile gauze for weeping or oozing sites, as recommended by the Centers for Disease Control and Prevention 4, 3
  • Use transparent semi-permeable dressing for dry sites, as recommended by the Centers for Disease Control and Prevention 4, 3

Prevention Strategies for Future IV Insertions

• Select catheters based on intended purpose and duration of use, as recommended by the Infectious Diseases Society of America 1, 2
• For adults, use upper extremity sites rather than lower extremity sites for catheter insertion, as recommended by the Infectious Diseases Society of America 1, 2
• Replace peripheral venous catheters at least every 72-96 hours in adults to reduce the risk of phlebitis, as recommended by the Centers for Disease Control and Prevention 2, 5
• Consider using a midline catheter or PICC when IV therapy is expected to exceed 6 days, as recommended by the Infectious Diseases Society of America 1
• Avoid steel needles for administration of fluids and medications that might cause tissue necrosis if extravasation occurs, as recommended by the Infectious Diseases Society of America 1, 2

Common Pitfalls to Avoid

• Do not delay removal of the catheter if phlebitis is suspected, as recommended by the Infectious Diseases Society of America 1, 2
• Avoid placing new catheters in the same area where phlebitis has occurred, as recommended by the Praxis Medical Insights 3
• Do not routinely apply prophylactic topical antimicrobial or antiseptic ointment to insertion sites of peripheral venous catheters, as recommended by the Centers for Disease Control and Prevention 6
• Do not submerge the affected area in water until healing is complete, as recommended by the Centers for Disease Control and Prevention 4