What is the treatment for phlebitis?

Treatment of Phlebitis

For phlebitis treatment, anticoagulation with fondaparinux 2.5 mg daily or low molecular weight heparin for 45 days is recommended for superficial vein thrombosis with high-risk features. 1

Types of Phlebitis and Initial Management

Superficial Vein Thrombosis/Thrombophlebitis

• First-line symptomatic treatment:

  • Warm compresses to affected area
  • Topical or oral NSAIDs for pain and inflammation
  • Elevation of affected limb
  • Early mobilization and continued exercise
  • Elastic compression stockings (20-30 mmHg gradient) 1, 2

• Anticoagulation therapy based on risk factors:

  • For SVT > 5 cm: Fondaparinux 2.5 mg daily or LMWH for 45 days
  • For SVT within 3 cm of saphenofemoral junction: Therapeutic anticoagulation for at least 3 months
  • Alternative: Rivaroxaban 10 mg daily for 45 days for high-risk features 1

Deep Vein Thrombosis (DVT)

• Initial treatment:
  • Parenteral anticoagulant therapy (Grade 1B) or rivaroxaban 3
  • LMWH or fondaparinux preferred over IV unfractionated heparin (Grade 2C) or subcutaneous unfractionated heparin (Grade 2B) 3
  • Early ambulation over bed rest (Grade 2C) 3
  • Home treatment if home circumstances are adequate (Grade 1B) 3

Special Considerations

Catheter-Associated Phlebitis

• Remove intravenous catheters if associated with thrombus and no longer clinically essential 1
• If catheter must remain in place, maintain anticoagulation as long as catheter remains and for at least 3 months after removal 1
• For septic phlebitis: Prompt removal of IV device, antibiotics, heat, and elevation 4
• Consider surgical excision of involved vein if clinical deterioration occurs or septicemia persists despite 24 hours of conservative therapy 4

Duration of Anticoagulation

• For proximal DVT provoked by surgery: 3 months of anticoagulation (Grade 1B) 3
• For unprovoked DVT: At least 3 months, then evaluate for extended therapy (Grade 1B) 3
• For DVT with active cancer: Extended anticoagulation if bleeding risk not high (Grade 1B) 3
• For upper extremity DVT involving axillary or more proximal veins: Minimum 3 months of anticoagulation (Grade 2B) 3

Special Populations

Renal Insufficiency

• Avoid fondaparinux in severe renal insufficiency (creatinine clearance <30 mL/min)
• Consider unfractionated heparin with appropriate monitoring 1

Pregnancy

• Use LMWH instead of fondaparinux or direct oral anticoagulants
• Continue for remainder of pregnancy and 6 weeks postpartum 1

Cancer Patients

• May require closer monitoring and potentially prolonged anticoagulation 1

Prevention of Phlebitis

• Change intravenous catheters every 24-48 hours
• Consider LMWH prophylaxis and nitroglycerin patches distal to peripheral lines in high-risk patients
• Early mobilization after surgery
• Proper IV catheter care and placement techniques
• Regular inspection of IV sites
• Remove IV catheters as soon as clinically appropriate 1, 2

Follow-up

• Comprehensive duplex ultrasound to assess both superficial and deep venous systems
• Follow-up ultrasound in 7-10 days to evaluate thrombus progression
• Continue anticoagulation for full recommended duration even if symptoms improve 1

The treatment approach should be guided by the type of phlebitis, location, extent, and patient-specific risk factors, with anticoagulation being the cornerstone of therapy for most cases beyond simple superficial thrombophlebitis.