The Visual Infusion Phlebitis score is a very popular tool for monitoring infusion sites.
In 2006 Paulette Gallant and Alyce Schultz completed an evaluation of the VIP score as a tool that determines the appropriate discontinuation of peripheral intravenous catheters.
The authors state that “The VIP scale, as evaluated in this study, was considered to be a valid and reliable measure for determining when a PIV catheter should be removed” Gallant and Schultz (2006).Reference:
Gallant P and Schultz AA (2006) Evaluation of a visual infusion phlebitis scale for determining appropriate discontinuation of peripheral intravenous catheters. Journal of Infusion Nursing. vol. 29, no. 6, p. 338-45.
Infusion phlebitis originates from two main sources. One is mechanical the other is chemical. Early recognition of phlebitis will help to maintain patient safety and comfort.
pH between 5 and 9 is considered appropriate for safe peripheral administration. However, Stranz and Kastango (2002) describe how a phlebitic episode depends upon the type of tissue that the drug is coming into contact with.
They further describe “In vitro experiments have demonstrated that solution pH values of 2.3 and 11 kill venous endothelium cells on contact.”Reference:
Stranz, M. and Kastango, E.S. (2002) A review of pH and osmolarity. International Journal of Pharmaceutical Compounding. 6(3), p.216-220.
The authors conducted a number of plan-do-study-act (PDSA) cycles, during which two interventions were introduced. The first was improvement in junior doctors' awareness of the VIP score. The second component provided easy access to the VIP score in the form of bedside intentional rounding charts.
Prior to the PDSA cycle on 30% of cannulae were reviewed and documented. This rose to 100% by the end of the third PDSA cycle.Reference:
Tzolos E, Salawu A. Improving the frequency of visual infusion phlebitis (VIP) scoring on an oncology ward. BMJ Qual Improv Rep. 2014 Sep 12;3(1):u205455.w2364. doi: 10.1136/bmjquality.u205455.w2364. PMID: 26734282; PMCID: PMC4645857.
Recent evidence points to managing peripheral intravenous catheters based on clinical indication which offers opportunities for early intervention, or removal/replacement of the catheter.
Therefore, the clinically indicated approach provides an arena where peripheral intravenous catheters can be used for a long time. However, this approach must be supported by decision-making tools such as the visual infusion phlebitis score and care bundles.Reference:
Poovelikunnel TT, Duffy F, Puthussery T, Gangadharan S, McCormack F, Carpenter H, Kizhakedath M, Hawkshaw S. Clinically indicated replacement of peripheral vascular catheters: is it safe for patients? Br J Nurs. 2020 Apr 23;29(8):S4-S10. doi: 10.12968/bjon.2020.29.8.S4. PMID: 32324461.