Incidence of phlebitis in heart failure admissions: a retrospective audit of peripheral venous access lines in a UK hospital
S Armstrong, I Chung, C Kemble, L Mandarano, L J AndersonAbstract
Background
Heart Failure (HF) is characterised by recurrent acute decompensation requiring inpatient treatment with intravenous (IV) therapies. Phlebitis is a common complication of peripheral venous cannulas (PVC) causing pain, requiring replacement and interruption of intravenous therapies. Reported phlebitis rates for peripheral venous devices differ significantly between studies, post infusion phlebitis rates ranging from 0 to 23% (Nickel B. et al. 2024). Rates have been shown to be higher with longer indwelling time, in females and when devices are inserted in emergency situations. Phlebitis rates specific to the HF population are not well characterised outside of the use of inotropes.
Methods
We conducted a retrospective audit of all primary coded adult HF admissions over a 15-month period (Jan’22–March’23) admitted under Cardiology with documentation of a peripheral IV line (n=401). Data collected regarding IV devices included vascular-access device type (PVC, midline or peripherally inserted central cannula (PICC)), daily device monitoring (when available) and device removal records. Phlebitis was defined as composite of any of the following: a recorded Visual Infusion Phlebitis (VIP) score of ≥2; visual assessment documented as equivalent to VIP ≥2; or device removal explicitly attributed to phlebitis. This data was then added to an existing dataset for all primary coded HF admissions collected for the NICOR national HF audit and analysed.
Results
In total, 7.7% of admissions had a recorded episode of phlebitis (n=31). The baseline characteristics of both groups and all admissions are available in figure 1. As expected, the risk of phlebitis increased with length of stay; median length of stay of 22 days with phlebitis compared to 14 without (p=0.01). Females had a higher incidence of phlebitis, accounting for 51.2% of phlebitis cases but only 39.7% of admissions. Overall all-cause mortality occurring during hospitalisation or within 30 days of discharge was 12.2% (n=49). This was significantly higher among patients who developed phlebitis during admission compared with those who did not (25.8% [n=8] vs 11.1% [n=41], p=0.016). Phlebitis remained associated with higher odds of mortality after adjustment (see figure 2).
Conclusion
In this retrospective audit evidence of phlebitis was identified in approximately one in thirteen patients. Phlebitis was associated with a significantly higher risk of all-cause mortality (during hospitalisation or within 30 days of discharge). An association that persisted after adjustment for demographic factors and markers of disease severity. The relatively small number of phlebitis events and deaths however limits statistical power and the precision of effect estimates, as reflected in the width of confidence intervals. A larger sample size will be required to confirm this association.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.