From the Guidelines
Phlebitis is inflammation of a vein, often caused by a blood clot, which can be superficial or deep, and may require anticoagulant therapy to prevent further complications.
Causes and Diagnosis
- Phlebitis can occur in any vein, but superficial phlebitis is more common, with an incidence of approximately 125,000 annually 1.
- Approximately 25% of patients with superficial phlebitis will have an underlying deep vein thrombosis (DVT), making ultrasound imaging necessary to confirm the diagnosis and exclude subclinical DVT 1.
Treatment
- Most cases of superficial phlebitis can be treated conservatively without anticoagulant therapy due to the low risk of pulmonary embolism (PE) 1.
- However, for superficial phlebitis exceeding 5 cm in length, prophylactic dose fondaparinux (2.5 mg daily) or low-molecular-weight heparin (LMWH) is recommended for 45 days 1.
- Fondaparinux is preferred over LMWH for the treatment of superficial phlebitis 1.
From the Research
Definition and Characteristics of Phlebitis
- Phlebitis is defined as thrombotic inflammation of a previously healthy superficial vein 2
- It is characterized as a localized inflammatory condition of the venous vessels underlying the skin, arising from thrombosis of a superficial vein 3
- Clinical presentation usually involves pain, erythema, and tenderness at the sites of inflammation 3
Types and Causes of Phlebitis
- Superficial venous thrombophlebitis (SVT) is a type of phlebitis that typically involves the superficial veins and is usually self-limited 3
- Varicophlebitis is another type of phlebitis that occurs in varicosities and is responsible for the majority of thrombotic venous occlusions 2
- Phlebitis can be caused by mechanical lesions, trauma to the wall of the vein, primary diseases such as auto-immune afflictions, endangiitis obliterans, or malignancy 2
- Iatrogenic causes of phlebitis include improper application of chemical substances, indwelling catheters, or cannulas 2
Symptoms and Diagnosis of Phlebitis
- Symptoms of phlebitis include fever, abdominal pain, and tender, hardened superficial veins 2, 4
- Diagnosis of phlebitis can be made through clinical presentation, differential diagnostic considerations, and imaging studies such as phlebography 5, 2
Treatment and Management of Phlebitis
- Medical therapies for phlebitis include bedrest, elastic stockings, compression bandages, nonsteroidal anti-inflammatory drugs, and low molecular weight heparins 3
- Surgical interventions such as phlebectomy, sclerotherapy, saphenous junction ligation, or saphenous vein stripping may be necessary in some cases 3
- Treatment of pylephlebitis, a rare condition involving infective thrombophlebitis of the portal vein, consists of broad-spectrum antibiotics and anticoagulants in some cases 4