Prevention and Management of Phlebitis

Introduction to Phlebitis Management

• The Centers for Disease Control and Prevention (CDC) recommends replacing peripheral venous catheters in adults every 72-96 hours to prevent phlebitis, as supported by the MMWR Recommendations and Reports 1
• The CDC suggests replacing administration sets no more frequently than every 72 hours, unless catheter-related infection is suspected, as per the MMWR Recommendations and Reports 1
• Tubing used for blood, blood products, or lipid emulsions should be replaced within 24 hours of initiating the infusion, as recommended by the CDC via the MMWR Recommendations and Reports 1
• The CDC advises completing the infusion of lipid-containing solutions within 24 hours of hanging the solution, and lipid emulsions alone within 12 hours of hanging the emulsion, as stated in the MMWR Recommendations and Reports 1

Catheter Maintenance and Care

• The CDC recommends cleaning injection ports with 70% alcohol or an iodophor before accessing the system, as outlined in the MMWR Recommendations and Reports 1
• Capping all stopcocks when not in use is advised by the CDC to minimize contamination risk, as stated in the MMWR Recommendations and Reports 1
• The CDC suggests minimizing contamination risk by accessing ports only with sterile devices, as recommended in the MMWR Recommendations and Reports 1
• Protecting catheters with an impermeable cover during showering can help prevent water submersion, as recommended by the CDC in the MMWR Recommendations and Reports 1
• Evaluate the catheter insertion site daily by palpation through the dressing to detect tenderness, as recommended by the CDC 1
• Visually inspect the site if a transparent dressing is used, as recommended by the CDC 1

Replacement and Removal of Catheters

• The CDC recommends replacing catheters inserted during medical emergencies with compromised aseptic technique as soon as possible and within 48 hours, as supported by the MMWR Recommendations and Reports 1
• Remove peripheral venous catheters if signs of phlebitis (warmth, tenderness, erythema, and palpable venous cord) develop, as recommended by the CDC with a Category IB recommendation 1
• Use upper extremity sites rather than lower extremity sites for catheter insertion to prevent phlebitis, as recommended by the American College of Physicians and the CDC 1
• Do not routinely apply prophylactic topical antimicrobial or antiseptic ointment or cream to the insertion site of peripheral venous catheters, as recommended by the CDC with a Category IA recommendation 1
• Avoid using steel needles for the administration of fluids and medication that might cause tissue necrosis if extravasation occurs, as recommended by the CDC 1
• The following guidelines apply for catheter type based on duration of therapy:

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• Midline catheters are suitable for solutions with pH between 5-9 and osmolarity less than 500 mOsm/L, but not for vesicant medications or solutions requiring central venous administration, as stated by the American Society of Anesthesiologists 3
• For patients with advanced chronic kidney disease (CKD stage 3b or greater, eGFR <45 mL/min), tunneled small-bore central catheters are recommended instead of midline catheters to preserve peripheral veins, as recommended by the American College of Physicians and the Infectious Diseases Society of America (IDSA) 2, 4

Special Considerations

• For patients with a history of intravenous drug use, careful risk assessment, appropriate patient selection, and implementation of specific monitoring strategies are required for PICC line placement, as recommended by the American College of Physicians 2
• For short-term therapy (≤5 days), peripheral IV catheters with ultrasound guidance may be considered as a safer alternative to PICC placement in patients with a history of IV drug use, as recommended by the American College of Physicians 2
• PICC-related bloodstream infections require prompt removal of the device, and a new PICC can be placed after documented clearance of infection, if still clinically indicated, as recommended by the American College of Physicians 2
• Enhanced monitoring protocols, including daily or frequent outpatient visits for line care and assessment, should be implemented for patients with active or recent IV drug use who receive a PICC, as recommended by the American College of Physicians 2
• Regular follow-up appointments should be scheduled to assess continued need and complications in patients with a history of IV drug use who receive a PICC, as recommended by the American College of Physicians 2