Impact of rigorous nursing training and reinforcement on incidence of thrombophlebitis at tertiary care centre

Suraj Purushothaman, Kinjal P. Patel, Dhaval N. Dalal, Trupti N. Carwal, Vijaykumar P. Gawali


Background: Peripheral venous cannulation (PVC) is one of the commonest procedures carried out in hospital.  It allows rapid and accurate administration of medication. However, there is dearth of formal training to nurses There are few studies which has shown benefits of offering formal training to improve clinical practice and patient care.

Methods: In view of rising cases of thrombophlebitis, nurses were trained in hand hygiene, patient skin preparation, wearing gloves and aprons, establishing a clean environmental field, using sterile equipment, disposing of contaminated or soiled equipment and linen appropriately, safe disposal of sharps and adherence to universal precautions. Retrospective, observational, single centre study to analyse data of inpatients for 4 years duration was carried out.  This included 2 years data prior to offering nursing training and 2 years post training.

Results: There is statistically significant improvement in number of thrombophlebitis event for 2 years prior and 2 years post training.  Total events in 2 years prior to training were 63 which reduced to 22 in later 2 years due to nursing training. A p value was 0.0297. Out of total 87 thrombophlebitis incidences, 40 and 47 incidences in males and females respectively were observed. Mean age for men was 58.39 and mean age for female was 52.62 with SD 27.39 and 22.06 respectively.

Conclusions: When nurses were trained in patient assessment, Insertion site selection (prefer hand and forearm; to avoid joints and lower limbs), catheter selection, dwell time, early identification of phlebitis and appropriate corrective measures and compliance with best practice guideline, thrombophlebitis rates drastically reduced.


Nurses training, Peripheral venous cannulation, Thrombophlebitis

Full Text:



Cooper S, Endacott R, Jevon P. Clinical Nursing Skills, Core and Advanced. Oxford: Oxford University Press; 2009.

Burke JP. Infection control-a problem for patient safety. N Eng J Med. 2003;348(7):651-6.

Frey AM. Success rates for peripheral I.V. insertion in a children's hospital. Financial implications. J Intraven Nurs. 1998;21:160-5.

Jacobson AF, Winslow EH. Variables influencing intravenous catheter insertion difficulty and failure: an analysis of 339 intravenous catheter insertions. Heart Lung. 2005;34:345-59.

Palefski SS, Stoddard GJ. The infusion nurse and patient complication rates of peripheral-short catheters. A prospective evaluation. J Intraven Nurs. 2001;24:113-23.

Hadaway L. Short peripheral intravenous catheters and infections. J Infus Nurs. 2012;35:230-40.

Abbas SZ, de Vries TK, Shaw S, Abbas SQ. Use and complications of peripheral vascular catheters: a prospective study. Br J Nurs. 2007;16:648-2.

Cicolini G, Manzoli L, Simonetti V, Flacco ME, Comparcini D, Capasso L, et al. Phlebitis risk varies by peripheral venous catheter site and increases after 96 hours: a large multi-centre prospective study. J Adv Nurs. 2014;70:2539-49.

Cicolini G, Bonghi AP, Di LL, Di MR. Position of peripheral venous cannulae and the incidence of thrombophlebitis: an observational study. J Adv Nurs. 2009;65:1268-73.

Scerbo MW, Bliss JP, Schmidt EA, Thompson SN. The efficacy of a medical virtual reality simulator for training phlebotomy. Hum Factors. 2006;48:72-84.

Reznek MA, Rawn CL, Krummel TM. Evaluation of the educational effectiveness of a virtual reality intravenous insertion simulator. Acad Emerg Med. 2002;9:1319-25.

Lyons MG, Kasker J. Outcomes of a continuing education course on intravenous catheter insertion for experienced registered nurses. J Contin Educ Nurs. 2012;43:177-81.

Wilfong DN, Falsetti DJ, McKinnon JL, Daniel LH, Wan QC. The effects of virtual intravenous and patient simulator training compared to the traditional approach of teaching nurses: a research project on peripheral I.V. catheter insertion. J Infus Nurs. 2011;34:55-62.