A Closed-loop Audit On Monitoring Visual Infusion Phlebitis Score And Timely Removal Of Peripheral Venous Cannulas In Patients Within Trauma & Orthopaedics Wards

A Closed-loop Audit On Monitoring Visual Infusion Phlebitis Score And Timely Removal Of Peripheral Venous Cannulas In Patients Within Trauma & Orthopaedics Wards

Hamza Virk , Jeshwin Thamburaj, Hamna Manan
University Hospital Southampton NHS Trust, Southampton, United Kingdom

Introduction: Phlebitis, inflammation of the vein typically around IV cannula insertion site, seen as pain, redness and warmth. We care about phlebitis because it disrupts treatment, causes pain, extends stays, and can lead to complications like infection and thrombosis. Early recognition and timely removal is key to improving outcomes. Both NICE and Trust guidelines recommend appropriate documentation at insertion, regular monitoring of visual infusion phlebitis (VIP) score thrice daily and timely removal at 72 hours or 96 hours if clinically indicated.

Aim: Aimed to improve compliance in documenting cannula insertion, monitoring VIP thrice daily and appropriate removal time.

Methods: Reviewed insertion, removal and VIP monitoring records on inpatient noting system for 74 cannulas in cycle one and 66 in cycle two. A staff questionnaire identified issues before changes were made.

Results: 1st cycle showed poor compliance in monitoring VIP score (12%) and removal time target at 72* hours (50%). With introduction of visual reminders (Posters in T&O wards), daily teaching sessions and reminders during board rounds, 2nd cycle showed marked improvement in monitoring VIP score (38%) & timely removal at 72* hours (89%).

Conclusion & Discussion: Audit revealed poor compliance with the cannula care policy however, with appropriate interventions, 2nd cycle showed improvement in protocol compliance from 12% (9/74) to 38% (25/66), a statistically significant increase. (p = 0.00065). The key takeaway was that poor compliance was not just a knowledge deficit but rather a systemic barrier. In resource limited settings, routine cannula replacement at 72 hours may not be sustainable.

Keywords: Audit, Orthopaedic, Cannula