VIP Score: Checking a Cannula Site for Phlebitis

The VIP score (Visual Infusion Phlebitis score) is a 0 to 5 scale for checking a cannula site for phlebitis, which is inflammation of the vein. A score of 0 or 1 means keep watching the site. A score of 2 or more means the cannula should come out and be resited if it's still needed, with treatment considered from 3 upwards.

This guide explains each score, how often to check, what phlebitis looks like, a quick word on cannula sizes, and what to record. It's written at awareness level for nurses, managers and the staff who notice things first. Always follow your local policy and the person's care plan.

Where the VIP score came from

The score was developed by Andrew Jackson, a consultant nurse in intravenous therapy at Rotherham General Hospital, and published in Nursing Times in 1998. It gave nurses a shared way to grade a cannula site and link each grade to an action.

That link is the point. "The site looks a bit red" means different things to different people. "VIP 2" means one thing, and everyone on the next shift knows the cannula needs to come out.

The six VIP scores and what each one means

Here's the scale in plain words. Use the official chart on your observation paperwork on shift.

• 0: the site looks healthy. No signs of phlebitis. Carry on observing the cannula.
• 1: possible first signs. Either slight pain or slight redness near the site. Carry on observing, and look again soon.
• 2: early phlebitis. Two of these: pain at the site, redness, swelling. Resite the cannula.
• 3: medium-stage phlebitis. All of these: pain along the path of the cannula, redness, and hardening of the tissue (induration). Resite the cannula and consider treatment.
• 4: advanced phlebitis or the start of thrombophlebitis. The signs at score 3 are present and extensive, and the vein can be felt as a firm cord. Resite the cannula and consider treatment.
• 5: advanced thrombophlebitis. All of the above, extensive, plus a raised temperature. Start treatment and resite the cannula.

"Resite" means removing the cannula and, if the person still needs one, putting a new one in a different place. Whether a new cannula is needed at all is a clinical decision, and "consider treatment" means the nurse or doctor responsible decides what's needed. Neither is a job for a carer acting alone.

How often should a cannula site be checked?

NICE's quality standard on infection prevention and control says peripheral cannula sites should be inspected at least every shift, with a visual phlebitis score recorded. You can read it in NICE quality standard QS61, statement 5.

Many local policies also ask for a check whenever the cannula is used: before a flush, before a medicine is given through it, and when an infusion is started, changed or stopped. That's often when pain first shows up.

The same NICE statement says vascular access devices should be removed as soon as they're no longer needed. A cannula that hasn't been used for a while is a risk with no benefit, so the check is also a good time to ask "does this still need to be here?"

What phlebitis looks like

The NHS describes phlebitis as inflammation of a vein near the surface of the skin. Having a cannula or injections into a vein is one of the things it's linked to. Signs include:

• pain, tenderness or swelling around the vein
• warm skin over the area
• redness, or a change in the colour of the skin
• skin or tissue that feels thick and hard
• itchy skin over the affected area

Around a cannula, the early sign is often the person saying it stings or aches, especially during a flush or infusion. Listen to that. People who can't easily tell you about pain, for example someone living with advanced dementia, may pull at the dressing or guard their arm instead, so look as well as ask.

A Nursing Times review of phlebitis care (2011) notes that cannula-related phlebitis can have a mechanical, chemical or infectious cause. In practice, that means the cannula rubbing the vein wall, irritation from what's going through it, or bacteria getting in. Aseptic technique when the site is accessed, and a clean, intact dressing, matter for exactly this reason. The NHS has a plain-English guide to phlebitis you can share with families.

Cannula sizes: a short guide

Peripheral cannulas are sized by gauge, written as G. The higher the number, the smaller the cannula. A 24G cannula is narrow; a 14G is wide. Packs and hubs are colour-coded, and a commonly published scheme is:

• 14G: orange or brown
• 16G: grey
• 17G: white
• 18G: green
• 20G: pink
• 22G: blue
• 24G: yellow

Colours can vary between manufacturers, so check the gauge printed on the pack rather than relying on colour alone. The person inserting the cannula chooses the size for the vein and the treatment, following local policy. For staff checking the site, the useful thing is to record the gauge and position, so whoever looks next knows what they're looking at.

What to record and when to escalate

A score only helps if it's written down and acted on. A good cannula record usually shows:

• the date and time of insertion, the gauge, the site, and who inserted it
• the VIP score at each check, with the date, time and your name
• the action taken: observed, reported, removed or resited
• who you told, and what they decided
• the date and time of removal, and the reason

Escalate in line with your policy. As a rule of thumb, anyone who isn't trained to remove or resite cannulas should report a score of 2 or more straight away to the nurse in charge or the responsible clinician. A score of 5, or any phlebitis with a raised temperature or the person seeming unwell, needs a prompt clinical review. Don't sit on it until the end of the shift.

Where this fits in care settings

Cannulas aren't everyday kit in most care homes, but they turn up more than people expect: a resident back from hospital with one still in, hydration or antibiotics given in a nursing home or hospice, or community services working alongside a hospital-at-home team. The person who notices a red, sore arm is often a carer helping someone wash or dress. Make sure they know what the VIP score is, where the chart lives, and who to tell.

If your nurses also take bloods or look after longer lines, the same habits apply. See our venepuncture training and PICC line care training.

How Kasorb can help

Our cannulation training teaches nurses and clinical staff to insert a peripheral intravenous cannula safely. It covers anatomy and vein selection, aseptic technique, inserting and securing a cannula, caring for the cannula site, documentation and removal, and recognising complications such as phlebitis, infiltration and infection, and what to do. It runs on-site as a full day, with practice on a simulation arm for up to 10 staff. Your trainer has used these skills for real, and certificates are emailed the next day. Your own supervised sign-off in practice then confirms each person before they cannulate on their own.

FAQs

What does a VIP score of 2 mean?

A VIP score of 2 means early phlebitis: two of pain at the site, redness or swelling. The action on the VIP scale is to resite the cannula, so it should be removed and, if still needed, a new one put in elsewhere. Report it straight away in line with your local policy.

How often should you check a VIP score?

NICE's quality standard says peripheral cannula sites should be inspected at least every shift and a phlebitis score recorded. Many local policies also ask for a check each time the cannula is used, such as before a flush or medicine. Follow your own policy and the person's care plan.

Who created the VIP score?

The Visual Infusion Phlebitis score was developed by Andrew Jackson, a consultant nurse in intravenous therapy at Rotherham General Hospital. It was published in Nursing Times in 1998 and is now widely used on cannula observation charts in the UK.

What are the signs of phlebitis from a cannula?

Look for pain or stinging at the site, redness, swelling, warmth, and tissue that feels hard. In more advanced phlebitis the vein can be felt as a firm cord, and a raised temperature can follow. Report any of these to the nurse in charge.

Which cannula size is smallest?

With peripheral cannulas, the higher the gauge number, the smaller the cannula. A 24G cannula, commonly yellow, is smaller than a 22G (blue) or 20G (pink). Colours can vary between manufacturers, so always check the gauge printed on the pack.