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Inter‐rater agreement on PIVC ‐associated phlebitis signs, symptoms and scales
Author(s) -
Marsh Nicole,
Mihala Gabor,
RayBarruel Gillian,
Webster Joan,
Wallis Marianne C.,
Rickard Claire M.
Publication year - 2015
Publication title -
journal of evaluation in clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.737
H-Index - 73
eISSN - 1365-2753
pISSN - 1356-1294
DOI - 10.1111/jep.12396
Subject(s) - medicine , erythema , tenderness , kappa , inter rater reliability , physical therapy , dermatology , surgery , rating scale , psychology , developmental psychology , philosophy , linguistics
Rationale, aims and objectives Many peripheral intravenous catheter ( PIVC ) infusion phlebitis scales and definitions are used internationally, although no existing scale has demonstrated comprehensive reliability and validity. We examined inter‐rater agreement between registered nurses on signs, symptoms and scales commonly used in phlebitis assessment. Methods Seven PIVC ‐associated phlebitis signs/symptoms (pain, tenderness, swelling, erythema, palpable venous cord, purulent discharge and warmth) were observed daily by two raters (a research nurse and registered nurse). These data were modelled into phlebitis scores using 10 different tools. Proportions of agreement (e.g. positive, negative), observed and expected agreements, C ohen's kappa, the maximum achievable kappa, prevalence‐ and bias‐adjusted kappa were calculated. Results Two hundred ten patients were recruited across three hospitals, with 247 sets of paired observations undertaken. The second rater was blinded to the first's findings. The C atney and R ittenberg scales were the most sensitive (phlebitis in >20% of observations), whereas the C urran, L anbeck and R ickard scales were the most restrictive (≤2% phlebitis). Only tenderness and the C atney (one of pain, tenderness, erythema or palpable cord) and R ittenberg scales (one of erythema, swelling, tenderness or pain) had acceptable (more than two‐thirds, 66.7%) levels of inter‐rater agreement. Conclusions Inter‐rater agreement for phlebitis assessment signs/symptoms and scales is low. This likely contributes to the high degree of variability in phlebitis rates in literature. We recommend further research into assessment of infrequent signs/symptoms and the C atney or R ittenberg scales. New approaches to evaluating vein irritation that are valid, reliable and based on their ability to predict complications need exploration.