Intravenous needle phlebitis

Phlebitis is a very common disease in daily life. It not only causes great harm to the patient's physical health, but may even cause a series of diseases. It is generally caused by intravenous needles, so it is particularly important to do a good job of prevention. Prevention can be achieved through optimization of management mode, selection of puncture site and catheter, strict control of indwelling time, effective sealing method, and prevention with drugs and fresh plants.

1. Phlebitis

Phlebitis is an inflammatory response of the lining of the vein wall caused by infusion and is a common complication of intravenous infusion. Its clinical manifestations are: first, local discomfort or slight pain occurs at the puncture site, followed by redness, swelling, and burning of the local tissue, and cord-like red lines appear along the direction of the vein, and cord-like nodules can be felt. It has a great impact on patients, may cause pain, or even lead to permanent damage to blood vessels and surrounding tissues, and increase treatment costs and clinical nursing workload. Therefore, actively preventing infusion phlebitis is an important task in intravenous treatment.

2. How to prevent phlebitis caused by intravenous needles

1. Optimize management mode

Combined with relevant nursing measures to prevent phlebitis, we first assess the patient's general condition, strengthen relevant nursing care, provide education on phlebitis protection knowledge, and then conduct psychological counseling to calm the patient's emotions and enhance the patient's immunity.

Staff should be trained and assessed regularly to reduce the pain of repeated punctures for patients. Those with poor vascular conditions should be cared for by highly professional and experienced nursing staff to improve the puncture rate. Care during the puncture process: strictly control the speed of the puncture process, master the puncture technique, and reduce friction on the blood vessel wall. Ensure that the entire puncture process is carried out under sterile conditions, and ensure that the skin at the puncture site is dry before puncture. Post-puncture care: Check the puncture site regularly to see if it is firmly fixed and keep the dressing dry. At the same time, we should do the relevant nursing work on a daily basis, improve the quality of nursing, maintain the sanitary environment of the ward, disinfect frequently, adjust the room temperature to an appropriate level, and closely observe the changes in the patient's puncture site.

2. Selection of puncture site and catheter

A multicenter prospective cohort study published by Cicolini et al. in Italy showed that peripheral venous catheter puncture on the dorsum of the hand was more likely to cause phlebitis than on the antecubital fossa and forearm (all p < 0.05).

The Standards for Infusion Therapy Practice developed by the Infusion Nursing Society (INS) states that placing a short intravenous catheter in the forearm can increase the retention time and reduce complications. For the selection of puncture sites for pediatric patients, it is recommended to select the vein location that is most likely to be retained throughout the prescribed entire course of treatment, considering the veins of the hand, forearm, and upper arm below the axilla, and avoiding the antecubital area where the failure rate is higher; for infants and young children, the veins of the scalp can also be considered, and if they have not yet learned to walk, the veins of the feet can also be used; avoid the hands or fingers, or the thumb/fingers that are sucked; after the treatment of congenital heart defects in infants and young children, the blood flow to the subclavian artery may be reduced, and the veins on the right arm should be avoided.

INS pointed out that for infusion therapy lasting less than 6 days, it is recommended to use a peripheral venous short catheter. For most treatments, 20G to 24G catheters should be considered. Newborns, children and the elderly should consider using 22 to 24G catheters. When rapid blood transfusion is required, consider a larger catheter.

3. Strictly control the detention time

Phlebitis is the most common complication of indwelling catheters and usually occurs within 5 to 7 days after catheterization. The 2014 edition of my country's "Technical Operation Specifications for Intravenous Therapy Nursing" stipulates that the retention time of peripheral venous catheters in adults is 72h-96h. For phlebitis caused by chemotherapy drugs, the catheter and blood vessels should be replaced every day. The INS guidelines also point out that indwelling needles inserted in the emergency department should be replaced within 48 hours to reduce the occurrence of phlebitis.

4. Effective tube sealing method

With the development of nursing research, there are also new ways and methods to prevent complications such as phlebitis. Through research, Jiang Zhenger et al. concluded that flushing the tube with warm saline before sealing it after intravenous infusion of mannitol can reduce the incidence of phlebitis. Wang Qing et al. used a catheter pre-flushing device to seal the intravenous catheters of 104 stroke patients. The results showed that its therapeutic effect was better than 5U/ml diluted heparin saline and reduced the incidence of phlebitis.

5. Prevention with drugs and fresh plants

The occurrence of phlebitis is related to the acidity and alkalinity, osmotic pressure, concentration and toxicity of the drug itself. Drugs that can cause phlebitis include: antimicrobial drugs, chemotherapy drugs, circulatory system drugs, etc. When it is unavoidable to use some drugs that may cause phlebitis, try to take other precautions. Studies have shown that external applications of Yunnan Baiyao aerosol, Xiliutuo ointment, Jinhuangsan with honey, aloe vera and potato chips all have a positive effect on the prevention of phlebitis.

6. Application of new dressings

Studies have shown that hydrocolloid dressings can better prevent phlebitis than ordinary transparent dressings. Apply the dressing upward along the direction of the vein at the puncture point, with the lower edge of the Kanghuier hydrocolloid dressing 2cm-3cm away from the puncture point. After disinfection again, fix it with a 3M transparent patch. Adding a hydrogel dressing to ordinary transparent dressings can also significantly reduce the incidence of phlebitis. The exact effect of hydrocolloid or hydrogel dressings in preventing phlebitis deserves further exploration.