Reducing peripheral intravenous catheter-related phlebitis: a multi-centre multi-component toolkit implementation study

Phlebitis is a frequent complication of peripheral intravenous catheters, leading to patient discomfort, inflammation, antibiotic use, and prolonged hospitalization. A multi-component Phlebitis Prevention Toolkit was developed to support healthcare workers in reducing phlebitis incidence.

The Toolkit - comprising an infographic, digital newsletter, nurse training, and a standardized protocol - was implemented in four Dutch hospitals (2024-2025). Each hospital prospectively collected data on catheter characteristics, insertion site observations, and phlebitis occurrence during a 2-month pre-implementation period and a 2.5-month postimplementation period. The primary outcome was the change in phlebitis incidence.

Phlebitis incidence decreased from 7.3% (84/1144) to 4.9% (48/976) (P = 0.02). A significant reduction was observed in one site, while site-level changes varied across hospitals. Phlebitis was more frequent when insertion sites were not visible (10.4% vs. 5.4%; relative risk [RR]: 1.92; P < 0.001) and when dressings were soiled, wet, or loose (20.4% vs. 3.2%; RR: 6.45; P < 0.001). Longer catheter dwell time was associated with progressively higher phlebitis incidence.

Implementation of a simple, multi-component toolkit was associated with a reduction in phlebitis incidence and highlights the importance of insertion site visibility, dressing integrity, and timely catheter removal for safer peripheral intravenous care.