Immediate Questions

A. What are vital signs? Fever and tachycardia, with or without hypotension, can indicate infectious cause. Persistent tachycardia without fever may indicate ongoing dehydration and signify continued need for IV hydration.

B. What medications are being infused? Vancomycin, amphotericin, acyclovir, cephalosporins, oxacillin, meropenem, potassium chloride, phenytoin, and various chemotherapeutic agents are among the many medications that may irritate the vein wall and contribute to phlebitis.

C. How long has the peripheral IV catheter been in place? In adults, rates of bacterial colonization and phlebitis increase if peripheral IV catheters are left in place for more than 72-96 hours. Similar studies in children, however, have concluded that rates of bacterial colonization and phlebitis do not significantly increase after 72 hours. The Centers for Disease Control and Prevention (CDC) recommend leaving the peripheral catheter in place in children until IV therapy is completed or a complication, such as phlebitis, occurs.

D. Are there comorbid conditions? Neutropenia, immunosuppression, and malnutrition can delay onset of symptoms and increase risk for phlebitis. Patients with peripheral neuropathies may be unaware of the pain associated with phlebitis.

E. Does patient still need the IV catheter? Peripheral catheters should be removed when no longer essential.

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