From the Guidelines
Phlebitis is inflammation of a vein, typically occurring in the legs, and is often associated with the formation of a blood clot, with an incidence of approximately 125,000 annually 1. Phlebitis can be classified into two main types: superficial phlebitis and deep vein thrombophlebitis. Superficial phlebitis is common and can be treated conservatively without anticoagulant therapy due to the low risk of pulmonary embolism (PE) of 1.3% 1. Some key points to consider in the management of phlebitis include:
- Ultrasound imaging is warranted to confirm the diagnosis and exclude subclinical deep vein thrombosis (DVT) 1
- For superficial phlebitis exceeding 5 cm in length, prophylactic dose fondaparinux or low molecular weight heparin (LMWH) is recommended for 45 days 1
- Fondaparinux (2.5 mg daily) is preferred to LMWH for the treatment of superficial phlebitis 1 It is essential to assess patients with iliac vein thrombosis for thrombolysis and mechanical thrombectomy candidacy 1. Symptoms of phlebitis include redness, warmth, tenderness, and swelling along the affected vein. Treatment usually involves anti-inflammatory medications and warm compresses to reduce discomfort. In cases of deep vein thrombophlebitis, anticoagulant medications like heparin or warfarin may be necessary to prevent clot expansion. Seeking prompt medical attention is crucial, especially if the affected area is very painful, red, or warm, as this could indicate a more serious deep vein thrombosis requiring immediate treatment.
From the Research
Definition of Phlebitis
- Phlebitis is a common complication of intravenous administration that affects clinical outcomes, patient satisfaction, and health-care expenditure 2.
- It involves multiple signaling pathways, upregulation of E-selectin, cell apoptosis, intracellular ROS generation, and induction of autophagy-associated cell death 2.
- Phlebitis is accompanied by endothelial dysfunction and may involve multiple molecular and cellular mechanisms 2.
Types of Phlebitis
- Superficial thrombophlebitis is a minimally thrombotic process of superficial veins associated with inflammatory changes and/or infection 3.
- Thrombophlebitis may be a relatively harmless disorder or a symptom of an underlying systemic disease 4.
- Idiopathic skipping phlebitis (phlebitis saltans) is a type of thrombophlebitis that is relatively harmless 4.
Causes and Risk Factors
- Intravenous administration of antibiotics is a known risk factor for infusion phlebitis 5.
- Certain antibiotics, such as dicloxacillin and erythromycin, have a greater tendency to cause phlebitis than others 5.
- The site of insertion and age 51-60 years are also risk factors for phlebitis 5.
- Medication with warfarin may be protective against phlebitis, but not with aspirin 5.
Prevention and Treatment
- Preventive and curative interventions for phlebitis include α-solanine, baicalein, escin, intermedin, and other compounds 2.
- Topical analgesia with nonsteroidal, anti-inflammatory creams applied locally to the affected area can control symptoms 3.
- Hirudoid cream (heparinoid) can shorten the duration of signs and symptoms of phlebitis 3.
- Low molecular weight heparin prophylaxis and nitroglycerin patches distal to peripheral lines may reduce the incidence of phlebitis in patients with vein catheters 3.