Notes to support the presentation 'Introduction to the Visual Infusion Phlebitis (VIP) score'
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Notes to support the presentation 'Introduction to the Visual Infusion Phlebitis (VIP) score'

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Notes to support the VIP score presentation. ...

Notes to support the VIP score presentation.

The Visual Infusion Phlebitis score is a standardised approach to monitoring peripheral IV catheter sites.

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.

The innovation of this tool is the recognition of the visual nature of peripheral IV problems and the subsequent benefits of a visual tool to identify these issues early.


As health care workers we have a duty of care to monitor the condition of a patients IV site.

Failure to monitor IV sites is seen as failure in duty of care.

The VIP score is internationally acknowledged as a proven standardised tool for the monitoring of peripheral IV catheter sites.

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  • 1. IV Care & Management: Site Monitoring Implementing the VIP scoreNotes:Premature peripheral IV catheter failure poses a significant problem that negativelyaffects patient treatment and safety.One of the contributing factors to premature peripheral IV catheter failure is the issueof infusion phlebitis.Phlebitis rates vary in the literature. Mowry and Hartman state that phlebitis ratescan range up to 27%.
  • 2. Regular evaluation of the condition of the IV site is essential to ensure and maintain patient safety. “...plunging aneedle directly intoa vein can beaccomplished withperfect ease andsafety under properasepticprecautions, so thatno scar or mark ofany kind is left toindicate the site ofinjection…”. Dutton (1924) Image from Dutton (1924)Notes:IV care has been part of healthcare for more than a century.Dutton (1924) began the journey to better IV safety in 1924. He talked about safetyreduction in scars and marks associated with the therapy.Every healthcare worker needs to identify how they can contribute to a reduction inpremature peripheral IV catheter failure.
  • 3. The VIP score wasdeveloped to reducethe incidence andimpact of infusionphlebitis. However,the added benefitsof site monitoringinclude earlyrecognition of otherissues such asinfiltration or “Phlebitis should be documented using a uniform standard scaleinfection. for measuring degrees or severity of phlebitis” (RCN 2010).Notes:The Visual Infusion Phlebitis score is a standardised approach to monitoringperipheral IV catheter sites.The fact that it encourages site observation means that it also has an impact onother peripheral IV catheter problems such as dislodgement, infiltration andinfection.The innovation of this tool is the recognition of the visual nature of peripheral IVproblems and the subsequent benefits of a visual tool to identify these issues early.
  • 4. The first approach to managing infusion phlebitis is associated with prevention. Prevention includes utilising the smallest gauge catheter for its intended use and ensuringInfusion phlebitis adequate blood flow past the tip of the catheter.originates from twomain sources. Oneis mechanical theother is chemical.By far the mostprevalent cause ofinfusion phlebitis ischemical in origin.Early recognition ofphlebitis will help to The second requirement associated withmaintain patient infusion care is the detection of the earliestsafety and comfort. signs of infusion phlebitis.Notes:The insertion of appropriate vascular access devices will make significantreductions in the incident of infusion phlebitis.This must be supported by the introduction of a standardised tool for the monitoringof peripheral IV sites.
  • 5. Blood flow in thecephalic and basilicveins in the upperarms is 40 to 95ml/min compared tothe superior venacava with a bloodflow of 2000 ml/min(Stranz andKastango 2002). Image from: NAVAN (1998) Tip location of peripherally inserted central catheters. Journal of Vascular Access Devices. 3(2), p.8-10.Notes:As we mentioned earlier prevention of phlebitis is the primary concern.Consideration of blood flow around the tip of the catheter is important tounderstand.Blood flow in the veins of the arms may be as little as 40ml/min (Stranz andKastango 2002).During the administration of irritant drugs the reduced blood flow may result in anincreased incidence of infusion phlebitis.
  • 6. Table from: Stranz, M. and Kastango, E.S. (2002) A review of pH and osmolarity. International Journal of Pharmaceutical Compounding. 6(3), p.216-220."...phlebitis causedby infusates ofincorrect pH andosmolarity occursfrequently... Thedegree of cellulardamage from eitherlow or high pH isdetermined by thetype of tissueexposed to the pHand the duration ofexposure” (Stranzand Kastango 2002).Notes:Consideration of blood flow past the tip of the catheter must be viewed inassociation with the chemical composition of the drug to be infused.A pH between 5 and 9 is considered appropriate for safe peripheral administration.However, Stranz and Kastango (2002) describe how a phlebitic episode dependsupon the type of tissue that the drug is coming into contact with. They furtherdescribe “In vitro experiments have demonstrated that solution pH values of 2.3 and11 kill venous endothelium cells on contact.”
  • 7. Failure to monitorand document thecondition of aperipheralintravenous cathetersite may result in aclaim due to abreach in duty ofcare. http://www.kennedys-law.com/media/docs/KennedysMedicalLawBriefMarch2010_832010.htmNotes:As health care workers we have a duty of care to monitor the condition of a patientsIV site.Failure to monitor IV sites is seen as failure in duty of care. The VIP score isinternationally acknowledged as a proven standardised tool for the monitoring ofperipheral IV catheter sites.
  • 8. VIP score recommendations Gallant and Schultz (2006) state that... “The VIP scale, as evaluated in this study, was In 2006 Paulette considered to be a valid and reliable measure for Gallant and Alyce determining when a PIV catheter should be Schultz completed removed” Galant and Schultz (2006). an evaluation of the The VIP score is the tool recommended by the RCN (2010) VIP score as a tool and the Department of Health (2010) in the UK. that determines the appropriate Also, the VIP score is recommended in the Infusion Nursing Standards of Practice (INS 2011). Stating that... discontinuation of peripheral “The Visual Infusion Phlebitis (VIP) scale has content intravenous validity, inter-rater reliability, and is clinically feasible. catheters. This scale includes suggested actions matched to each scale score” Infusion Nurses Society (2011).Notes:The VIP score empowers healthcare workers. IV catheters can be removed at thefirst indication of phlebitis.The VIP score is recommended by the Department of Health (UK), INS (US) and RCN(UK). It is also used in many other countries and has been translated into a numberof languages.
  • 9. VIP score incorporated into national bundlesThe VIP score isaccepted as theinternational tool forthe early recognitionof infusion phlebitisand appropriateremoval of thevascular accessdevice.Notes:Here we have an example of a peripheral IV care bundle for the Department ofHealth (UK).
  • 10. All patients with aperipheralintravenous accessdevice in place musthave the IV sitechecked at leastdaily for signs ofinfusion phlebitis.The subsequentscore and action(s) The cannula site must also be observed when:taken (if any) must Bolus injections are administeredbe documented. IV flow rates are checked or altered Solution containers are changedNotes:The VIP score is based around a traffic light system of site monitoring.0 = Site is healthy.1 = Extra vigilance required. Closely monitor the IV site as infusion phlebitis maysoon develop.2 = First signs of early phlebitis. Remove short peripheral IV device.3 - 5 = Established phlebitis of increasing degrees of severity.Removal of vascular access devices at VIP stage 2 should ensure that extremelevels of phlebitis rarely occur.
  • 11. References Danchaivijitr, S., Srihapol, N., Pakaworawuth, S., Vaithayapiches, S., Judang, T., Pumsuwan, V. and Kachintorn, K. (1995) Infusion-related phlebitis. Journal of the Medical Association of Thailand. 78, Suppl 2:S85-90. Department of Health (2010) High impact intervention: Peripheral intravenous cannula care. DH, London. Danchaivijitr et al Dutton, W.F. (1924) Intravenous Therapy: Its application in the modern practice of medicine. F.A. Davis Company, Philadelphia. (1995) states 34.1 Gallant P and Schultz AA (2006) Evaluation of a visual infusion phlebitis scale for determining per cent of infusions appropriate discontinuation of peripheral intravenous catheters. Journal of Infusion Nursing. vol. 29, no. 6, p. 338-45. are interrupted by INS (2011) Infusion Nursing Standards of Practice. Journal of Infusion Nursing. Supplement. 34(1s). complications of Jackson A. (1998) A battle in vein: infusion phlebitis. Nursing Times. 94 (4), p.68-71. which 6.2 per cent Jackson A. (2003) Reflecting on the nursing contribution to vascular access. British Journal of were infusion Nursing. 12(11), p.657-665. phlebitis. Mowry, J.L. and Hartman, L.S. (2011) Intravascular thrombophlebitis related to the peripheral infusion of amiodarone and vancomycin. Western Journal of Nursing Research.33(3), p. 457-471 NAVAN (1998) Tip location of peripherally inserted central catheters. Journal of Vascular Access Devices. 3(2), p.8-10. RCN (2010) Standards for infusion therapy. Royal College of Nursing, London. Stranz, M. and Kastango, E.S. (2002) A review of pH and osmolarity. International Journal of Pharmaceutical Compounding. 6(3), p.216-220.Notes:Every short peripheral IV catheter should be monitored and the findingsdocumented.The VIP score essentially facilitates the removal of short peripheral IV catheters atthe earliest signs of infusion phlebitis.