Male patient with phlebitis red line off IV site

Understanding and Managing Phlebitis: A Common Complication of Peripheral IV Therapy

Peripheral intravenous (PIV) therapy is widely used in clinical settings for the administration of fluids, medications, and blood products. However, one of the most frequent and concerning complications is phlebitis—inflammation of the vein wall that can lead to pain, infection, and therapy disruption.

What is Phlebitis?

Phlebitis refers to the inflammation of the tunica intima, the inner lining of the vein, typically caused by mechanical, chemical, or infectious irritation from the IV catheter or its contents. It is classified into three types:

  • Mechanical Phlebitis: Caused by catheter movement or insertion trauma.
  • Chemical Phlebitis: Triggered by irritant or vesicant medications.
  • Bacterial (Infectious) Phlebitis: Resulting from microbial contamination.

How to Identify Phlebitis

Early identification is crucial for minimizing complications. Signs and symptoms include:

  • Redness and warmth along the vein path
  • Swelling and palpable cord
  • Pain or tenderness at the insertion site
  • Increased skin temperature near the site
  • Slowed or stopped infusion flow

Many institutions use standardized phlebitis scales (e.g., the INS Phlebitis Scale) to grade severity and guide intervention.

How to Prevent Phlebitis

Prevention starts with best practices in IV therapy:

  • Use smallest-gauge catheter appropriate for therapy.
  • Choose the appropriate site, avoiding areas of flexion when possible.
  • Practice strict aseptic technique during insertion and maintenance.
  • Monitor for early signs and assess regularly. Resite catheter with any sign of complication. 

How to Treat Phlebitis

Management strategies depend on the severity:

  • Mild cases: Remove the catheter immediately, apply warm compresses, and monitor the site.
  • Moderate to severe cases: May require pharmacologic treatment (e.g., anti-inflammatory medications) and, in infectious cases, antibiotic therapy.
  • Documentation and reporting are essential for quality improvement and patient safety.

Continue Your Learning

For healthcare providers who want to deepen their understanding of safe IV practices and complication management, I highly recommend the Pedagogy Basics of Peripheral IV Therapy Course. This course offers comprehensive guidance on PIV therapy, current standards of care, and best practices for complication prevention. Looking for an IV certification course for your state? Click here!