What is the treatment for phlebitis?

Treatment of Phlebitis

For phlebitis treatment, anticoagulation is the primary intervention, with prophylactic-dose fondaparinux or low-molecular-weight heparin (LMWH) recommended for extensive superficial vein thrombosis, with fondaparinux preferred over LMWH. 1

Types of Phlebitis and Initial Management

Superficial Phlebitis (Superficial Vein Thrombosis)

• For extensive superficial phlebitis (exceeding 5 cm in length), prophylactic-dose fondaparinux or LMWH is recommended for 45 days, with fondaparinux (2.5 mg daily) preferred over LMWH 1
• Ultrasound imaging is warranted to confirm diagnosis and exclude subclinical deep vein thrombosis (DVT), as approximately 25% of patients with superficial phlebitis have underlying DVT 1
• Conservative treatment is appropriate for less extensive superficial phlebitis due to low risk of pulmonary embolism (1.3%) 1

Deep Vein Thrombosis (DVT)

• Initial treatment with parenteral anticoagulation is recommended (Grade 1B) 1
• Options include:
  • Low-molecular-weight heparin (LMWH)
  • Fondaparinux
  • IV unfractionated heparin (UFH)
  • Subcutaneous unfractionated heparin 1
• LMWH or fondaparinux is preferred over IV UFH (Grade 2C) and over SC UFH (Grade 2B for LMWH; Grade 2C for fondaparinux) 1

Duration of Anticoagulation Therapy

• For proximal DVT provoked by surgery: 3 months of anticoagulation (Grade 1B) 1
• For proximal DVT provoked by nonsurgical transient risk factor: 3 months of anticoagulation (Grade 1B) 1
• For unprovoked DVT: at least 3 months of treatment (Grade 1B) 1
• For DVT associated with active cancer: extended therapy recommended (Grade 1B) with LMWH preferred over vitamin K antagonists (Grade 2B) 1

Local and Supportive Measures

• Early ambulation is suggested over bed rest for acute DVT (Grade 2C) 1
  • If edema and pain are severe, ambulation may need to be deferred 1
• Compression stockings (30-40 mm Hg knee high) worn for 2 years are recommended to reduce the risk of postthrombotic syndrome by 50% (Grade 2B) 1
• Warm water compresses can be effective for treating peripheral intravenous catheter-related phlebitis 2, 3
  • Application of warm moist compresses at 28°C for 15 minutes three times daily can reduce redness, edema width, and pain intensity 3
• Topical treatments such as heparinoid creams or diclofenac gels may improve pain compared to placebo 4

Special Considerations

Catheter-Related Phlebitis

• Intravenous catheters should be changed every 24-48 hours to prevent phlebitis 5
• If phlebitis develops, the catheter should be promptly removed 5, 6
• For septic phlebitis, treatment should include:
  • Prompt removal of the intravenous device
  • Appropriate antibiotics
  • Heat application
  • Elevation of the affected limb 6
  • Consider operative excision of the involved vein if clinical deterioration occurs or if septicemia persists after 24 hours despite conservative therapy 6

Home vs. Hospital Treatment

• Initial treatment at home is recommended over hospital treatment for patients with acute DVT whose home circumstances are adequate (Grade 1B) 1
• Adequate home circumstances include:
  • Well-maintained living conditions
  • Strong support from family or friends
  • Phone access
  • Ability to quickly return to the hospital if deterioration occurs 1

Prevention Strategies

• Low molecular weight heparin prophylaxis may reduce the incidence of phlebitis in patients with vein catheters 5
• Nitroglycerin patches placed distal to peripheral lines may reduce phlebitis incidence 5
• Regular exercise helps reduce pain and the possibility of deep vein thrombosis 5

Remember that the choice of treatment should be guided by the type and severity of phlebitis, with anticoagulation being the cornerstone of therapy for extensive superficial vein thrombosis and DVT, while local measures like warm compresses and topical treatments can help manage symptoms in less severe cases.