Infusion phlebitis assessment measures: a systematic review

Abstract

Rationale, aims and objectivesPhlebitis is a common and painful complication of peripheral intravenous cannulation. The aim of this review was to identify the measures used in infusion phlebitis assessment and evaluate evidence regarding their reliability, validity, responsiveness and feasibility.MethodWe conducted a systematic literature review of the Cochrane library, Ovid MEDLINE and EBSCO CINAHL until September 2013. All English-language studies (randomized controlled trials, prospective cohort and cross-sectional) that used an infusion phlebitis scale were retrieved and analysed to determine which symptoms were included in each scale and how these were measured. We evaluated studies that reported testing the psychometric properties of phlebitis assessment scales using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines.ResultsInfusion phlebitis was the primary outcome measure in 233 studies. Fifty-three (23%) of these provided no actual definition of phlebitis. Of the 180 studies that reported measuring phlebitis incidence and/or severity, 101 (56%) used a scale and 79 (44%) used a definition alone. We identified 71 different phlebitis assessment scales. Three scales had undergone some psychometric analyses, but no scale had been rigorously tested.ConclusionMany phlebitis scales exist, but none has been thoroughly validated for use in clinical practice. A lack of consensus on phlebitis measures has likely contributed to disparities in reported phlebitis incidence, precluding meaningful comparison of phlebitis rates.

A Prospective Study to Compare Routine versus Need Based Change of IV Cannula on Development of Infusion Phlebitis in Adult Surgical Patients

“…In recent years, studies suggest that the recommendation may need to be revised in lieu of the improved in catheter design and composition. On the other hand, based on level 1 evidence, the most recent Infusion Nursing Standards of Practice and the EPIC3 National Evidence Based Guidelines recommend that short peripheral catheters should be replaced when clinically indicated, unless the patient is receiving parenteral nutrition peripherally [15,16]. The projected 5-year savings from implementing clinically indicated peripheral intravenous catheter removal policies is US$300 million and 1 million health-worker hours in the United States alone [17,18].…”

Complications of Peripheral Venous Access Devices: Prevention, Detection, and Recovery Strategies

“…6 SPCs are often described as the most commonly used VAD in health care. 6,8,32 Peripherally Inserted Central Catheters…”

“…[1][2][3]27,32,43 Reported rates of SPC-associated phlebitis vary widely among different populations of patients and are often not comparable because of variations in the definition of phlebitis. 2,3,6 Phlebitis may develop up to 48 hours after an SPC is removed.…”

Translation and adaptation of the Phlebitis Scale for the Portuguese population

“…However, the studies report rates between 7% and 68.9% (Abolfotouh et al, 2014;Oliveira, 2014;Pasalioglu & Kaya, 2014;Webster et al, 2015). The variability of results concerning phlebitis incidence may be due to the lack of consensus on the measures used for assessing phlebitis, preventing the meaningful comparison of phlebitis rates (Ray-Barruel et al, 2014). Thus, the use of quality indicators seems to be important to improve the quality of care in order to monitor, measure, and compare, both internally and externally, the obtained results.…”

“…A systematic literature review identified 71 scales for phlebitis assessment. However, not all of them were analyzed in psychometric studies, which may lead to differences in the incidence of phlebitis, hampering comparison (Ray-Barruel, Polit, Murfield, & Rickard, 2014). According to the same study, the most widely used phlebitis scales are the Phlebitis Scale, the Visual Infusion Phlebitis, the Baxter Scale, and the Maddox Scale (Ray-Barruel et al, 2014).…”