International Journal of Science and Research (IJSR) ISSN: 2319-7064 ResearchGate Impact Factor (2018): 0.28 | SJIF (2018): 7.426 Volume 8 Issue 4, April 2019 www.ijsr.net Licensed Under Creative Commons Attribution CC BY Contributing Factors of Peripheral Intravenous Catheter Related Phlebitis among Patients at a Teaching Hospital, Chitwan Basanta Thapa 1 , Laxmi Rajbanshi 2 , Govinda Prasad Dhungana 3 , Babita Devi Dahal 4 1 Associate Professor, Chitwan Medical College, School of Nursing 2 Professor, Chitwan Medical College, School of Nursing 3 Assistant Professor, Birendra Multiple Campus, Department of Statistics 4 Lecturer, Shree Medical and Technical College Abstract: Peripheral intravenous catheter-related phlebitis (PIVC) is a common procedure and significant problem in day to day clinical practice. The study aimed at finding out the incidence and contributing factors of PIVC related phlebitis among admitted patients. Prospective observational study design was used among 586 PIVC sites of 465 patients having at least one PIVC sites of general wards of Chitwan Medical College Teaching Hospital by using semi-structured interview schedule and a specific form was prepared and used to observe signs and symptoms of phlebitis. Data were statistically analyzed by using descriptive statistics and chi- square test. The study findings revealed that the overall incidence of phlebitis was at 33.44% and early stage phlebitis was 88.26%. The incidence of phlebitis was at its highest with in the first 49-72 hours. It is associated with hypertension, patient being admitted to a nephrology ward, patient received isotonic fluid and potassium chloride. Therefore, the staffs should consider these areas and the insertion site should be observed at each shift change by the care provider to prevent phlebitis as well as it is recommended to explore other factors especially infection prevention measures. Keywords: CMCTH, Incidence, PIVC, Phlebitis, Nepal 1. Introduction Intravenous cannulation is the commonest invasive procedure among hospitalized patients. [1] However, the placement of an intravenous cannula can have undesirable effects, the most common of which is phlebitis. PIVC related phlebitis is referring to the inflammation of the vein at cannula site. [2] Depending on the populations studied, the occurrence of phlebitis varies. Thus, Webster cites that the phlebitis rate ranges from 2.3% - 67%. [3] One of the more serious complications of IV therapy is bacteraemia which occurs in about 0.8% of cases. [4] Recent large trials suggest that the incidence of phlebitis per catheter in tertiary hospitals is most likely to be around 4.6%. [5] The incidence of phlebitis in Dhulikhel hospital Nepal was relatively mild at around 59.1%. [6] The study conducted in Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal, found that 79% developed thrombophlebitis highlighting the severity of the problem in that setting. [7] Various different factors have been known to contribute to the genesis of phlebitis: such as namely chemical factors (low pH, KCl, hypertonic solutions, amino acids and certain antibiotics), physical factors (catheter’s material, size of the cannula, site of insertion, duration of cannulation) etc. [8] The complication of PIVC leads to a patient's discomfort and the need of an increased medical treatment, leading to a longer stay of the patients in hospital. All of this resulting in a rise of the overall cost of treatment, and is, additionally associated with an increase in morbidity and mortality. [9] There are two phlebitis scoring systems, which should be used in routine practice to identify and treat early signs of the inflammation. [2] According to the Visual Infusion Phlebitis Score (VIP), phlebitis can be classified in different stages such as: no sign of phlebitis as 0, first sign as 1, early stage as 2, medium as 3, advanced stage or start of thrombophlebitis as 4 and advanced stage of thrombophlebitis as 5. [10] The introduction of the visual infusion phlebitis (VIP) score tool for assessment of the early signs of phlebitis, along with prompt removal of peripheral intravenous cannulas, has been very successful in reducing the incidence below the acceptable rate of 5%. [11] The findings of the study conducted by Morrison and Holt also showed the replacement of PIVC only when clinically indicated and does not increase patient risk of phlebitis when compared to the current practice of routine replacement between 72 and 96 hours in the adult patients. [12] The review found no evidence to support changing catheters every 72 to 96 hours. Catheters are changed only if there is a clinical indication like signs of infection, blockage or infiltration. To minimise PIVC- related complications, health personnel should observe the insertion site in each shift change and remove the catheter if signs of inflammation, infiltration, occlusion, infection or blockage are present, or if the catheter is not needed for further therapy. [13] And, the appropriate choice of device and site can make a significant difference in preventing phlebitis. Good infection control techniques are also crucial when it comes to preventing the condition. [2] Paper ID: ART20196992 10.21275/ART20196992 1019