The document discusses the importance of regular evaluation and monitoring of intravenous (IV) sites to enhance patient safety and prevent complications such as infusion phlebitis. It emphasizes the use of the Visual Infusion Phlebitis (VIP) score as a validated tool for assessing IV site conditions and guiding necessary actions. Recommendations include daily checks of IV sites and documentation of any changes or actions taken to manage potential phlebitis.

1. IV Care & Management: Site Monitoring
Implementing the VIP score

2. Regular evaluation of the condition of the IV site is essential to
ensure and maintain patient safety.
“...plunging a
needle directly into
a vein can be
accomplished with
perfect ease and
safety under proper
aseptic
precautions, so that
no scar or mark of
any kind is left to
indicate the site of
injection…”.
Dutton (1924)
Image from Dutton (1924)

3. The VIP score was
developed to reduce
the incidence and
impact of infusion
phlebitis. However,
the added benefits
of site monitoring
include early
recognition of other
issues such as
infiltration or “Phlebitis should be documented using a uniform standard scale
infection. for measuring degrees or severity of phlebitis” (RCN 2010).

4. The first approach to managing infusion phlebitis is
associated with prevention. Prevention includes utilising the
smallest gauge catheter for its intended use and ensuring
Infusion phlebitis adequate blood flow past the tip of the catheter.
originates from two
main sources. One
is mechanical the
other is chemical.
By far the most
prevalent cause of
infusion phlebitis is
chemical in origin.
Early recognition of
phlebitis will help to
The second requirement associated with
maintain patient
infusion care is the detection of the earliest
safety and comfort.
signs of infusion phlebitis.

5. Blood flow in the
cephalic and basilic
veins in the upper
arms is 40 to 95ml/
min compared to
the superior vena
cava with a blood
flow of 2000 ml/min
(Stranz and
Kastango 2002).
Image from:
NAVAN (1998) Tip location of peripherally inserted central
catheters. Journal of Vascular Access Devices. 3(2), p.8-10.

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 caused
by infusates of
incorrect pH and
osmolarity occurs
frequently... The
degree of cellular
damage from either
low or high pH is
determined by the
type of tissue
exposed to the pH
and the duration of
exposure” (Stranz
and Kastango 2002).

7. Failure to monitor
and document the
condition of a
peripheral
intravenous catheter
site may result in a
claim due to a
breach in duty of
care.
http://www.kennedys-law.com/media/docs/KennedysMedicalLawBriefMarch2010_832010.htm

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).

9. VIP score incorporated into national bundles
The VIP score is
accepted as the
international tool for
the early recognition
of infusion phlebitis
and appropriate
removal of the
vascular access
device.

10. All patients with a
peripheral
intravenous access
device in place must
have the IV site
checked at least
daily for signs of
infusion phlebitis.
The subsequent
score and action(s) The cannula site must also be observed when:
taken (if any) must Bolus injections are administered
be documented.
IV flow rates are checked or altered
Solution containers are changed

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.