Phlebitis

Phlebitis
Other names: Venitis
Veins in the popliteal area
SpecialtyEmergency medicine
SymptomsPain, swelling, redness[1]
ComplicationsDeep vein thrombosis, pulmonary embolism[2]
Usual onsetOlder people[1]
TypesInfusion phlebitis, superficial thrombophlebitis[3]
Risk factorsIntravenous catheters, varicose veins, cancer, pregnancy, poor mobility[4][5]
Differential diagnosisCellulitis, hematoma, lymphangitis, tendonitis[2]
TreatmentWarmth, pain medication (NSAIDs), anticoagulants[4][3]
FrequencyRelatively common[5][2]

Phlebitis is inflammation of a vein.[1] It generally results in pain, swelling, and redness of the area in question.[1] Hardness of the vein may also occur.[1] Complications may include deep vein thrombosis or pulmonary embolism.[2]

It may occur in about 30% of people with intravenous catheters; though only 4% of cases are severe.[5] Risk factors include longer duration of catheter use and giving antibiotics through it.[5] Underlying mechanisms may include injury to the vein, chemical irritation, and bacterial infection.[1] Another cause is blood clotting, a condition known as superficial thrombophlebitis.[4] Risk factors include varicose veins, cancer, pregnancy, and poor mobility.[4] Usually the legs are involved.[4]

While evidence to support treatment is low, efforts may include the application of warmth and pain medication.[6][3] When do due a blood clot treatment may include elevating the lead, NSAIDs, and occasionally anticoagulants.[4][7] Older people are more commonly affected.[1] In cases due to intravenous catheters females are more commonly affected than males.[5]

Signs and symptoms

  • Localized redness and swelling
  • Pain or burning along the length of the vein
  • Vein being hard and cord-like[8]

There is usually a slow onset of a tender red area along the superficial veins on the skin. A long, thin red area may be seen as the inflammation follows a superficial vein. This area may feel hard, warm, and tender. The skin around the vein may be itchy and swollen. The area may begin to throb or burn. Symptoms may be worse when the leg is lowered, especially when first getting out of bed in the morning. A low-grade fever may occur. Sometimes phlebitis may occur where a peripheral intravenous line was started. The surrounding area may be sore and tender along the vein.[9]

Cause

Phlebitis is typically caused by local trauma to a vein, usually from the insertion of an intravenous catheter.[10] However, it can also occur due to a complication of connective tissue disorders such as lupus, or of pancreatic, breast, or ovarian cancers. Phlebitis can also result from certain medications and drugs that irritate the veins, such as desomorphine.[11]

Superficial phlebitis often presents as an early sign in thromboangiitis obliterans (Buerger's disease), a vasculitis that affects small and medium-sized arteries and veins in distal extremities often associated with cigarette smoking.[12]

Management

Treatment usually consists of NSAIDs, such as ibuprofen and local compression (e.g., by compression stockings or a compress).[13] If the phlebitis is associated with local bacterial infection, antibiotics may be used.[14]

For acute infusion superficial thrombophlebitis, not enough evidence exists as of 2015 to determine treatment.[6]

See also

References

  1. 1 2 3 4 5 6 7 Macklin, D (February 2003). "Phlebitis". The American journal of nursing. 103 (2): 55–60. doi:10.1097/00000446-200302000-00027. PMID 12582339.
  2. 1 2 3 4 Czysz, A; Higbee, SL (January 2022). "Superficial Thrombophlebitis". PMID 32310477. {{cite journal}}: Cite journal requires |journal= (help)
  3. 1 2 3 Dychter, SS; Gold, DA; Carson, D; Haller, M (March 2012). "Intravenous therapy: a review of complications and economic considerations of peripheral access". Journal of infusion nursing : the official publication of the Infusion Nurses Society. 35 (2): 84–91. doi:10.1097/NAN.0b013e31824237ce. PMID 22382792.
  4. 1 2 3 4 5 6 Beckman, Joshua A. (22 October 2002). "Diseases of the Veins". Circulation. 106 (17): 2170–2172. doi:10.1161/01.CIR.0000036740.75461.80. PMID 12390942.
  5. 1 2 3 4 5 Lv, L; Zhang, J (May 2020). "The incidence and risk of infusion phlebitis with peripheral intravenous catheters: A meta-analysis". The journal of vascular access. 21 (3): 342–349. doi:10.1177/1129729819877323. PMID 31547791.
  6. 1 2 Di Nisio, M; Peinemann, F; Porreca, E; Rutjes, AW (20 November 2015). "Treatment for superficial infusion thrombophlebitis of the upper extremity" (PDF). The Cochrane Database of Systematic Reviews. 11 (11): CD011015. doi:10.1002/14651858.CD011015.pub2. PMC 6885032. PMID 26588711. Archived (PDF) from the original on 16 February 2020. Retrieved 12 January 2022.
  7. ↑ Di Nisio, M; Wichers, IM; Middeldorp, S (25 February 2018). "Treatment for superficial thrombophlebitis of the leg". The Cochrane database of systematic reviews. 2: CD004982. doi:10.1002/14651858.CD004982.pub6. PMID 29478266.
  8. ↑ Benjamin Wedro. "Phlebitis Symptoms". emedicinehealth. Archived from the original on 21 June 2013. Retrieved 13 May 2013.
  9. ↑ Ratini, Melinda (30 October 2020). "Phlebitis Basics". WebMD. Archived from the original on 2021-01-20. Retrieved 2021-01-01.
  10. ↑ Benjamin Wedro. "Phlebitis Causes". emedicinehealth. Archived from the original on 22 June 2013. Retrieved 30 May 2013.
  11. ↑ "Blood Clots - Causes, Symptoms, Treatment, Diagnosis - Canoe.com". canoe.ca. Retrieved 7 April 2018.{{cite web}}: CS1 maint: url-status (link)
  12. ↑ "UpToDate". www.uptodate.com. Archived from the original on 8 April 2018. Retrieved 7 April 2018.
  13. ↑ Benjamin Wedro. "Phlebitis Treatment". emedicinehealth. Archived from the original on 24 June 2013. Retrieved 30 May 2013.
  14. ↑ Benjamin Wedro. "Phlebitis Medical Treatment". emedicinehealth. Archived from the original on 24 June 2013. Retrieved 30 May 2013.
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