Intravenous infusion of medication through peripheral pathways is one of the most common practices in hospitals. Although its advantages are numerous, like all invasive therapies, it is not without complications. As such, it is important to be aware of these complications and know how to prevent them.
The most common complication (despite this, it only affects a minimum percentage of patients treated) is acute post-puncture phlebitis. It is the inflammation of the vein area closest to the catheter insertion point, and may be caused by improper asepsis (bacterian phlebitis), poor catheter insertion (mechanical phlebitis), or the very nature of infused drugs (chemical phlebitis), which may sometimes have vesicant effects, which may affect the internal epithelium of the vein and cause it to become inflamed. In severe cases, it can cause a blood clot that partially or completely obstructs blood circulation, which can lead to thrombosis.
The appearance of phlebitis is an adverse effect that has negative consequences for both the patient and the health system, as it may cause an unwanted prolongation of hospital admission time. Therefore, carefully following asepsis protocols before inserting the catheter, being well aware of the patient’s clinical history, as there are both genetic factors and concomitant pathologies that can predispose a patient to phlebitis, adequately verifying the patency of the pathway and periodically monitoring the patient’s condition are fundamental precautions that must be taken to prevent phlebitis.
In addition to rigorous asepsis, it is advisable to use a transparent dressing to visually verify the condition of the canalized vein, as well as to re-disinfect and change the dressing frequently. Washing the pathway with physiological serum is also a good practice.
It is important to assess the risks of phlebitis at the time of choosing the vein in which the catheter is to be inserted. Veins that appear hard upon palpation or ones that we are not sure can be canalized must be discarded.
While in the emergency services it is usually preferred to canalize veins in the elbow flexion, when a patient is going to spend time in the hospital it is important to assess their comfort and mobility, so veins on the back of the hand are more preferable in these cases.
In any case, changes in the appearance of the canalized vein, the presence of swelling, redness, or the appearance of pain, are warning signs that should prompt us to change the peripheral pathway to avoid more serious consequences.