Introduction to the Visual Infusion Phlebitis (VIP) score


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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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Introduction to the Visual Infusion Phlebitis (VIP) score

  1. 1. IV Care & Management: Site MonitoringImplementing the VIP score
  2. 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)
  3. 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).
  4. 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.
  5. 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.
  6. 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).
  7. 7. Failure to monitorand document thecondition of aperipheralintravenous cathetersite may result in aclaim due to abreach in duty ofcare.
  8. 8. VIP score recommendations Gallant and Schultz (2006) state that... “The VIP scale, as evaluated in this study, wasIn 2006 Paulette considered to be a valid and reliable measure forGallant and Alyce determining when a PIV catheter should beSchultz 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 theappropriate Also, the VIP score is recommended in the Infusion Nursing Standards of Practice (INS 2011). Stating that...discontinuation ofperipheral “The Visual Infusion Phlebitis (VIP) scale has contentintravenous validity, inter-rater reliability, and is clinically feasible.catheters. This scale includes suggested actions matched to each scale score” Infusion Nurses Society (2011).
  9. 9. VIP score incorporated into national bundlesThe VIP score isaccepted as theinternational tool forthe early recognitionof infusion phlebitisand appropriateremoval of thevascular accessdevice.
  10. 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 changed
  11. 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 determiningper 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 ofwere 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.