EVERYDAY NURSING CARE FOR ONE BILLION PERIPHERAL INTRAVENOUS CATHETERS

1.2 billion peripheral intravenous catheters (PIVC) are inserted every year across the world. Caring and monitoring of PIVCs is an important part of  nursing practice. Over half of patients admitted into hospital will have a PIVC at some point.

If a PIVC fails, the patient faces early interruption of important intravenous therapy fluids and medications. As well as having to have a new PIVC inserted with increased patient anxiety and pain.

Global guidelines recommend removal of PIVC should be based on clinical reasons. Previously the advice was that they should be changed at preset intervals.

Phlebitis, or inflammation of the vein, is a complication that occurs with PIVC. There are 71 scales that measure phlebitis. None of the scales has been properly validated.

A recent world first study looked at the signs and symptoms that are associated with phlebitis. They made over 23000 observations looking for swelling, erythema, leakage, palpable venous cord, purulent discharge, warmth, pain and tenderness. Most signs and symptoms of phlebitis occurred only occasionally or rarely.

As the authors of the study say

“Justification for the use of a certain sign/symptom to ascertain the presence of a condition relies on its diagnostic performance. In the case of phlebitis, little is known regarding which signs and symptoms are the most common, and how these findings relate to each other. “

Tenderness was observed in over 5% of the time, which was the highest amount of observed signs and symptoms. The next highest observation was swelling at 2.2%. What this means for nurses is that they should physically palpate and assess for tenderness. It is not enough to just ask about whether the patient feels pain or not.

Warmth was closely associated with tenderness and swelling. As was erythema. The authors advise that nurses should do “regular reassessment of the insertion site and early removal for signs of any complications and as soon as the (PIVC) is no longer clinically needed.”

To learn more about PIVC,

Alexandrou, Evan, et al. “International prevalence of the use of peripheral intravenous catheters.” Journal of hospital medicine 10.8 (2015): 530-533.

Mihala, Gabor, et al. “Phlebitis Signs and Symptoms With Peripheral Intravenous Catheters: Incidence and Correlation Study.” Journal of Infusion Nursing 41.4 (2018): 260-263.

NB We will be back the week commencing on Monday 15 October 2018.