Pdf evaluation of the psychometric properties of the. As infusion phlebitis can have serious consequences for the patient, including catheterassociated. Values used to estimate the sample size were based on previous experience. To the best of our knowledge, this is the first study to demonstrate the effectiveness of the. Peripheral intravenous therapyrelated phlebitis rates in an. Phlebitis shall be documented using a uniform standard scale for. Phlebitis scale from ins standards of practice flashcards. Developed in alignment with ins infusion therapy standards of practice, fit is a valuable tool for students and practitioners at all levels of the infusion nursing specialty. Increase incidence rates of infusion related phlebitis were associated with males compared with females. The implications of osmolality, osmolarity and ph in infusion therapy. I depended on that to grade level of infiltration and used the i4 for any amount of irritatnt, vesicant or blood product. The ins scale has changed over time, with the current version being a progressive score from 0 no symptoms to 4 all symptoms present.
The vip score is recommended in the infusion nursing standards of practice ins, 2011. Prospective study of incidence and predictors of peripheral intravenous catheterinduced complications mostafa a abolfotouh,1,2 mahmoud salam,1 alaa banimustafa,1 david white,3 hanan h balkhy2,4 1king abdullah international medical research center kaimrc, 2king saud binabdulaziz university for health sciences ksauhs, 3nursing department, 4infection prevention and control department. Nurses know that phlebitis is the inflammation of the vein and is considered an adverse patient outcome. The nurses completed the instruments relatively quickly, with a mean completion time of 1. The phlebitis scale does mean something nurses know that phlebitis is the inflammation of the vein and is considered an adverse patient outcome.
Umscheid, md, msce from center for evidencebased practice, university of pennsylvania health system philadelphia, pa. See 2016 ins standard 46, page s101 practice criteria l and the corresponding references. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Januaryfebruary 2016 visual infusion phlebitis vip scale score observation 0 iv site appears healthy 1 one of the following is evident. Phlebitis is a common and painful complication of peripheral intravenous cannulation. Standards for infusion therapy anaesthesiaconference. The phlebitis scale can be used to help the nurse performing an iv infusion to describe and document any signs of phlebitis. When higher rates occur, the data should be analyzed for degree of phlebitis and potential causes to develop a performance improvement plan. To determine the incidence of peripheral intravenous therapyrelated phlebitis in an adult population, 305 peripheral iv catheter sites were observed from the time of admission of the patient or initiation of the first peripheral iv catheter to the time of the participants discharge from the facility or 48 hours after the removal of the final catheter. Infusion nurses society insinfusion nursing standards of practice. Ins standards of practice recommends that infiltration be rated using a scale as. Describe the site using the ins classification scale. According to the infusion nurses society ins standards of practice. Improving vascular access outcomes and enhancing practice.
Safe administration of vancomycin through a novel midline. Start studying phlebitis scale from ins standards of practice. According to the infusion nurses society ins standards of practice, a standardized scale that is valid, reliable, and. The phlebitis scale does mean something infusion nurse blog. Gallant p and schultz aa 2006 evaluation of a visual infusion phlebitis scale for determining appropriate discontinuation of peripheral intravenous catheters. Early recognition of phlebitis will help to maintain patient safety and comfort. Dec 01, 2012 the incidence of phlebitis in this study 11. Since 1989, the oncology nursing society ons has provided guidelines to establish a foundation for access device management. The reasons for this were several and i was the primary one suggesting and supporting this action. Guidelines for the prevention of intravascular catheter. The phlebitis scores obtained for pediatric patients who used the i. These are exciting times in the field of infusion practice. Catheter flushing protocol the infusion nurses society s infusion nursing standards of practice clearly define three purposes of catheter flushing. Phlebitis should be documented using a uniform standard scale for measuring grade and severity.
The term superficial phlebitis denotes the presence of pain and inflammation involving a vein in the absence of thrombus. As discussed in the septemberoctober speaking of standards horizontal. This scale includes suggested actions matched to each scale score ins 2011. May, 20 vascular access sites should be routinely assessed for signs and symptoms of phlebitis, as well as the severity of phlebitis. Ins practice guidelines state that an acceptable rate for short peripheral iv catheter phlebitis should be 5% or less. This guidance can reflect a range of evidence, from a preponderance of evidence and specific clinician actions. A pediatric scale referenced there is the only infiltration scale that has been tested for validity and reliabiity. I work in multiple long term care facilities and it may take hours. The incidence rate of phlebitis rise sharply after 36 hours of catheter insertion. An antiinflammatory drug, such as aspirin or ibuprofen, can help lessen the pain and inflammation of superficial phlebitis. Infusion nurses society ins recommends phlebitis rates should be less than 5%, but until phlebitis can be measured and reported in a consistent way this seems an arbitrary goal. It often occurs when the size of the cannula is too big for the selected vein martinho and. Are infusion phlebitis assessment scales reliable and.
This scale includes suggested actions matched to each scale score infusion nurses society 2011. Phlebitis was diagnosed using the infusion nurses society evaluation scale 12. The infiltration scale was moved from the standards of practice to the policy and procedure book from ins. Based on the phlebitis scale, if a patient has no erythema at the site but complains of pain would it be classified as grade 0 or grade 1.
Anybody know why ins has done away with the infiltration scale. Incredibly we found 71 different phlebitis scales using different combinations, definitions and cutoff points for 15 discrete symptoms. What solution did you use to flush, nsheparin or both. Guidelines for the prevention of intravascular catheterrelated infections 4 acknowledgments we wish to acknowledge ingi lee, md, msce and craig a. Phlebitis grading scale site observation score stageaction iv site.
Consideration of blood flow past the tip of the catheter must be viewed in association with the chemical composition of the drug to be infused. This is a perfect course book for students and a perfect companion for professionalsresearchers in. The most common grades of phlebitis were grade 1 and 2 37. The journal of infusion nursing, the official publication of the infusion nurses society. Using the infusion nursing society standards of practice as a guide, we have developed the first uk standards for infusion therapy and it is exciting to be able to launch them at the first rcn international intravenous therapy forum.
Visual infusion phlebitis score policy statement all patients with an intravenous access device in place must have the iv site checked at least daily for signs of infusion phlebitis. Medications that cause vein irritation should be infused through a midline catheter. With advances in technology, involvement in selection of the device and its insertion, maintenance and removal has become an integral part of the nurses role. Review literature on thrombophlebitis treatment with alovera. Incidence of phlebitis in patients with peripheral. Jan 01, 2016 in contrast, the infusion nurses society ins, 2011 indicated nurses should decide when to replace a peripheral iv catheter based on the following clinical assessment. The ins in the united states developed the first ins phlebitis scale in 1998 15 18. The following is an overview of the new standards and practice criteria changes as they relate to this i. Effectiveness of an intravenous protection device in pediatric. Spc insertion steps, infusionrelated phlebitis, and cvad necessity and removal. The infusion should be stopped immediately and the catheter removed at the first sign or symptom, which may include skin coolness, blanching, feelings of skin tightness, decreased mobility of the extremity, pain, or discomfort.
Participants practiced pivc placements in three sequential procedural. Ins practice guidelines state that an acceptable rate for short peripheral iv. How to prevent, identify and treat phlebitis in patients with a venous cannula. However, tests have also been made on pvcs 8 and they are recommended by the most important guidelines 2. An infusion nurse is a registered nurse who specializes in the practice of infusion. Any incidence of phlebitis greater than grade 2 should be reported to the physician and other appropriate healthcare personnel. Welcome to the first edition of the standards for infusion therapy. These phlebitis assessment scales are used to inform clinical practice and decision making, indicating to clinicians the first stages of phlebitis and when intravenous cannulas. Phlebitis note red streak indicating inflammation along vein path. Search the worlds information, including webpages, images, videos and more. Sufficient sample size is needed with preference for power analysis adding to the strength of evidence. Prospective study of incidence and predictors of peripheral.
A ph between 5 and 9 is considered appropriate for safe peripheral administration. Approximately every 5 years, the infusion nurses society publishes evidencebased practice standards. Phlebitis should be documented using a uniform standard scale for. The implications of osmolality, osmolarity and ph in.
Google has many special features to help you find exactly what youre looking for. We apologize for any delay in response times and book store orders. The phlebitis scale does mean something infusion nurse. Infusion nursing standards of practice researchgate. Evidencebased information on visual infusion phlebitis score from hundreds of trustworthy sources for health and social care. Although the infusion nurses society standards recommend that the vascular access site should be monitored for 48 hours following removal of the catheter to identify complications, little is known about the incidence of postinfusion phlebitis. The subsequent score and actions taken if any must be documented.
The degree of phlebitis was determined using the visual infusion phlebitis scale vips and was recorded every 8 hours from the start of antibiotic therapy until catheter removal. A number of literature articles have written that phlebitis can occur in as much as 2570% of patients. The implications of osmolality, osmolarity and ph in infusion therapy marc stranz, pharmd. Which diagnostic criteria are used to determine infusion phlebitis in the clinical. The incidence of phlebitis in a medical clinical unit. Jan 08, 2014 the ins scale was also assessed for acceptability and feasibility. Effectiveness of an intravenous protection device in. According to the infusion nurses societyins standards of practice.
In my practice i never see the infiltration until the iv has been dcd and the infusate is gone. The scale only provided signs and symptoms of infiltration from a piv. Start studying infiltration scale from ins standards of practice. Procedures for infusion nursing infusion therapy standards of practice 2016. Inject subcutaneously into the extravasation area within 12 hours of extravasation. Which diagnostic criteria are used to determine infusion phle.
The sites were examined using jackson standard of visual phlebitis scale once a day. Ins position paper recommendations for frequency of. The objective of this study was to verify the incidence of phlebitis in a clinical medical unit. Practice committee developed the rating scale for the.
Phlebitis was considered to be present if 1 or more of the following indicators were included in the medical record chart. How to prevent, identify and treat phlebitis in patients. Peripheral iv site rotation based on clinical assessment vs. Superficial phlebitis is usually an initial clinical diagnosis. The 15 symptoms included in phlebitis assessment scales were pain. Registered users can save articles, searches, and manage email alerts. The program features 8 learning modules that take the participant, step by step, through the essential elements of infusion therapy. For more information about the different types of phlebitis and using a phlebitis scale during iv therapy visit cne explorer for their. Ongoing observation of sites should continue for 48 post removal to detect postinfusion phlebitis.
Only two studies reported postinfusion phlebitis separately from phlebitis occurring during therapy. Vancomycin administration through a novel midline catheter. This article provides an overview of the process used in standards development, describes the format of the standards, and provides a short summary of selected standards as applied to home care. The new ins standards of practice that were published in january february of 2016 contain 5 new standards of practice, revisions to selected standards of practice, and a few modifications of practice criteria. Clinical article, clinicalprofessional book, consensus report, case report, guideline. Aug 04, 2014 according to the 2011 infusion nursing standards of practice, the low ph of intravenous vancomycin requires that it be administered through a central line.
According to the infusion therapy standards of practice, the most important. In 2011, the infusion nurses society standards of practice committee developed the rating scale for the strength of the body of evidence to provide guidance for clinicians when implementing standards of practice. Other authors did not report the source of their scale at all. According to the infusion nurses society ins standards of practice, a standardized scale that is valid, reliable, and clinically feasible should be used. The use of a scale such as the phlebitis scale is recommended to assess phlebitis since it allows standardizing the assessment and documenting. Infiltration scale from ins standards of practice flashcards. Standards of practice recommends routine assessment for signs and symptoms of phlebitis and infiltration. Prepare by diluting 5 mg phentolamine in 10 ml of 0.
Started in 1995, this collection now contains 6407 interlinked topic pages divided into a tree of 31 specialty books and 722 chapters. Phlebitis score or infusion nurses society phlebitis scale, have spawned almost innumerable variants, having been. Related documentation requirements according to the infusion nursing standards of practice ins. When a published tool such as the visual infusion phlebitis vip, 14, infusion nurses society ins 1518, maddox 19, 20, baxter 21, lipman 22 or dinley 23 scale was used, many authors did not state which version they had used, despite wide variations between different versions. For more information about the above listed phlebitis scale or the associated standards of practice visit the infusion nurses society. According to the infusion therapy standards of practice, the most important practice standards are protecting special patient populations particularly pediatric patients and managing and monitoring pivcs, joint stabilization, and phlebitis 8, 21. Introduction to the visual infusion phlebitis vip score. Vascular access sites should be routinely assessed for signs and symptoms of phlebitis, as well as the severity of phlebitis.
Slight pain near iv site slight redness near iv site 2 two of the following are evident. The practice criteria under the phlebitis standard also recommend that sites be observed for 48 hours after removal to detect postinfusion phlebitis and that patients be given written instructions about signs and symptoms to report. The vip score now recommended by the infusion nursing standards of practice ins 2011. According to the infusion therapy standards of practice. Sep 04, 2011 the visual infusion phlebitis score is a standardised approach to monitoring peripheral iv catheter sites. The study nurses reported the scales to be easy to use, taking an average of 1. Phlebitis grading scale phlebitis should be documented using a uniform standard scale for measuring grade and severity.
The fact that it encourages site observation means that it also has an impact on other peripheral iv catheter problems such as dislodgement, infiltration and infection. Use a transparent semipermeable dressing so you can see the skin distal to the tip of the catheter as well as. Phlebitis is defined as the acute inflammation of the internal lining of the vein infusion nursing standards of practice, 2000. Some studies considered phlebitis when the patient had one symptom, others used 2 or 3, or even 4 symptoms. Are infusion phlebitis assessment scales reliable and valid. The ins phlebitis and infiltration scales have been shown to be easy to use, valid, and reliable scales.
909 651 1201 467 1055 921 357 629 986 717 390 1200 31 1592 881 1638 710 57 192 1232 1574 1640 958 1037 1432 1220 642 849 1366 1509 1154 1135 1261 834 1258 146 678 1462 735 754