Treatment of Phlebitis

Remove the catheter immediately if phlebitis develops, as this is the most critical first step in management. 1

Immediate Management

Remove peripheral venous catheters immediately if signs of phlebitis develop (warmth, tenderness, erythema, palpable venous cord) 1
For catheter-related phlebitis, removal of the intravenous device is the cornerstone of treatment and should be performed promptly 2

Anticoagulation is the preferred treatment for superficial thrombophlebitis:

Fondaparinux 2.5 mg subcutaneously daily for 45 days is the most evidence-based option, significantly reducing VTE (85% reduction), ST extension (92% reduction), and recurrence (79% reduction) with no increased bleeding risk 4
Low molecular weight heparin (LMWH) at prophylactic doses is an effective alternative, reducing extension and recurrence of superficial thrombophlebitis 4, 5
- Dalteparin has been shown superior to NSAIDs in preventing thrombus extension at 14 days 5
NSAIDs (oral) reduce extension and recurrence compared to placebo but are less effective than anticoagulation 4

Topical treatments for symptom relief:

Topical NSAIDs (anti-inflammatory creams) applied locally control symptoms effectively 3
Heparinoid cream (Hirudoid) shortens duration of signs and symptoms 3
Topical nitroglycerin has shown effectiveness in reducing the inflammatory process 6

Do not routinely use antibiotics unless there is documented infection 3
If septic phlebitis is suspected (persistent fever, bacteremia, systemic toxicity):
- Start empiric antibiotics covering Staphylococcus aureus (most common, 41% of cases) and Group A streptococcus (20% of cases) 2
- If clinical deterioration occurs or septicemia persists after 24 hours despite conservative therapy, surgical excision of the involved vein should be performed 2

Replace peripheral venous catheters every 72-96 hours in adults to prevent phlebitis 1
In pediatric patients, leave catheters in place until IV therapy is completed unless complications occur 1
Use upper extremity sites instead of lower extremity sites 1
Consider midline catheters or PICCs when IV therapy will likely exceed 6 days 1
Avoid steel needles for medications that might cause tissue necrosis if extravasation occurs 1

Failing to remove the catheter promptly is the most common error—catheter removal is mandatory, not optional 1, 2
Underestimating the risk of VTE with superficial thrombophlebitis—anticoagulation should be strongly considered 4
Using antibiotics routinely when infection is not documented wastes resources and promotes resistance 3
Prescribing bed rest when ambulation is actually beneficial and reduces DVT risk 3