Infective phlebitis can have significant ramifications for the patient due to the potential development of systemic sepsis.
After insertion, the cannula should be dressed to minimise movement in the vein lumen, which could lead to mechanical phlebitis. 10. Randle J et al (2009) Oxford Handbook of Clinical Skills in Adult Nursing. 3. Instruct client to avoid rubbing and massaging the affected extremity. Microorganisms are not able to move freely between hosts by themselves – they require either direct physical contact with a new host, or they use another person, animal or inanimate object, to gain access. Evidence suggests that the addition of drugs such as heparin and hydrocortisone can reduce the incidence of phlebitis (Ikeda et al, 2004); patients on intravenous steroid therapy have a lower incidence of phlebitis (Kohno et al, 2009). Nursing diagnosis for postpartum thrombophlebitis: altered peripheral tissue perfusion may be related to interruption of venous flow possibly evidenced by edema of affected extremity; erythema (superficial thrombophlebitis) or pallor and coolness (DVT), diminished peripheral pulses, pain. Note guarding of extremity.
Pyrexia and haemodynamic deterioration of an unknown origin should prompt investigation into cannula infection and potential systemic sepsis. To avoid chemical phlebitis, the possibility of bringing drug pH or osmolarity in line with physiological ranges should be explored (Kuwahara et al, 1999). 5. Dougherty L, Lister S (2008) The Royal Marsden Hospital Manual of Clinical Nursing Procedures. NURSING PRIORITIES Nursing Standard; 21: 47, 43-48. Catton JA et al (2006) The effect of heparin in peripheral intravenous nutrition via a fine-bore midline: a randomised double-blind controlled trial. Reis PED et al (2009) Pharmacological interventions to treat phlebitis, systematic review. I have been suffering from (HERPES) disease for the last four years and had constant pain, especially in my knees. American Journal of Nursing; 103: 2, 55-60. Calf vein involvement of DVT is usually associated with absence of edema; mild to moderate edema suggests femoral vein involvement, and severe edema is characteristic of ileofemoral vein thrombosis. Rationale: Reduces discomfort associated with muscle contraction and movement. The VIP score is recommended in the Infusion Nursing Standards of Practice (INS, 2011). Rapidly empties superficial and tibial veins and keeps veins collapsed, thereby increasing venous return.
An unhygienic environment can harbour micro-organisms and facilitate their contamination and spread (Randle et al, 2009).
Journal of Infusion Nursing; 32: 3, 145–155. Good practice during insertion will also extend the life of the cannula. Note: Client may remain symptom-free and undiagnosed until emboli develop.
It often occurs when the size of the cannula is too big for the selected vein (Martinho and Rodrigues, 2008). Oxford: Oxford University Press. Isotonic fluids have been found to lower rates of phlebitis, while hypertonic fluids increase the incidence of phlebitis by initiating the inflammatory response (Uslusoy and Mete, 2008). Rationale: Produces increased negative pressure in thorax, which assists in emptying large veins. Keywords Phlebitis, Venous catheter, Infection control. 3. 2. These include intravenous antibiotic administration, intravenous fluids, intravenous pain relief and/or total parenteral nutrition (TPN). Desired Outcomes: 1. The commonest symptoms of any form of phlebitis are erythema and swelling along the venous track, leading to hardened, cord -like veins (Endacott et al, 2009). Engage in behaviors/activities to enhance tissue perfusion. 5. This type of phlebitis can be avoided by selecting the smallest possible device for the largest vessel (although some studies such as Uslusoy and Mete (2008) have suggested that catheter size is not a significant causative factor). Clinical staff, especially those in close physical contact with patients, can act as a portal for disease-causing organisms, facilitating their spread between patients and the clinical environment. Nursing diagnosis for postpartum thrombophlebitis: altered peripheral tissue perfusion may be related to interruption of venous flow possibly evidenced by edema of affected extremity; erythema (superficial thrombophlebitis) or pallor and coolness (DVT), diminished peripheral pulses, pain. Journal of Toxicological Sciences; 24: 2, 113-121.
If intravenous therapy is indicated for longer periods, central venous access will be required. The initial treatment for any form of phlebitis is to stop the infusion and remove the PVC (Webster et al, 2010). Free Samples of Nursing Care Plan, Nursing Diagnosis and Nursing Intervention with Rationale.
Journal of Infusion Nursing; 29: 6, 338-345. Another risk factor is poor skin cleansing technique before cannula insertion. Observe extremity for color; inspect from groin to foot for edema. The incidence of phlebitis can be reduced by use of simple measures. Nurses are well placed to assess for the presence of phlebitis and act accordingly. 7.Initiate active or passive exercises while in bed (e.g., flex/extend/rotate foot periodically). 1. Nursing Diagnosis for Thrombophlebitis | Impaired ... Fear/Anxiety | Nursing Care Plan for Lung Cancer. The doctor orders IV fluids, a central line and indwelling catheter for a patient admitted with a gunshot wound. Encourage deep-breathing exercises.
Loewenstein R (2011) Treatment of superficial thrombophlebitis.
Recommend increased fluid intake to 2000+ ml/day. A significant number of patients admitted into hospital receive some form of intravenous therapy via PVC. TPN is hypertonic but its osmolarity can be adjusted without affecting the pharmacodynamics of the solution, which, alongside the addition of drugs such as heparin, has been shown to increase the life of a fine bore midline cannula (Catton et al, 2006). Rationale: Physical restriction of circulation impairs blood flow, thus increasing venous stasis, pain, and trauma. They can help reduce the progression of phlebitis through early detection.
Royal College of Nursing (2010) Standards for Infusion Therapy. This broad range has also been reported in studies from other countries (Uslusoy and Mete, 2008) and suggests poor identification of phlebitis or poor reporting protocols. Uslusoy E, Mete S (2008) Predisposing factors to phlebitis in patients with peripheral intravenous catheter: a descriptive study. Malach T et al (2006) Prospective surveillance of phlebitis associated with peripheral intravenous catheters. It has also been suggested that placement of a cannula near a joint or venous valve will increase the risk of mechanical phlebitis due to irritation of the vessel wall by the tip of the cannula (Macklin, 2003). Martinho RFS, Rodrigues AB (2008) Occurrence of phlebitis in patients on intravenous amiodarione. Report that pain or discomfort is alleviated or controlled. Anti-inflammatory analgesics can be prescribed to treat both the inflammation and the pain associated with phlebitis. Loewenstein R (2011) Treatment of superficial thrombophlebitis. 3. American Journal of Nursing… Desired Outcomes:
International Journal of Medical Sciences; 6: 4, 218-223. Administer medications, as indicated, for example, analgesics (opioid and nonopioid) and antipyretics, such as acetaminophen (Tylenol).
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