VIP score checklist

1. ERA LUCKNOW MEDICAL COLLEGE AND HOSPITAL,SARFRAZGANJ,LUCKNOW 226003
DAILY ASSESSMENT VISUAL INFUSION PHELIBITIS (V.I.P ) SCALE
Floor :……………………………….Ward :-------------------------------------Dept. :----------------------
DATE:
IPD NO
S.No Criteria Score Action to be
taken
Remarks
1. I.V site appears healthy 0 -No sign of
phlebitis
-Observe cannula
2 One of the following is
evident:
Slight pain near I.V.site
Or slight redness near
I.V.site
1 -Possible first
sign of phlebitis
-Observe cannula
3. Two of the following are
evident
 Pain near I.V site
 Erythema
 Swelling
2 -Early stage of
phlebitis
-Re-site cannula
4. All of the following are
evident:
 Pain long path of
cannula
 Erythema
 Induration
3 -Medium size
phlebitis
-Re-site the
cannula
-Consider the
treatment
5 All of the following are
evident:
 Pain long path of
cannula
 Erythema
 Induration
 Palpable venous
cord
4 -Advanced stage
of phlebitis or -
start of
thrombophlebitis
-Re-site the
cannula
-Consider the
treatment
6. All of the following are
evident:
 Pain long path of
cannula
 Erythema
 Induration
 Palpable venous
cord
 Pyrexia
5 -Advanced stage
of phlebitis or
-Initiate the
treatment
-Re-site the
cannula
-Consider the
treatment
Sign of performer/staff
Sign of supervisor
Sign of HOD

3. DAILY ASSESSMENT VISUAL INFUSION PHELIBITIS (VIP ) SCALE
Name of the patients:……………………………….IPD No:…………….....D.O.A :……………………
Ward :-----------------------Diagnosis :………………………………………Dept. :----------------------
Date of In-sertion : Date of Removal :
Date: Date: Date:
S.No Criteria Score Action to be
taken
M E N M E N M E N Remarks
1. I.V site appears healthy 0 -No sign of
phlebitis
-Observe cannula
2 One of the following is
evident:
Slight pain near I.V.site
Or slight redness near
I.V.site
1 -Possible first
sign of phlebitis
-Observe cannula
3. Two of the following are
evident
 Pain near I.V site
 Erythema
 Swelling
2 -Early stage of
phlebitis
-Re-site cannula
4. All of the following are
evident:
 Pain long path of
cannula
 Erythema
 Induration
3 -Medium size
phlebitis
-Re-site the
cannula
-Consider the
treatment
5 All of the following are
evident:
 Pain long path of
cannula
 Erythema
 Induration
 Palpable venous
cord
4 -Advanced stage
of phlebitis or -
start of
thrombophlebitis
-Re-site the
cannula
-Consider the
treatment
6. All of the following are
evident:
 Pain long path of
cannula
 Erythema
 Induration
 Palpable venous
cord
 Pyrexia
5 -Advanced stage
of phlebitis or
-Initiate the
treatment
-Re-site the
cannula
-Consider the
treatment
Sign of performer/staff
Sign of Incharge
Sign of Supervisor

4. In duration image
VIP Score interpretation

5. Areas to be avoid selection of IV- Cannula insertion

6. Monitoring IV site daily

7. Cnnuala replacements

8. Indicator to calculate percentage of IV infection in Hospital

9. POINT TO BE OBSERVE DAILY
i. Selection of IV site
ii. Indication of IV infusion must be checked
iii. Size of IV cannula selection to be appropriate patient vise
iv. I V site must be healthy
v. No blood steam in plaster, I V cannula site
vi. I V Site to be change with in 72 hours
vii. Every touching of IV accessories to be do five movements of hand hygiene.
viii. Every time rub and clean the adaptor/ IV site whenever open/close
ix. If IV adaptor to be means store in close containers .
x. Add alcohol
xi. Change the alcohol with 24 hours
xii. No stain/blood/dirty store of alcohol containers
xiii. Apply thumbolin/ ointment/oil.
xiv. Apply temperature to remove plaster stain