Introduction• Almost 80% of patients have a peripheral intravenous catheter

(PIVC) when hospitalized, as a result, septic phlebitis is one of the

most severe complications1

• A 2014 unpublished pilot study at Patan Hospital (PH) in

Kathmandu, Nepal recorded the rate of septic phlebitis at 4%, almost

four times the 0.5% recorded rate in a Western setting2,3

• Hospital-based educational interventions demonstrate effectiveness

in reducing PIVC associated bloodstream infections4,5

Study Aims• Conduct quality improvement study to improve care at PH

• Establish present PH septic phlebitis baseline

• Implement intervention to reduce rate of phlebitis

MethodsPHASE 1

• Observe all PIVC sites in medical, geriatric, and step-down wards at

PH every day from July 2 to July 16, 2017

• Use nursing VIP phlebitis scale to evaluate each PIVC line for signs

of phlebitis in addition to custom phlebitis sign scale

• Collect additional data via patient hospital charts (i.e. admission

date, diagnosis, temperature (if VIP > 3), etc.)

PHASE 2

Implement ”Plan” of “plan, do, study, act cycle” (PDSA) via presenting

data to PH head nurse and developing literature informed serial

intervention

PHASE 3

Conduct “do, study, act” phases of PDSA cycle through intervention,

post-interventional data collection + analysis, and repeat PDSA cycle.

Peripheral IV Septic Phlebitis Quality Improvement

Project in Patan Hospital, NepalAndrew Stein1 ∙ William Shi1 ∙ Prashant Raj Bhatt, MBBS2 ∙ Ujjawal Paudel, MBBS2

Theodore MacKinney, MD, MPH, FACP1 ∙ Darlene House, MD2 ∙ Gyan Kayastha, MD, MPH2

Medical College of Wisconsin1, Patan Hospital2

Discussion• Phase 1 data collection revealed a decrease in septic phlebitis

since the 2015 pilot study

• Data represents only current PIVC data in Nepal

• The rate of general phlebitis (16.44%) is higher than the 5%

standard outlined by the Intravenous Nursing Society6

• Phase 2 consisted of distributing an interventional flyer

outlining phase 1 findings and IV insertion technique to the

participating wards along with addressing all queries from

nurses in each department

• Post-interventional data has been collected for phase 3 and is

currently being analyzed

Next Steps• Statistically analyze post-interventional data

• Determine effectiveness of intervention based on final data

collection

AcknowledgementsDr. Elaine Kohler Summer Academy of Global Health Research and

the Medical College of Wisconsin Office of Global Health

References 1. Zingg, W. and Pittet, D. (2009). Peripheral venous catheters: an under-evaluated

problem.International Journal of Antimicrobial Agents, 34, pp.S38-S42.

2. MacKinney, T. (2014). Septic phlebitis rates at Patan Hospital, Nepal.

Unpublished.

3. Maki DG,Kluger DM, Crnich CJ. The risk of bloodstream infection in adults with

different intravascular devices: a systematic review of 200 published prospective

studies. Mayo Clin Proc. 2006;81(9):1159-71.

4. Coopersmith CM, Rebmann TL, Zack JE, et al. Effect of an education program on

decreasing catheter-related bloodstream infections in the surgical intensive care

unit. Crit Care Med 2002; 30:59–64.

5. Warren DK, Zack JE, Cox MJ, Cohen MM, Fraser VJ. An educational intervention

to prevent catheter-associated bloodstream infections in a non-teaching

community medical center. Crit Care Med 2003; 31:1959–63.

6. Ray-barruel G, Polit DF, Murfield JE, Rickard CM. Infusion phlebitis assessment

measures: a systematic review. J Eval Clin Pract. 2014;20(2):191-202.

RESULTS

Observed PIVC VIP Scores

Score Stage of Phlebitis n0 No signs of phlebitis 2211 Early signs of phlebitis 912 Early stage of phlebitis 403 Medium stage of phlebitis 214 Advanced phlebitis/thrombophlebitis 05 Advanced stage of thrombophlebitis 0

Observed PIVC General Statistics

Total patients 93

Total PIVC lines 372

Dated 252 68%

No date 120 32%

PIVC Dwell Time median(dated PIVC only) 1.5 days

0-3 days 229

4-6 days 22

PIVCs indicating resiting (VIP>2) 61

Indicated PIVCs resited within 24 hours 53 87%

Image 1. Nursing VIP Phlebitis Scale