Infusion Phlebitis Assessment Scales: A Systematic Review of Their Use and Psychometric Adequacy.

Purpose/Design: We sought to identify the definitions and symptoms used in assessment of infusion phlebitis, scope the number of scales available to assess phlebitis incidence and severity, and evaluate evidence regarding their reliability, validity, responsiveness, and feasibility. Methods: We conducted a systematic literature review of the Cochrane Library, Ovid MEDLINE, and EBSCO CINAHL until November 2012. All English-language studies (RCTs, prospective cohort, and cross-sectional) that included phlebitis associated with peripheral intravenous cannulation in adults as a primary outcome measure, or that evaluated an infusion phlebitis scale, were retrieved. Studies that assessed infusion phlebitis using a provided definition or scoring tool were included in the review. Results: Phlebitis related to peripheral intravenous cannulation was the primary outcome measure in 316 studies; of these, 222 provided no definition of phlebitis. Of the 94 studies that reported measuring infusion phlebitis incidence and/or severity, 62 used an assessment scale and 32 used a definition only. We identified 57 different assessment scales, which differed in symptoms included, definitions of symptoms, and cutpoints for a phlebitis diagnosis. None of the studies reported comprehensive psychometric testing. Psychometric analyses were undertaken for four assessment tools, but these analyses had many limitations. Nevertheless, the evidence from these studies suggests that inter-rater reliability for these phlebitis assessment scales is modest. Limitations: We only reviewed articles published in English, and we did not contact any of the authors for further psychometric details. Conclusions: No phlebitis assessment measure reported in the literature met rigorous psychometric standards. Many phlebitis scales and tools have been developed, but none have been sufficiently validated for use in the clinical setting. Consequently, a lack of consensus on phlebitis assessment criteria has led to disparities in reported phlebitis incidence, precluding any meaningful comparison of reported phlebitis rates. You can go to http://www.avainfo.org/posters to view this poster.