How to Prevent Phlebitis

8/3/2019 How to Prevent Phlebitis

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How to prevent phlebitis

by Angeles, Tess

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PHLEBITIS, A COMMON BUT USUALLY avoidable

complication of I.V. therapy, is an inflammation of one or

more layers of the vein wall. Irritation of the innermost layer,

the tunica intima, causes tenderness-the first symptom of

phlebitis. By the time you see skin color changes (redness),

the irritation has progressed to include the tunica media,

tunica adventitia, dermis, and epidermis. (See illustration.)

On palpation, the vein may be hard and cordlike (a late sign).

The best way to prevent phlebitis is to change the I.V. site

before inflammation occurs. The Intravenous Nurses Society

standard of practice is to change peripheral catheters and

tubing every 48 hours and intermittent I.V. tubing every 24hours.

The Centers for Disease Control and Prevention (CDC)

guidelines are slightly different. In general, the CDC

recommends changing catheters every 48 to 72 hours. The

I.V. tubing should be changed no more frequently than every

72 hours, unless clinically indicated or the catheter is

changed sooner. However, the CDC recommends replacing

tubing used to administer blood, blood products, or lipid

emulsions within 24 hours of initiating the infusion, and

replacing catheters inserted under emergency conditions

within 24 hours.
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Of course, you should remove a catheter immediately if you

suspect infiltration, phlebitis, or contamination. Restart the

I.V. infusion at a higher site or in the other arm. Documerit

what you saw, what you did, and any comments from the

patient.

Postinfusion phlebitis can develop up to 96 hours after

catheter removal, so continue to assess the I.V. access site

for signs of phlebitis after the catheter has been removed.

For tips on preventing and treating phlebitis, see the

following chart.

BY TESS ANGELES, RN, BSN Vice-President PerivascularNurse Consultants, Inc. - Rockledge, Pa.

Copyright Springhouse Corporation Jan 1997

Provided by ProQuest Information and Learning Company. All

rights Reserved

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Protect yourself and others from infectious agents byfollowing these updated guidelines.

If you've ever been confused by words Universal

Precautions, Body Substance, ilosaltion precautions, and

similar infection-control terms, fret no more. Recently, the

Centers for Disease Control and Prevention (CDC) and the

Hospital Infection Control Practices Advisory Committee

(HICPAC) revised the isolation precautions for hospitals and

other health care facilities. To clarify the confusion and

maintain up-to-date isolation precautions nationwide, the

CDC and HICPAC have standardized terminology, simplified

precautions, and reclassified certain infections. Here's what

you need to know.
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First up: "Standard" precautions

The new term standard precautions incorporates features of

universal blood and body fluid precautions and body

substance isolation (BSI) precautions. Use standardprecautions when performing procedures that may require

contact with blood, body fluids, secretions (except sweat),

excretions, nonintact skin, and mucous membranes or any

item soiled or contaminated with any of these substances.

Apply standard precautions to all patients regardless of

diagnosis and infection status. To protect yourself and

others, follow these guidelines:

1. Wash your hands before and after performing invasive

procedures and after touching blood, body fluids, secretions,

excretions, and contaminated items, even if you were

wearing gloves during the procedure. Also wash your hands

between patients and whenever indicated. Use a dry paper

towel to turn off the water after washing your hands under a

hand-operated faucet.

2. Always wear gloves during procedures that may involvecontact with any patient's blood, body fluids, secretions,

excretions, nonintact skin, and mucous membranes. Also,

wear gloves during all vascular access procedures,

including phlebotomy. Remove gloves promptly after use,

before touching noncontaminated surfaces and other

patients, then wash your hands.

Remember, gloves may have unnoticeable defects or gettorn or damaged during use, so washing your hands after

you remove gloves is important. Change gloves as needed.

For example, if you're caring for a patient's infected wound

and then need to care for another part of his body, remove


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your gloves, wash your hands, and put on a clean pair of

gloves.

3. Wear personal protective equipment such as fluid-

repellent gowns, protective eyewear, and face masks duringprocedures that are likely to produce splashes or sprays of

blood, body fluids, secretions, and excretions. Use a

resuscitation mask or bag to avoid mouth-to-mouth contact.

4. Avoid recapping used needles. But if you must, never

recap them with two hands or with any other technique that

involves directing the point of a needle toward any part of

your body. Instead, use either a one-handed "scoop"

technioue or a needle-recannini device that holds the needle

sheath. Don't remove used needles from syringes by hand.

Place used disposable syringes and needles, scalpel blades,

and other sharps such as broken glass, dental wires, and

trocars in designated puncture-resistant sharps containers.

5. To clean blood spills, wear *goves (and other personal

protective equipment as needed), blot the blood with paper

towels, and discard them in a designated medical waste

container. Then clean the area with a bleach solution or hos

pital-grade disinfectant.

6. Carefully review room assignments and place patients

who may contaminate the environment (such as those who

are incontinent or have diarrhea) in private rooms.

7. Handle used patient-care equipment and articles soiled

with blood, body fluids, secretions, and excretions carefully,

preventing skin and mucous membrane exposure, clothing

contamination, and the transfer of microorganisms to other

patients and environments. Also, clean reusable items

appropriately between patients and properly discard


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disposable items. Remember to wear appropriate barriers

such as gloves when cleaning equipment. Wear a mask and

protective eyewear if splashing is likely to occur.

Double protection

When a patient may be infected with a pathogenic

microorganism or communicable disease, or if he may be

colonized by a pathogenic microorganism, use transmission-

based precautions along with standard precautions. These

precautions revise and combine the old category-specific as

well as the old disease-specific isolation precautions (such

as respiratory isolation) into three sets of guidelines:

1. Airborne precautions. Use these when caring for patients

who have infections that spread through the air, such as

tuberculosis (TB), varicella (chickenpox), disseminated

zoster, and rubeola (measles). These pathogens, which can

remain suspended in the air for long periods, are transmitted

when a person inhales small airborne droplets or dust

particles containing the pathogen. So place an infected

patient in a negative-pressure isolation room with the doorclosed.

Wear respiratory protection (high-efficiency particulate air

[HEPA]-filter respirator or N95 respirator) when entering the

room of a patient witl suspected or known pulmonary TB. If

you're susceptible to the rubeola or varicella virus, wear

respiratory protection when entering the room of a patient

infected with either virus.Make sure a patient who has an infection that spreads by

airborne transmission wears a surgical mask when leaving

his room. Note that surgical masks filter expired air.

Respirators such as the HEPA-filter respirator and the N95

respirator filter inspired air.


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2. Droplet precautions. Apply these precautions when caring

for patients who have infections that spread by large

particle droplets containing microorganisms. These

infections, which include rubella, diphtheria, mumps,

pertussis, influenza, and the adenovirus infection in infants

and young children, are spread when an infected patient

propels droplets through the air (by coughing, sneezing, or

talking). The pathogens can infect another person if they

land on his conjunctivas, nasal mucosa, or mouth.

If a patient has this type of infection, place him in a private

room or with another patient who has the same disease.

Wear a surgical mask when coming within 3 feet of thepatient to protect yourself from contaminated droplets.

Make sure the patient wears a surgical mask when leaving

his room. Because large-particle droplets generally travel

only about 3 feet before falling from the air, special

ventilation precautions aren't necessary and you can keep

the patient's door open.

3. Contact precautions. Use these precautions when caringfor patients who are infected or colonized by a

microorganism that spreads by direct contact (skin to skin)

with the patient or by indirect contact (touch) with a

contaminated object in the infected patient's environment,

such as an instrument, needle, dressing, or bed rail.

Place a patient who has this type of infection in a private

room or with another patient who has the same illness. Weargloves when entering an infected patient's room and change

gloves as needed during care. Before leaving the patient's

room, remove your gloves and immediately wash your hands.

Wear a gown if you anticipate that your clothing may come

into contact with the patient, environmental surfaces, or


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items in the patient's room or if the patient is incontinent or

has diarrhea, an ileostomy, a colostomy, or wound drainage

not contained by a dressing. Remove the gown before

leaving the patient's room. Also, consider using dedicated

equipment when treating a patient with a multipleresistant

microorganism. For example, leave a stethoscope in the

patient's room, indicating that staff members use that

stethoscope, not their own, when caring for him.

Contact precautions are intended to contain pathogenic

microorganisms to prevent the spread of infection.

Conditions that require using contact precautions include:

gastrointestinal, respiratory, skin, or wound infections orcolonizations with multiple antimicrobialresistant

microorganisms such as vancomycinresistant enterococci

and methicillin-resistant Staphylococcus aureus

* Clostridium difficile

* respiratory syncytial virus

* hepatitis A in incontinent patients

* highly contagious skin diseases such as impetigo, scabies,

and pediculosis

* varicella and zoster (disseminated in any patient and

localized in immunocompromised patients).

When a patient with a virulent microorganism requiring

transmission-based precautions is transferred to another

unit or is sent to another area for testing, make sure:he's wearing appropriate barriers (such as a mask or

impervious dressing) and knows how to help prevent the

spread of the microorganism the transporter has taken the

necessary precautions and is wearing appropriate barriers

staff in the receiving area have been notified and understand


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the precautions to take. Keep in mind that under the new

guidelines, some infections and conditions fall into two

categories because the microorganisms are transmitted in

more than one way. For example, varicella (chickenpox) and

zoster (disseminated in any patient and localized in

immunocompromised patients) can spread through both the

airborne and contact routes. And the adenovirus infection in

infants and young children can spread through the droplet

and contact routes. If a patient has a microorganism with

two transmission routes, hang both precaution signs on his

room door.

SELECTED REFERENCE

Garner, J.: "Guideline for Isolation Precautions in Hospitals,"

Infection Control and Hospital Epidemiology. 17:(1)53-80,

January 1996. http:llWWW.splngnet.COm NURSING97,

JANUARY

BY DOROTHY BORTON, RN, CIC, BSN Infection-Control

Practitioner Albert Einstein Medical Center Philadelphia, Pa.

Copyright Springhouse Corporation Jan 1997

Provided by ProQuest Information and Learning Company. All

rights Reserved

How to Prevent Phlebitis

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