Abstract : The placement of intravascular cannula for administration of fluids, drugs, blood
products and nutritional solutions is one of the most common invasive procedures performed in
hospitals. The insertion and daily use of these devices is associated with risks and complications
that can have impact on the clinical status and outcome of the patient. The present study was thus
undertaken to investigate various risk factors responsible for the infiltration and phlebitis in the
emergency department of Nehru Hospital, PGIMER, Chandigarh. Total of 168 peripheral intravenous
cannulae were included in the study using purposive sampling technique and were studied
prospectively for the after effects of the intravenous therapy and related incidents. The study revealed
incidence of infiltration and phlebitis as 31.5% and 29.8% respectively. It was found that the peripheral
intravenous cannula insertions during morning and night shifts in emergency department to patients
with medical and surgical conditions along with inappropriate aseptic technique during insertion and
handling of cannula, use of forearm as the site of insertion, involvement of elbow joint, soiling of the
cannula dressing, longer duration of cannula placement along with the use of IV infusion sets for
more than 24 hours, administration of large volumes of crystalloids and colloids at high flow rates
and medications such as antibiotics and electrolytes through the peripheral intravenous cannulae
were the most important risk factors for the development of infiltration and phlebitis. The protocol
was developed based on the findings of the study for use by the nurses and other health care
professionals who are involved directly or indirectly in the handling of peripheral intravenous cannula.
Key words :
Peripheral intravenous cannula, infiltration,
phlebitis
Correspondence at :
Ruchi Saini
Lecturer,
Swift College of Nursing,
Vill. Ghaggar Sarai, Teh. Rajpura,
Distt. Patiala, Punjab
Introduction
Each year, millions of patients admitted
in the hospitals require some form of vascular
access as a critical component of their medical
care. Vascular access devices are used for the
hemodynamic monitoring of the patient,
administration of medications, fluids,
nutritional solutions and blood products1.
22
23
24
Results
Phlebitis
(n=50)
n(%)
Grade I
Grade II
Grade III
Grade IV
53 (31.5)
6 (11.0)
38 (72.0)
6 (11.0)
3 ( 6.0)
Grade I
Grade II
Grade III
Grade IV
50 (29.8)
2 ( 4.8)
23 (46.0)
22 (44.0)
3 ( 6.0)
Others
Drop-Out
Nursing and Midwifery Research Journal, Vol-7, No. 1, January 2011
51 (30.4)
14 ( 8.3)
25
26
Infiltration
n(%)
Phlebitis
n(%)
Other
n(%)
Total
(N)
X2 test
value
*
p value
Morning
Evening
Night
26 (35.6)
18 (32.7)
09 (22.5)
15 (20.6)
13 (23.6)
22 (55)
32 (43.8)
24 (43.7)
09 (22.5)
73
55
40
14.37, df=4
p= 0.006*
PLACE
Emergency Medical OPD
Emergency Surgical OPD
22 (22.9)
31 (43.1)
34 (35.4)
16 (22.2)
40 (41.7)
25 (34.7)
96
72
8.21, df=2
p= 0.016*
PERSON
Age**
<30 yrs
30-40 yrs
40-50 yrs
>50 yrs
13 (27.7)
13 (38.2)
12 (38.7)
15 (26.8)
18 (38.3)
11 (32.4)
07 (22.6)
14 (25.0)
16 (34.0)
10 (29.4)
12 (38.7)
27 (48.2)
47
34
31
56
16.47,
df=6
p= 0.011*
41 (32.2)
12 (29.3)
42 (33.1)
08 (19.5)
44 (34.7)
21 (51.2)
127
41
4.22, df=2
p= 0.121
Disease condition
Medical conditions
Surgical conditions
22 (22.9)
31 (43.1)
34 (35.4)
16 (22.2)
40 (41.7)
25 (34.7)
96
72
8.18, df=2
p= 0.016*
Co morbidities
Present
Not present
15 (25.4)
38 (34.9)
24 (40.7)
26 (23.9)
20 (33.9)
45 (41.2)
59
109
5.5, df=2
p= 0.063
Consciousness level
GCS >10
GCS < 10
42 (30.6)
11 (35.5)
42 (30.6)
08 (25.8)
53 (38.8)
12 (38.7)
137
31
1.21, df=2
p= 0.55
TIME
Sex
Males
Females
27
Phlebitis
n(%)
Other
n(%)
Total
(N)
X2 test
value
*
p value
01 (16.7)
36 (36.0)
16 (25.8)
02 (33.3)
29 (29.0)
19 (30.6)
03 (50.0)
35 (35.0)
27 (43.5)
06
100
62
2.309, df=4
p=0.679
22 (31.4)
21 (27.3)
07 (33.3)
23 (32.9)
35 (45.4)
07 (33.3)
70
77
21
2.82, df=4
p=0.588
Insertion site
Forearm
Hand
24 (38.1)
29 (27.3)
22 (34.9)
29 (27.3)
17 (27.0)
48 (45.4)
63
105
11.62, df=4
p=0.020*
Joint Involvement
No
Yes
22 (55.0)
31 (24.2)
07 (17.5)
43 (33.6)
11 (27.5)
54 (42.2)
40
128
6.55, df=2
p=0.038*
21 (30.0)
10 (29.4)
29 (41.4)
14 (24.1)
20 (28.6)
34 (46.5)
70
58
8.02, df=2
p=0.018*
Difficulty in insertion
Yes
No
15 (42.9)
38 (28.6)
05 (14.2)
45 (33.8)
15 (42.9)
50 (37.6)
35
133
5.55, df=2
p=0.062
Securement device
Dynaplast
Leukoplast
29 (40.3)
24 (25.0)
17 (23.6)
33 (34.4)
26 (36.1)
39 (40.6)
72
96
6.74, df=2
p=0.034*
34 (47.2)
19 (19.8)
15 (20.8)
35 (36.5)
23 (31.9)
42 (43.8)
72
96
14.67, df=2
p=0.00*
Variable
Cannula size
16 G
18 G
20 G
Flush
Yes
No
28
Phlebitis
n(%)
Other
n(%)
Total
(N)
X2 test
value
*
p value
06 (17.6)
36 (34.9)
05 (14.7)
40 (38.8)
23 (67.7)
27 (26.3)
34
103
19.05,
df=2,p=0.00*
10 (33.3)
09 (21.4)
23 (35.4)
09 (30.0)
05 (11.9)
31 (47.7)
11 (36.7)
28 (66.7)
11 (16.9)
30
42
65
63
df = 4
p = 0.00
Variable
29
Infiltration
n(%)
Phlebitis
n(%)
Other
n(%)
Total
(N)
Crystalloids
39 (33.3)
40 (34.2)
38 (32.5)
117
Colloids
02 (11.1)
11(61.1)
05 (27.8)
18
Inotropes
03 (60)
02 (40)
05
Electrolytes
12(85.7)
02 (14.3)
14
Antibiotics
35 (38.9)
33 (36.7)
22 (24.4)
90
41 (32.3)
44 (34.6)
42 (33.1)
127
Table 6: The cumulative risk for infiltration and phlebitis associated with the duration of
I/V infusion set usage among peripheral intravenous cannulae
(N=81)
Duration of
I/V infusion set
usage
Infiltration (n=40)
Frequency
Cumulative
n(%)
n(%)
Phlebitis (n=41)
Frequency
Cumulative
n(%)
n(%)
1 Day
25(62.5)
25(62.5)
15(36.6)
15(36.6)
2 Days
14(35.0)
39(97.5)
08(19.5)
23(56.1)
3 Days
01(2.5)
40(100)
14(34.2)
37(90.3)
4 Days
04(09.7)
41(100)
30
31
2.
32
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
33