Choice of Vascular Access in Critically Ill Patients: Is It Time to Consider the Risk of Drug-Induced Phlebitis?

Phlebitis is a frequent and clinically significant complication in critically ill patients receiving intravenous therapy. While mechanical and infectious causes are well recognised, the contribution of drug physicochemical properties remains underappreciated in vascular-access decision-making.

The purpose of this manuscript is to review the potential risk of phlebitis of commonly used drugs in the ICU according to a previously published algorithm and thus determine the prevalence of drugs with a high risk of phlebitis in order to choose the optimal vascular access that allows reducing the risk.

Literature review. We analysed the physicochemical properties (pH, osmolarity, concentration and anticipated duration of infusion) of frequently used drugs in the Intensive Care Unit (ICU). Data were extracted from technical datasheets and peer-reviewed publications from PubMed and Google Scholar and classified using the Manrique-Rodríguez phlebitis-risk algorithm.

Sixty-one drugs were analysed. Overall, 32.7% of the drugs were classified as high phlebitis risk. Among these, 13.1% were according to osmolarity criteria (greater than 600 mOsm/L) and 19.6% due to extreme pH values (less than 4 or more than 9). Both situations require the use of central venous catheter (CVC) or peripherally inserted central catheter (PICC) for its administration.

The prevalence of drugs with a high risk of phlebitis in intensive care units is elevated. Drug physicochemical properties significantly influence the risk of phlebitis and should be incorporated into bedside vascular-access selection.

This review provides critical care nurses with a practical, pharmacology-based framework to guide vascular-access decisions, reduce phlebitis risk and optimise patient safety.