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IV Medications pH and Phlebitis

In the past the pH of a medication was a value used to determine if a medication was appropriate for administration via a short peripheral catheter, and often medication pH was used as a determining factor for the placement of a central venous access device. If the pH was less than 5 or greater than 9, the medication was thought not appropriate for peripheral administration, due to the potential to cause phlebitis and/or infiltrations.  Phlebitis is the inflammation of a vein often accompanies by pain, erythema, edema, streak formation and/or playable cord. Institutions should grade phlebitis using a standard scale. You may view and print the Phlebitis Grading Scale, developed by Andrew Jackson RN, as a standard for measurement, by clicking the link.

After an extensive review of data, the Infusion Nurse Society has issued new guidelines in the Infusion Therapy Standards of Practice (2016)2, which now omit the pH criteria as a single determining factor for appropriateness for peripheral infusion of a medication and/or insertion of a central venous access device.

The causes of phlebitis are multifactorial and not related to the single factor of medication pH. The choice of what type of vascular access device is most appropriate for any given patient should be based on many factors such as anticipated duration of infusion therapy, type and number of infusates required for the prescribed therapy, current condition of the patients veins, ability to choose a venous site with larger veins and not in an area of flexion, and the patients preference.1

1. Intermittently Delivered IV Medication and pH: Reevaluating the EvidenceJournal of Infusion Nursing: January/February 2015 - Volume 38 - Issue 1 - p 27–46, Gorski, Lisa A. MS, RN, CRNI®, HHCNS-BC, FAAN; Hagle, Mary E. PhD, RN, FAAN; Bierman, Steve MD
2. Infusion Therapy Standards of PracticeJournal of Infusion Nursing. January February 2016- Volume 39, Number 1S

For a complete review of the new standards of practice in peripheral IV therapy, you may take Pedagogy’s online continuing education 7.5 contact hour course Basics of Peripheral IV Therapy; Current Standards of Practice 2016 

This course may be ordered for an individual or purchased for an entire facility. Interested in purchasing the course for your facility staff? Contact sales@pedagogy-inc.com 
Posted: 8/23/2016 12:00:35 PM
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