Authors reported testing inter‐rater reliability, but actually assessed criterion validity. It is also possible that there are newer phlebitis scales in use and as yet unpublished. This section describes the psychometric adequacy of those three scales: VIP scale, INS phlebitis scale and PVC ASSESS. In any event, the reported kappa was 0.45, which is considered ‘moderate’ using Landis and Koch's 81 standards (kappas of 0.21–0.40 are ‘fair,’ 0.41–0.60 are ‘moderate,’ 0.61–0.80 are ‘substantial,’ and 0.81 and greater are ‘almost perfect’). Reported phlebitis incidence varied dramatically for studies using a scale – from 0% 44 to 91% 45. The regular clinical use of a phlebitis tool is believed to provide a trigger, alerting nurses to take action if problems occur 92. Inter‐rater reliability assessed. Oxford: Blackwell Publications. Prevention and Management of Phlebitis. evidence that two separate measures of a construct are correlated) rather than criterion validation. Oxford: Oxford University Press. The selection of appropriate measurement tools is essential to clinical practice 100. One of the most serious complications – although fortunately rare – is septic thrombophlebitis, a condition characterised by venous thrombosis and inflammation in the presence of bacteraemia (Mermel et al, 2009). ... provider’s phlebitis risk assessment tool to ensure . In the UK in 1998, Jackson 14 published guidelines for scoring phlebitis based on an adaptation of the Maddox method and a scale developed by Lundgren and colleagues in 1993 48, which was relabelled the VIP score. DOI: 10.1002/14651858.CD007798.pub2. 851 PIVC in 513 adult cardiac surgical and cardiothoracic patients, Research IV team nurses trained in VIP scale. The area can feel warm and patients may experience pain or discomfort during drug administration (nurses should assess if this pain persists between administrations). The reference lists of these articles were checked for other studies of potential relevance, and these were also retrieved. Pandero A et al (2002) A dedicated intravenous cannula for postoperative use: effect on incidence and severity of phlebitis. Frequency of reported assessment ranged from every PIVC access for medication or infusion, to twice daily, daily or second daily assessment. Journal of Infusion Nursing: 34, 2, 117–123. If left untreated, it can lead to infection or thrombus formation (Royal College of Nursing, 2010). If left untreated, it can lead to infection or thrombus formation (Royal College of Nursing, 2010). Content validity and feasibility assessed. The Phlebitis Scale was developed by the Infusion Nurses Society (2006). The team did undertake an assessment of acceptability and feasibility. They monitored 851 PIVCs in 513 cardiac surgical patients in one hospital. Only 11 of the items measure phlebitis symptoms – 5 based on patient reports (pain, tenderness, communicating) and 6 based on nurse observation. None of the existing scales has been subjected to rigorous and thorough psychometric testing. These phlebitis assessment scales are used to inform clinical practice and decision making, indicating to clinicians the first stages of phlebitis and when intravenous cannulas should be replaced (Creed and Spears, 2010). Visual Infusion Phlebitis (VIP) Scale Score Observation 0 IV site appears healthy 1 One of the following is evident: • Slight pain near IV site • Slight redness near IV site 2 Two of the following are evident: • Pain at IV site • Erythema • Swelling 3 All of the follwoing signs are evident: • … Of the 180 studies that reported measuring phlebitis incidence and/or severity, 101 (56%) used a scale and 79 (44%) used a definition alone. This study was the only one in which intra‐rater reliability (constancy of assessment by the same rater over time) was evaluated. Phlebitis has been linked with inappropriate catheter insertion sites and inappropriate catheter usage. Seventy‐one phlebitis assessment scales including 15 symptoms were identified. It would be advantageous to replicate this research in additional centres and with a better ‘gold standard’ phlebitis criterion, such as evaluation of patients by an infusion expert. Assessors ranged from ward nurses, research nurses, experienced IV teams, medical students, doctors, to independent IV assessors. During the 1980s and early 1990s, several researchers used the Maddox scale or a slightly modified version of it 27, 47, 53-61, but psychometric assessments were still not reported. Oxford: Oxford University Press. New England Journal of Medicine; 348: 651-656. Despite modifying the scale, the authors continued to use the label of VIP scale. Cochrane Database of Systematic Reviews; Issue 3, Art No: CD007798. No data provided. Lastly, it would be extremely useful to compare two or more scales for their psychometric adequacy in the same study. Anesthetic medications via peripheral IV route is one of the important therapies routinely offered to patients undergoing surgery with anesthesia [1] . We did not contact study authors to request potentially unpublished psychometric data. The data collection tool was a five-point phlebitis assessment scale. The VIP scale assesses the presence/absence of six symptoms: pain, erythema, swelling, induration, palpable venous cord and pyrexia. Typical modifications include the addition or removal of phlebitis symptoms and variations in the scoring process, including the number of symptoms required for diagnosis and changes to the numerical scale. Inter‐rater reliability and feasibility assessed. Keywords Phlebitis, Venous catheter, Infection control. This likely contributes to the wide variation in reported phlebitis incidence, which precludes meaningful comparison of studies. Many phlebitis scales exist, but none has been thoroughly validated for use in clinical practice. Inter‐rater reliability of phlebitis assessment using PIVC assessment tool, Inter‐rater and intra‐rater reliability assessed; content validity informally assessed; acceptability and feasibility assessed, 514 medical and surgical patients at 4 hospitals, Incidence of IV site symptoms, and associated patient and practice factors, Incidence and severity of phlebitis in patients given peripherally infused amiodarone, Every 4 hours until 24 hours after infusion ceased. Although there are dozens of phlebitis assessment instruments, formal evaluations of their measurement properties are rare. No data provided. Authors reported concurrent (criterion) validity, but actually tested convergent validity.‡‡Measurement property values are shown in the text of the paper. The treatment of phlebitis will depend to some extent on the severity of inflammation and presence of a thrombus. Frequency of symptoms reported in 71 phlebitis scales. The nurses completed the instruments relatively quickly, with a mean completion time of 1.3 minutes (range 1–15 minutes, SD 0.9 minutes) to complete both the phlebitis scale and the INS infiltration scale (the INS infiltration scale is not covered in this review). Sign in or Register a new account to join the discussion. Analyses showed that catheter indwell time, antibiotic usage, sex, and catheterization sites were significantly associated with development of phlebitis. Only erythema was reported as a phlebitis symptom in every scale. Reliability was assessed at the item level and only for the six items that required nurses' observations. Byrt et al. Visit our, Phlebitis: treatment, care and prevention, 100 years: Centenary of the nursing register, 2020: International Year of the Nurse and Midwife, Nursing Times Workforce Summit and Awards, print-friendly PDF file of the complete article, Sexual harassment against nurses: Tell us your experiences, Uganda’s pioneer midwife meets HRH The Duchess of Cambridge, Free Webinar Series: Essential Skills – Continence Care Week, How will genomics benefit my patients? I.V. The site should also be carefully selected, to avoid any bony prominences, joints and venous valves that would cause the cannula to move within the vein lumen. Post‐study, the hospital made a decision to adopt the VIP as a standardized assessment tool, which suggests they found it easy to use in clinical practice; however, no data regarding feasibility were provided. Journal of Infusion Nursing; 32: 2, 74-79. Furthermore, the scale's responsiveness was not evaluated. 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