Perceptions of risk factors for phlebitis among Malaysian nurses

Intravenous (IV) therapy is the most common invasive procedure performed in hospitals (Helm et al, 2015; Erdogan and Denat, 2016; Li et al, 2016). It is used to administer IV infusions, blood and blood products, and medicines, as well as for parenteral feeding (Pasalioglu and Kaya, 2014; Erdogan and Denat, 2016). IV therapy is frequently administered through peripheral IV devices (Pasalioglu and Kaya, 2014; Milutinovic et al, 2015).

Phlebitis is inflammation of the tunica intima of the vein caused by chemical, mechanical, or bacterial factors. The symptoms include pain, erythema (redness), oedema (swelling), induration (hardened mass or formation), palpable venous cord, and pyrexia (Higginson and Parry, 2011; Sarī et al, 2016). Phlebitis complications include bacteraemia, increasing pain, a slower recovery, extended hospital stays, and increased healthcare costs (Webster et al, 2015). Phlebitis has been recognised as the most common local complication of IV therapy administered specifically through a peripheral IV cannula (Phillips and Gorski, 2014; Bernatchez, 2014; Milutinovic et al, 2015; Erdogan and Denat, 2016). The incidence rate of phlebitis in the literature varies. It has been reported to be 31.4% in India (Mandal and Raghu, 2019), 61.5% in Portugal (Rego Furtado, 2011a; 2011b) and 31% in China (Luyu and Zhang, 2019). People aged over 60 years and females have an increased risk of developing phlebitis, and the site of insertion and the size of catheter used have also been factors in phlebitis development (Mandal and Raghu, 2019). Risk factors for phlebitis due to peripheral IV therapy are classified into four groups: cannula-related, drug-related, patient-related, and healthcare-related (Milutinovic et al, 2015). Improper cannula size and location, pharmacological properties (pH, solution osmolality), the presence of associated diseases in patients, and poor aseptic techniques can increase the risk (Milutinovic et al, 2015; Li et al, 2016). Other risk factors include patients' age, weight, prolonged immobility and duration of IV therapy (Nabili and Shiel, 2019).