Phlebitis Rates in Trauma Patients: Peripheral Intravenous Catheters Started In or Outside the Emergency Department
Ligia J. Zarate College of Nursing Master of Science Peripheral catheter-related phlebitis is the inflammation of a superficial vein that can lead to infection or thrombus formation if untreated. About 150 million peripheral intravenous catheters (PIVC) are inserted in the United States each year with phlebitis rates reported between 5% and 70%. Many PIVCs are started on trauma patients, but the rate of phlebitis in trauma patients whether the PIVC is started outside the emergency department (ED) or inside the ED is unknown. Therefore, the purpose of this pilot study was to determine phlebitis rates in trauma patients when PIVC's are started inside or outside the emergency department. Variables investigated, which may influence phlebitis rates were duration of time the catheter was in place, the anatomical placement site of the PIVC, the catheter gauge, where the PIVC initially was placed (inside or outside the ED), and the injury severity score (ISS). This was a prospective descriptive design. Results indicated 432 catheters were placed inside or outside the ED in trauma patients that met the inclusion criteria. The overall phlebitis rate was 5.79 %. The rate of phlebitis when the PIVC was started inside the ED was 2.92%. The rate of phlebitis when the PIVC was started outside the ED was 6.94%. If the PIVC was started outside the ED by EMTs the rate was 6.09%. When the PIVC was started outside the ED by paramedics the rate was 7.78%. There was no significant difference in rates of phlebitis according to where the PIVC was started when a Chi Square analysis was performed. No variables predicted phlebitis no matter where the PIVC was started when regression analyses were conducted. The rate of phlebitis in PIVCs started in the ED, or by EMTs or Paramedics outside the ED in this study was similar to and low according to the literature. The Center for Disease Control and Prevention (CDC) suggests removal of the PIVC within 48 hours if placed under emergency situations. However in this study, phlebitis rates of trauma patients meet the benchmark of best practice and perhaps removal of the PIVC within 48 hours should be reconsidered. Complete documentation of medical records was 87.4%. However, best practice of recording information and patient response to treatment should be higher.
Phlebitis, Peripheral, Intravenous, Trauma, Injury Severity Score (ISS), Nursing
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