Phlebitis

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Phlebitis
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Veins in the popliteal area
Specialty Phlebology   OOjs UI icon edit-ltr-progressive.svg

Phlebitis (or venitis) is inflammation of a vein, usually in the legs. It most commonly occurs in superficial veins. Phlebitis often occurs in conjunction with thrombosis and is then called thrombophlebitis or superficial thrombophlebitis. Unlike deep vein thrombosis, the probability that superficial thrombophlebitis will cause a clot to break up and be transported in pieces to the lung is very low. [1]

Contents

Signs and symptoms

There is usually a slow onset of a tender red area along the superficial veins on the skin. A long, thin red area may be seen as the inflammation follows a superficial vein. This area may feel hard, warm, and tender. The skin around the vein may be itchy and swollen. The area may begin to throb or burn. Symptoms may be worse when the leg is lowered, especially when first getting out of bed in the morning. A low-grade fever may occur. Sometimes phlebitis may occur where a peripheral intravenous line was started. The surrounding area may be sore and tender along the vein. [3]

Cause

Phlebitis is typically caused by local trauma to a vein, usually from the insertion of an intravenous catheter. [4] However, it can also occur due to a complication of connective tissue disorders such as lupus, or of pancreatic, breast, or ovarian cancers. Phlebitis can also result from certain medications and drugs that irritate the veins, such as desomorphine. [5]

Superficial phlebitis often presents as an early sign in thromboangiitis obliterans (Buerger's disease), a vasculitis that affects small and medium-sized arteries and veins in distal extremities often associated with cigarette smoking. [6]

Management

Treatment usually consists of NSAIDs, such as ibuprofen and local compression (e.g., by compression stockings or a compress). [7] If the phlebitis is associated with local bacterial infection, antibiotics may be used. [8]

For acute infusion superficial thrombophlebitis, not enough evidence exists as of 2015 to determine treatment. [9]

See also

Related Research Articles

<span class="mw-page-title-main">Vein</span> Blood vessels that carry blood towards the heart

Veins are blood vessels in the circulatory system of humans and most other animals that carry blood towards the heart. Most veins carry deoxygenated blood from the tissues back to the heart; exceptions are those of the pulmonary and fetal circulations which carry oxygenated blood to the heart. In the systemic circulation, arteries carry oxygenated blood away from the heart, and veins return deoxygenated blood to the heart, in the deep veins.

<span class="mw-page-title-main">Lemierre's syndrome</span> Medical condition

Lemierre's syndrome is infectious thrombophlebitis of the internal jugular vein. It most often develops as a complication of a bacterial sore throat infection in young, otherwise healthy adults. The thrombophlebitis is a serious condition and may lead to further systemic complications such as bacteria in the blood or septic emboli.

<span class="mw-page-title-main">Intravenous therapy</span> Medication administered into a vein

Intravenous therapy is a medical technique that administers fluids, medications and nutrients directly into a person's vein. The intravenous route of administration is commonly used for rehydration or to provide nutrients for those who cannot, or will not—due to reduced mental states or otherwise—consume food or water by mouth. It may also be used to administer medications or other medical therapy such as blood products or electrolytes to correct electrolyte imbalances. Attempts at providing intravenous therapy have been recorded as early as the 1400s, but the practice did not become widespread until the 1900s after the development of techniques for safe, effective use.

<span class="mw-page-title-main">Venous thrombosis</span> Blood clot (thrombus) that forms within a vein

Venous thrombosis is the blockage of a vein caused by a thrombus. A common form of venous thrombosis is deep vein thrombosis (DVT), when a blood clot forms in the deep veins. If a thrombus breaks off (embolizes) and flows to the lungs to lodge there, it becomes a pulmonary embolism (PE), a blood clot in the lungs. The conditions of DVT only, DVT with PE, and PE only, are all captured by the term venous thromboembolism (VTE).

<span class="mw-page-title-main">Great saphenous vein</span> Large, subcutaneous, superficial vein of the leg

The great saphenous vein (GSV) or long saphenous vein is a large, subcutaneous, superficial vein of the leg. It is the longest vein in the body, running along the length of the lower limb, returning blood from the foot, leg and thigh to the deep femoral vein at the femoral triangle.

<span class="mw-page-title-main">Deep vein thrombosis</span> Formation of a blood clot (thrombus) in a deep vein

Deep vein thrombosis (DVT) is a type of venous thrombosis involving the formation of a blood clot in a deep vein, most commonly in the legs or pelvis. A minority of DVTs occur in the arms. Symptoms can include pain, swelling, redness, and enlarged veins in the affected area, but some DVTs have no symptoms.

<span class="mw-page-title-main">Cellulitis</span> Bacterial infection of the inner layers of the skin called the dermis

Cellulitis is usually a bacterial infection involving the inner layers of the skin. It specifically affects the dermis and subcutaneous fat. Signs and symptoms include an area of redness which increases in size over a few days. The borders of the area of redness are generally not sharp and the skin may be swollen. While the redness often turns white when pressure is applied, this is not always the case. The area of infection is usually painful. Lymphatic vessels may occasionally be involved, and the person may have a fever and feel tired.

<span class="mw-page-title-main">Thrombophlebitis</span> Inflammation of a vein due to a blood clot

Thrombophlebitis is a phlebitis related to a thrombus. When it occurs repeatedly in different locations, it is known as thrombophlebitis migrans.

Phlebothrombosis occurs when a blood clot in a vein forms independently from the presence of inflammation of the vein (phlebitis). Thrombophlebitis is phlebitis related to a thrombus. These conditions are usually of the superficial veins and are generally mild and uncomplicated as opposed to deep vein thromboses, which can be life-threatening.

<span class="mw-page-title-main">Vascular disease</span> Medical condition

Vascular disease is a class of diseases of the vessels of the circulatory system in the body, including blood vessels – the arteries and veins, and the lymphatic vessels. Vascular disease is a subgroup of cardiovascular disease. Disorders in this vast network of blood and lymph vessels can cause a range of health problems that can sometimes become severe, and fatal. Coronary heart disease for example, is the leading cause of death for men and women in the United States.

<span class="mw-page-title-main">Compression stockings</span> Compression garment

Compression stockings are a specialized hosiery designed to help prevent the occurrence of, and guard against further progression of, venous disorders such as edema, phlebitis and thrombosis. Compression stockings are elastic compression garments worn around the leg, compressing the limb. This reduces the diameter of distended veins and increases venous blood flow velocity and valve effectiveness. Compression therapy helps decrease venous pressure, prevents venous stasis and impairments of venous walls, and relieves heavy and aching legs.

<span class="mw-page-title-main">Post-thrombotic syndrome</span> Residual symptoms following thrombosis (clots in the blood vessels)

Post-thrombotic syndrome (PTS), also called postphlebitic syndrome and venous stress disorder is a medical condition that may occur as a long-term complication of deep vein thrombosis (DVT).

The Trousseau sign of malignancy or Trousseau's syndrome is a medical sign involving episodes of vessel inflammation due to blood clot (thrombophlebitis) which are recurrent or appearing in different locations over time. The location of the clot is tender and the clot can be felt as a nodule under the skin. Trousseau's syndrome is a rare variant of venous thrombosis that is characterized by recurrent, migratory thrombosis in superficial veins and in uncommon sites, such as the chest wall and arms. This syndrome is particularly associated with pancreatic, gastric and lung cancer and Trousseau's syndrome can be an early sign of cancer sometimes appearing months to years before the tumor would be otherwise detected. Heparin therapy is recommended to prevent future clots. The Trousseau sign of malignancy should not be confused with the Trousseau sign of latent tetany caused by low levels of calcium in the blood.

<span class="mw-page-title-main">Chronic venous insufficiency</span> Pooling of blood in the veins

Chronic venous insufficiency (CVI) is a medical condition in which blood pools in the veins, straining the walls of the vein. The most common cause of CVI is superficial venous reflux which is a treatable condition. As functional venous valves are required to provide for efficient blood return from the lower extremities, this condition typically affects the legs. If the impaired vein function causes significant symptoms, such as swelling and ulcer formation, it is referred to as chronic venous disease. It is sometimes called chronic peripheral venous insufficiency and should not be confused with post-thrombotic syndrome in which the deep veins have been damaged by previous deep vein thrombosis.

<span class="mw-page-title-main">Superficial thrombophlebitis</span> Medical condition

Superficial thrombophlebitis is a thrombosis and inflammation of superficial veins presenting as a painful induration (thickening) with erythema, often in a linear or branching configuration with a cordlike appearance.

Pseudothrombophlebitis is a clinical condition where there are signs and symptoms of phlebitis in the absence of a thrombophlebitis lesion. Symptoms include pain, swelling, erythema and tenderness evolving over hours or days. It is often associated with the rupture or dissection of a popliteal cyst otherwise known as a Baker's cyst, although it can be associated with other disorders such as the arthritides. It may also occur as an orthopaedic surgical complication, secondary to trauma or as a presentation of septic arthritis. It is crucial to differentiate this condition from deep vein thrombosis as the treatment for DVT can cause adverse effects in patients with pseudothrombophlebitis.

Septic thrombophlebitis is characterized by a bacterial or fungal infection that coexists with venous thrombosis. Deep veins or superficial veins could be affected. Septic thrombophlebitis can manifest as anything from a harmless condition that affects a small area of superficial veins to serious systemic infections that cause shock and even death.

Septic pelvic thrombophlebitis (SPT), also known as suppurative pelvic thrombophlebitis, is a rare postpartum complication which consists of a persistent postpartum fever that is not responsive to broad-spectrum antibiotics, in which pelvic infection leads to infection of the vein wall and intimal damage leading to thrombogenesis in the ovarian veins. The thrombus is then invaded by microorganisms. Ascending infections cause 99% of postpartum SPT.

<span class="mw-page-title-main">Superficial vein thrombosis</span> Medical condition

Superficial vein thrombosis (SVT) is a blood clot formed in a superficial vein, a vein near the surface of the body. Usually there is thrombophlebitis, which is an inflammatory reaction around a thrombosed vein, presenting as a painful induration with redness. SVT itself has limited significance when compared to a deep vein thrombosis (DVT), which occurs deeper in the body at the deep venous system level. However, SVT can lead to serious complications, and is therefore no longer regarded as a benign condition. If the blood clot is too near the saphenofemoral junction there is a higher risk of pulmonary embolism, a potentially life-threatening complication.

Venous access is any method used to access the bloodstream through the veins, either to administer intravenous therapy, parenteral nutrition, to obtain blood for analysis, or to provide an access point for blood-based treatments such as dialysis or apheresis. Access is most commonly achieved via the Seldinger technique, and guidance tools such as ultrasound and fluoroscopy can also be used to assist with visualizing access placement.

References

  1. Beckman, Joshua A. (22 October 2002). "Diseases of the Veins". Circulation. 106 (17): 2170–2172. doi: 10.1161/01.CIR.0000036740.75461.80 . PMID   12390942.
  2. Benjamin Wedro. "Phlebitis Symptoms". emedicinehealth. Retrieved 13 May 2013.
  3. Ratini, Melinda (30 October 2020). "Phlebitis Basics". WebMD. Retrieved 2021-01-01.
  4. Benjamin Wedro. "Phlebitis Causes". emedicinehealth. Retrieved 30 May 2013.
  5. "Blood Clots - Causes, Symptoms, Treatment, Diagnosis - Canoe.com". canoe.ca. Archived from the original on June 28, 2013. Retrieved 7 April 2018.{{cite web}}: CS1 maint: unfit URL (link)
  6. "UpToDate". www.uptodate.com. Retrieved 7 April 2018.
  7. Benjamin Wedro. "Phlebitis Treatment". emedicinehealth. Retrieved 30 May 2013.
  8. Benjamin Wedro. "Phlebitis Medical Treatment". emedicinehealth. Retrieved 30 May 2013.
  9. Di Nisio, M; Peinemann, F; Porreca, E; Rutjes, AW (20 November 2015). "Treatment for superficial infusion thrombophlebitis of the upper extremity" (PDF). The Cochrane Database of Systematic Reviews. 11 (11): CD011015. doi:10.1002/14651858.CD011015.pub2. PMC   6885032 . PMID   26588711.

Further reading