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Phlebitis

Introduction
Causes
Symptoms
Exams and Tests
Treatment
Prognosis
Prevention

Superficial thrombophlebitis may occur after the recent use of an intravenous (IV) line, after trauma to the vein, or for no apparent reason in persons at risk for thrombophlebitis.

Risks for superficial thrombophlebitis include the following:

• Disorders that involve increased blood clotting
• Infection
• Varicose veins
• Chemical irritation of the area
• Sitting or being immobilized for a prolonged period

The risk is also increased in women who are or were recently pregnant, and by the use of oral contraceptives.

Superficial thrombophlebitis may be associated with Factor V Leiden, prothrombin gene mutation, and, occasionally, abdominal cancers (such as carcinoma of the pancreas), deep vein thrombosis, and thromboangiitis obliterans.

• Skin redness or inflammation along a superficial vein
• Warmth of tissue around a superficial vein
• Tenderness or pain along a superficial vein (worse when pressure is applied)
• Limb pain
• Hardening of a superficial vein (induration) -- the vein feels cord-like

Your health care provider will diagnose superficial thrombophlebitis based primarily on the appearance of the extremity. Frequent checks of the pulse, blood pressure, temperature, skin condition, and circulation may be required.

The diagnosis of superficial thrombophlebitis may be confirmed with the following tests:

• Doppler ultrasound
• Duplex ultrasound
• Venography

If infection is suspected, cultures of the skin or blood cultures may be performed.

Superficial thrombophlebitis may be associated with deficient blood levels of:

• Antithrombin III (AT-III)
• Protein C (PC)
• Protein S (PS)

Phlebitis in the superficial veins is generally treated at home with periods of rest with the leg elevated, pain relievers such as aspirin and, if needed, antibiotics. Warm compresses may ease the inflammation and elastic stockings may be prescribed. The goals of treatment are reduction of pain and inflammation, and prevention of complications.

If a catheter or IV line produced the thrombophlebitis, it should be removed.

To reduce discomfort and swelling, support stockings and elevation of the affected extremity are recommended.

Medications to treat superficial thrombophlebitis may include the following:

• Analgesics for pain
• Nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation
• Intravenous anticoagulants followed by oral anticoagulants to reduce the likelihood of clotting

If deeper clots (deep vein thrombosis) are also present, your provider may prescribe thrombolytic drugs to dissolve an existing clot. Antibiotics are prescribed if infection is present. Deep vein thrombophlebitis is treated with anticoagulants (drugs that prevent the blood from clotting) or with thrombolysis, a procedure in which clot busting drugs are infused to the site of a blood clot. This procedure usually is performed by an interventional radiologist.

Surgical removal (phlebectomy), stripping, or sclerotherapy of the affected vein are occasionally needed to treat large varicose veins or to prevent further episodes of thrombophlebitis in predisposed patients.