Signs of Infection Under IV Dressing — Assessment Guide
PIVC site infection affects 0.1-4.5% of catheterized patients, but phlebitis occurs in 6-38% without proper monitoring. Early detection prevents systemic infection.
VIP Score — Standardized Assessment Tool
| Score | Signs | Action |
|---|
| 0 — Healthy | No signs of phlebitis | Continue to observe |
| 1 — Possible | One of: slight pain OR slight redness | Observe more frequently |
| 2 — Early stage | Two of: pain, erythema, swelling | Resite cannula |
| 3 — Medium stage | All: pain, erythema, swelling, +/- palpable cord | Resite. Consider treatment |
| 4 — Advanced | All above + cord >2.5cm +/- purulent discharge | Resite. Medical review |
| 5 — Thrombophlebitis | All signs + purulent discharge + pyrexia | Remove. Culture. Antibiotics |
Key Visual Signs
- Erythema: Redness extending >=1cm beyond site along vein track
- Edema: Unilateral swelling at or above site vs contralateral limb
- Purulent discharge: Cloudy yellow/green discharge — definitive infection sign
- Moisture under dressing: Visible fluid, fogging — compromised sterile barrier
- Tracking: Red line along vein path — chemical thrombophlebitis
Patient Symptoms (May Precede Visual Signs)
- Pain or burning at insertion site — detects phlebitis 12-24h before visible signs
- Tenderness along vein path
- Fever or chills — possible bloodstream infection
Assessment Frequency (INS 2021)
- Adult acute care: every 4 hours
- Critically ill, sedated, pediatric: every 1-2 hours
- Long-term care: every shift minimum
- Immediately if patient reports pain or pump alarms
References: Jackson A. "Infection Control in Intravenous Care." BJN, 1998. Ray-Barruel G, et al. "International Prevalence of PIVC Failure." JHM, 2019. Gorski LA, et al. "INS Standards." 2021.
