Phlebitis : Causes, Symptoms, Treatment and Surgery

What is Phlebitis?

Photo By: Yale Rosen/ CC BY

Phlebitis is a condition characterized by vein inflammation. When the inflammation is due to one/more blood clots in the vein, it is called thrombophlebitis. Phlebitis occurs in veins on the skin’s surface, in which case it is known as superficial phlebitis. It also is found in varicose veins, deeper veins and more in the legs than any other part. When blood clots occur in deep veins of an inflamed area, deep vein thrombophlebitis is diagnosed. Thrombophlebitis occurs in the leg as well as arm veins. In the vein, there is a thrombus leading to pain and irritation because it blocks blood flow.

Superficial phlebitis impacts veins on the surface of the skin and is rarely complicated. This condition resolves rapidly, but those with superficial phlebitis can also get deep vein thrombophlebitis. A medical evaluation may, therefore, be necessary. Deep vein thrombophlebitis impacts the blood vessels situated deep in the legs and larger in size. This can result in a medical condition called pulmonary embolism whereby massive blood clots form and travel to the lungs.

Phlebitis may or may not lead to symptoms. The common symptoms associated with phlebitis include pain, redness, tenderness, and bulging veins. Low fever may also impact phlebitis patients. High fever or pus drainage indicates an infection of thrombophlebitis called septic thrombophlebitis. Deep vein thrombosis can even create impediments while walking.

Causes

Superficial phlebitis has no clear reason. It can take place after medical treatment such as IV line insertion. Minor, small injuries to current varicose veins can also cause this.

Causes of deep vein thrombosis include:

• Increased inactivity such as sitting stationary for long periods of time or being bedridden.
• Paralysis leading to inactivity
• Certain types of cancer
• HRT and use of hormone estrogen
• Genetics
• Injury to the inner lining of the vein
• Clotting disorders
• Conditions which impede blood flow

Who Develops Phlebitis?

Those who are at risk of DVT include:

• Obese people
• Smokers
• Sedentary inactivity for time periods
• Pregnancy
• HRT or birth control pills
• Arm or leg injuries
• Family genetics of blood clots.

Superficial phlebitis causes complications due to surgical or medical procedures. Vein injuries increase the chances of forming blood clots, which can sometimes occur without injury as well.

Risk factors for thrombophlebitis include:

• Inactivity: Staying in bed or sitting for hours causes stagnancy or slow blood flow from the legs in a dependent position. The thrombus formation comes from blood pooling in the legs.
• Sedentary habits or not getting enough exercise can also be other factors.
• Obesity: Heavyweight can also be a factor causing DVT.
• Medical Conditions: These include certain medical conditions such as cancer or blood disorders increasing the clotting potential of the blood. Pregnancy or varicose veins are also associated with this condition, as are arm or leg injuries.
• HRT/Pills: Hormone replacement therapy or birth control pills also cause thrombophlebitis.

Symptoms

Superficial Phlebitis

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Along the superficial vein, there is an onset of tenderness and redness. A thin red area is caused due to inflammation of the vein.

The area may feel hard, tender and warm. The skin around the veins becomes irritated and inflamed. There will be throbbing or burning sensations in the area as well.

Symptoms will worsen when the leg is lower, except when getting out of the bed. Low fever may occur and phlebitis can occur when peripheral IV is administered.

There will be soreness and tenderness along the vein. If there is an infection, symptoms range from:

• Pain
• Redness
• Fever
• Swelling
• Skin breakdown

These symptoms may worsen when the affected area such as the leg or arm is lowered. Superficial phlebitis, though symptomatic, is rarely serious, Only when the clotting occurs, does the inflammation of the vein feel like a strong cord or string under the skin which does not collapse much like a normal vein.

Deep Vein Phlebitis

This can have superficial phlebitis symptoms too. There can even be a complete absence of symptoms. Pain and swelling may be felt through the entire limb or leg. Lower leg may have inflammation.

People also get a fever from superimposed bacteria and skin ulcers, if the condition is long-standing and not well treated. Deep vein thrombophlebitis causes warmth, redness and swelling in the affected area.

DVT is life-threatening because the blood clot in the vein can break apart from there and reach the lungs, causing shortness of breath and chest pains, apart from fatal consequences.

Treatment

When to Seek Medical Care?

If you have signs of swelling, pain and inflamed veins on the arms or legs, it is time to seek medical help. This is more so if the condition gets worse or you don’t feel better in a week or two.

Deep vein thrombophlebitis is a condition requiring immediate medical care and you need to visit the ER if you develop this condition. Signs of this include high fever with symptoms in arms or legs. You also may have lumps in the limbs or unexplained shortness of breath. In case the clot has traveled to your lungs, you need to go to the hospital immediately.

Diagnosis of Phlebitis

A simple physical examination is enough to diagnose superficial phlebitis. For DVT, you need to use ultrasounds, CT scans, MRI scans, and blood tests. Diagnosis of superficial phlebitis is based on a medical exam by a doctor. The symptoms you must display include redness, warmth, tenderness and swelling along the veins.

Deep vein thrombosis is a difficult condition to diagnose and in the event of extremity swelling, an ultrasound may be required. Venography may also be required. D-dimer is a blood test to diagnose phlebitis. Chemicals are released into the blood by the clots when they degrade and the rest is based on that.

Conditions that are similar to phlebitis include:

• Cellulitis
• Lymphangitis

Superficial phlebitis of the extremities can be treated using warm compresses, raising extremities. walking and oral anti-inflammatory medications. Compression stockings and topical anti-inflammatory medicines can also work.

If the IV line or catheter is the cause, it should be removed. Superficial thrombophlebitis is diagnosed through ultrasound to make a differential diagnosis from deep venous thrombophlebitis.

If deep vein thrombophlebitis is suspected, anticoagulants are released into the bloodstream. Patients with DVT can be treated with a combination of these and catheter-directed thrombolysis. DVT patients may even need placement of inferior vena cava filters to prevent serious complications. While superficial phlebitis takes a few weeks to recover from, thrombophlebitis can take months.

D- dimer is a test that measures a release of substances from a dissolved blood clot. If the test is negative, then the possibility of having a blood clot is ruled out. Ultrasound detects clots or blockage of blood flow in upper veins. A probe may also be used as a non-invasive means of identifying the blood clot. If the blood clot has developed in the smaller veins, a venogram is carried out.

Self Care

If you have superficial phlebitis, it can be treated at home. An anti-inflammatory drug such as ibuprofen or aspirin can lessen pain. In case one is walking, this also is an effective treatment method because it increases the flow of the blood and prevents clots from forming.

Prescription leg compression stocking which is up to the knee or thigh can also enhance the flow of blood and rid the body of pain and inflammation. Don’t go in for bed rest as this can worsen the symptoms.

In case you have deep vein thrombophlebitis, you may require a stay in the hospital.

Medical Treatment and Related Drugs

Photo By: Yale Rosen/ CC BY

Phlebitis improves on its own in a couple of days if it is superficial. Treatment comprises warm soaks, rest, and NSAIDs such as ibuprofen and aspirin. Elastic compression stockings also work wonders. The blood clot can also be removed using a local anesthetic by the doctor.

If phlebitis has developed in the groin, where the deep and superficial vein meets. the blood clot will extend into the deep vein. In such a case, doctors may have to perform emergency surgery as well.

If the medical assessment reveals superficial phlebitis, you need to use:

• Compression stockings
• Heparin containing ointments
• Anti-inflammatory medicines
• Warm Compresses
• A rare case of antibiotics

If there is a history of DVT, or phlebitis has spread to deep veins, blood thinner medication may have to be taken. Anticoagulant treatment lasts anywhere between 3 to 6 months.

If there are signs of infection, an antibiotic may help. Deep vein thrombophlebitis is a serious condition that requires extended medical care and treatment. Physicians treat this condition with blood clots. Anticoagulant heparin is injected to stop the clot from expanding and then the patient takes an oral anticoagulant for more months afterward. An angioplasty may also be needed to remove the clot and a clot filter may be inserted to keep it from reaching the lung.

Severe thrombophlebitis does not need rest unless there is severe pain following movement. Affected extremities need to be placed at an elevation and large, compresses of sufficient warmth may be needed as well. Exercise reduces the pain associated with DVT. Prescription-strength compression stocking can reduce pain and prevent DVT. If blood thinners cannot be taken, a filter needs to be inserted into the main vein in the abs (vena cava) to stop blood clots from traveling to the lungs. Another useful treatment involves surgically removing varicose veins that cause pain or recurring thrombophlebitis, through varicose vein stripping.

Pharmacological Interventions

Topical analgesic with NSAID cream can be applied to superficial vein thrombosis or superficial thrombophlebitis. Hirudoid cream is also effective (also called heparinoid). Low molecular weight heparin may need to be ingested for a month as well.

In case there is a likelihood of pulmonary embolism or DVT, Fondaparinux can prove beneficial. It reduces the risk of thrombophlebitis extension and recurrence. Antibiotics are needed if there is a possible infection.

For superficial thrombophlebitis, warm compresses may work along with elevating the affected leg, using OTC NSAIDS and wearing compression stockings.

For treatment of thrombophlebitis, the following medicines are used:

Anticoagulants

This is blood thinning medication. If you have deep vein thrombosis, injection of blood thinning medication can prove beneficial. This includes:

• Heparin
• Arixtra
• Coumadin
• Jantoven
• Xarelto

Clot Dissolving Medicines

Medications such as alteplase or Activase are perfect for dissolving blood clots. This is also known as thrombolysis which involves treatment for DVT or pulmonary embolism.

NSAIDs

Non-steroidal anti-inflammatory drugs reduce the risk of superficial thrombophlebitis. They also prevent it from becoming a deep venous system and most easily administered.

Antibiotics

These are not considered routine for superficial thrombophlebitis. If supportive thrombophlebitis is present, antibiotics can prove useful.

Surgery

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Ligation and excision may be performed if thrombophlebitis occurs with considerable varicose veins. Other complications which require surgical intervention such as extension into deep veins, hyperpigmentation over the vein, suppurative phlebitis causing septicemia or abscesses.

With a spread, the vein causing thrombophlebitis should be excised. Patients with septic thrombophlebitis require excision for controlling septic focus. This is performed when an incision is made over the vein. This allows removal of the segment that is infected along with the surrounding tissue.

Saphenous thrombophlebitis may also need surgical treatment, especially if the process extends upwards despite the use of blood thinners. Surgery may also be required if anticoagulants are not permitted for treatment due to underlying medical conditions of the patient. Saphenous ligation can lead to relief from the condition.

Superficial veins with intravascular coagulum may be treated through puncture incision with a needle. Puncture and evacuation are effective in the week after the symptoms appear.

Conclusion

Phlebitis is not a serious condition if it is superficial. But if it is deep venous or shows a tendency to develop into the same, medical care is essential for the condition to be effectively treated. If the blood clot in a thrombophlebitis condition crosses over to the lungs, it can be catastrophic. So check with your doctor if you develop any of these symptoms.