From the Guidelines
Treatment for phlebitis typically involves a combination of self-care measures and medication, with anticoagulant medications such as heparin, low-molecular-weight heparin, or oral anticoagulants being prescribed for 3-6 months to prevent blood clot formation and growth, as recommended by the most recent guidelines 1. For superficial phlebitis, treatment includes:
- Applying warm compresses to the affected area for 15-20 minutes several times daily
- Elevating the affected limb
- Taking non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) to reduce pain and inflammation
- Wearing compression stockings to improve circulation For more severe cases or deep vein thrombosis (DVT), anticoagulant medications such as:
- Heparin
- Low-molecular-weight heparin (like enoxaparin 1mg/kg twice daily)
- Oral anticoagulants (like warfarin with target INR 2-3, or direct oral anticoagulants such as rivaroxaban 15mg twice daily for 21 days, then 20mg once daily) may be prescribed for 3-6 months to prevent blood clot formation and growth. Antibiotics are necessary if the phlebitis is caused by an infection. Physical activity is encouraged rather than bed rest, as movement helps improve circulation and prevents further clot formation. Phlebitis requires treatment because inflammation of the vein can lead to blood clot formation, which may break loose and cause serious complications like pulmonary embolism if left untreated, as noted in the guidelines 1. It's also important to consider the patient's individual risk factors and medical history when determining the best course of treatment, as recommended by the guidelines 1.
From the Research
Treatment Options for Phlebitis
- Fondaparinux, a subcutaneous injection, has been associated with fewer symptomatic venous thromboembolic events (VTE), lower rates of superficial venous thrombosis extension, and recurrence with no increases in major bleeding compared to placebo 2, 3.
- Low-molecular-weight heparin and nonsteroidal anti-inflammatory drugs are associated with lower rates of superficial thrombophlebitis extension or recurrence, but data regarding symptomatic VTEs are inconclusive 2, 3.
- Topical treatments, such as nitroglycerin and notoginseny, have been found to be effective in reducing the inflammatory process 4.
- Surgical treatment combined with elastic stockings may be associated with a lower VTE rate and ST progression compared to elastic stockings alone 3.
- Vasomotor substances and anti-inflammatory agents, such as Butazolidine and Ketazone, have been used in the treatment of deep phlebitis, particularly in cases where anticoagulants are contraindicated 5.
Prevention and Care
- Good practice when inserting a cannula, including appropriate choice of device and site, can help to prevent phlebitis 6.
- Good infection control techniques are vital in preventing the condition 6.
- Phlebitis scoring systems should be used in routine practice to identify and treat early signs of peripheral venous cannulation 6.