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Iv phlebitis definition: What are the stages of catheter-related phlebitis?

by alexxlab

What are the stages of catheter-related phlebitis?

Phlebitis stages indicates the severity of inflammation in a vein due to an intravenous (IV) catheter. The score ranges from 0–4, according to how severe the symptoms are.

Symptoms in the early stage involve redness and pain at the IV site. If the condition progresses to the advanced stage, additional symptoms include swelling and a palpable venous cord, which is firmness in the vein.

In the early stage, doctors recommend removing the IV device and inserting a new one in another site. If phlebitis reaches the medium stage, they advise considering treatment.

One treatment may entail topical anti-inflammatory medications for people to apply to the skin over the vein. Another treatment option is an oral medication to reduce the formation of blood clots.

Keep reading to learn more about phlebitis stages due to IV therapy, causes, diagnosis, treatment, and outlook.

Phlebitis is the inflammation of a vein, which results in redness, swelling, and pain. It can happen in an arm when a person receives IV therapy in a hospital.

The condition may also occur from a blood clot. When this happens, it is called thrombophlebitis. This may affect veins near the surface of the skin or deeper veins, but it usually occurs in the leg.

The staging system only applies to phlebitis due to IV therapy, a method of putting fluids into the bloodstream. It involves inserting a tube called a cannula into a vein. Approximately 25–35% of people who receive IV therapy in a hospital acquire phlebitis, notes an older 2002 study.

The chart below shows the phlebitis staging scale for IV therapy.

StageDescription
Score of 0.The IV site looks healthy.
Score of 1.The IV site looks slightly red, and a person experiences slight pain near the site.
Score of 2, or early-stage phlebitis.Redness and pain at the IV site are present.
Score of 3, or medium stage phlebitis.Redness, swelling, and pain along the path of the IV cannula are present.
Score of 4, or advanced stage phlebitis.Signs include redness, swelling, a palpable venous cord, and pain along the path of the IV cannula.

Causes of phlebitis include:

  • infection
  • injury
  • irritation

The use and removal of an IV can lead to these causes. A 2016 study explains that IV-related phlebitis may stem from:

  • Mechanical damage: This may happen when movement of the IV cannula inside a vein produces friction. It can also be due to irritation when a cannula is too wide for a vein.
  • Chemical damage: This may occur when a drug or other component of fluid flowing through an IV has a characteristic that produces vein irritation.
  • Infection: In response to IV insertion, bacteria may infiltrate a vein. This can create serious complications if the infection develops into sepsis. In sepsis, the infection leaves the IV site and becomes systemic, or circulates throughout the body.

Aside from IV therapy, thrombophlebitis can cause injury or trauma to a vein. If it affects a vein close to the skin surface, doctors call this superficial thrombophlebitis.

Risk factors for surface thrombophlebitis include:

  • smoking
  • taking oral contraceptives or hormone replacement therapy
  • pregnancy
  • underlying cancer

If phlebitis involves an IV site, a diagnosis may be evident by observing the symptoms.

In contrast, if symptoms suggest superficial thrombophlebitis, the following procedures are necessary for diagnosis:

  • Physical examination: This entails noting any symptoms of redness, warmth, and tenderness over the track of a surface vein, along with a palpable cord.
  • Medical history: This includes discovering whether a person has risk factors or conditions that may cause injury to a vein.
  • Ultrasound: This imaging test can show the extent of superficial thrombophlebitis. It may also determine whether it has developed into the complication of deep vein thrombosis, a blood clot in a deep vein.
  • D-dimer blood test: This test measures a protein fragment that results when a blood clot dissolves. As the level of D-dimer is not always higher than normal in superficial thrombophlebitis, its use is limited.

Treatment of IV-related phlebitis differs from the treatment of superficial thrombophlebitis.

Treatment for IV-related phlebitis

In the early stage, experts recommend removing the IV and inserting a new one in a different site. Once phlebitis reaches the medium stage, they also advise considering treatment.

A 2015 review evaluated the effectiveness of treatments for IV-related phlebitis. Due to limited, poor-quality data, the authors concluded that research is too preliminary to determine how well current treatments work. However, options include:

  • Topical treatments. Examples include a nonsteroidal anti-inflammatory drug such as diclofenac gel (Voltaren) or a medication to reduce swelling of inflamed veins such as heparinoid (Hirudoid).
  • Nonsteroidal anti-inflammatory drugs: These decrease inflammation and include medications, such as ibuprofen.

Treatment for superficial thrombophlebitis

Research from 2018 reports that most cases of superficial thrombophlebitis resolve on their own. Treatment may involve:

  • elevating the leg above the heart to reduce swelling
  • wearing elastic stockings
  • applying warm compresses to the area
  • using topical or oral anti-inflammatory medications

If superficial thrombophlebitis is more severe, treatment may include an anticoagulant, such as fondaparinux (Arixtra).

When the cause of the condition is an infection, in rare cases, treatment may necessitate surgical removal of the infected part of the vein.

Cases of phlebitis from an IV infusion can range from those involving mild discomfort to those with severe complications, such as sepsis. The outlook depends on the severity.

Phlebitis stages are a grading system that doctors use to diagnose and monitor the severity of inflammation of a vein associated with IV therapy.

Doctors do not use phlebitis stages to diagnose the severity of thrombophlebitis. Instead, the diagnostic process involves a physical exam, history, and ultrasound.

There are some differences in treatment between IV-related phlebitis and thrombophlebitis. Yet both conditions may entail treatment with nonsteroidal anti-inflammatory drugs or anticoagulants.

What Is It, Symptoms, Causes, and More

Phlebitis is the inflammation of a vein. It often occurs in the legs but can affect veins in other parts of your body, as well. It may be caused by damage to the vein wall or by a blood clot that blocks a vein.

Phlebitis may be caused by damage to the vein wall or by a blood clot that blocks a vein. Inflammation caused by a blood clot, or thrombus, is called thrombophlebitis.

Blood clots can occur in veins near the surface of the skin or in veins deep within your muscles. If a blood clot is in a deep vein, it’s called deep vein thrombophlebitis or deep vein thrombosis (DVT).

Phlebitis can affect both superficial and deep veins.

Superficial phlebitis refers to the inflammation of a vein near the surface of your skin. It can result from a blood clot or from something causing irritation in a vein, such as an intravenous (IV) catheter.

This type of phlebitis usually isn’t serious, but it can lead to:

  • infection of the surrounding skin
  • wounds on the skin
  • bloodstream infections

If a clot in the superficial vein is extensive enough and involves the area where the superficial vein and a deep vein come together, a DVT can develop.

Deep vein phlebitis refers to inflammation of a deeper, larger vein, such as those found in your legs. Deep vein phlebitis is more likely to be caused by a blood clot, which can have very serious consequences.

A blood clot may break off and travel to your lungs. This is called a pulmonary embolism (PE) and can be life threatening. It’s important to know the risk factors and symptoms of a DVT so you can seek prompt attention from a healthcare professional.

Symptoms of phlebitis affect the arm or leg where the inflamed vein is located. They often include swelling and pain in the affected area. These symptoms can vary depending on whether you have superficial or deep vein phlebitis.

Superficial phlebitis symptoms

If the inflamed vein is located near the surface of your skin, you may experience:

  • redness
  • swelling
  • warmth
  • tenderness
  • visible red “streaking“ on the skin along the vein
  • a rope- or cord-like structure that you can feel through the skin

Deep vein phlebitis symptoms

If the inflamed vein is deep within a muscle, you may experience the following symptoms in the affected limb:

  • pain
  • swelling
  • warmth
  • skin discoloration

You may also notice pain in your calf or thigh if your phlebitis is caused by a DVT. The pain may be more noticeable when walking or flexing your foot.

Only about half of those who develop a DVT experience symptoms, according to the Centers for Disease Control and Prevention (CDC). This is why a DVT may not be diagnosed until a serious complication occurs, such as a PE.

Symptoms of PE include:

  • unexplained shortness of breath
  • chest pain
  • coughing up blood
  • pain with deep breathing
  • rapid breathing
  • feeling lightheaded or passing out
  • fast heart rate

Call your local emergency services if you think you may be experiencing a PE. This is a medical emergency that requires immediate treatment.

The most common causes of phlebitis are injury or irritation to the lining of a blood vessel or a blood clot inside the vein. In the case of superficial phlebitis, this may be due to:

  • placement of an IV catheter
  • administration of irritating medications into your veins
  • a small clot
  • an infection
  • a soft tissue injury

Causes of deep vein phlebitis may include:

  • irritation or injury due to physical trauma, such as surgery, a broken bone, or serious injury
  • slowed blood flow due to lack of motion, which may occur if you’re on bed rest or sitting in one position for a long period of time
  • blood that is more likely to clot, which may be due to medications, cancer, connective tissue disorders, or inherited blood clotting conditions

A number of factors can increase your risk of phlebitis. You may be more likely to experience phlebitis if you:

  • have a personal or family history of blood clots
  • have a blood clotting disorder, such as factor V Leiden thrombophilia
  • take hormone therapy or birth control pills
  • experience long periods of inactivity, which may be needed after surgery
  • sit for long periods of time, such as during travel
  • have certain cancers and cancer treatments
  • are pregnant
  • have overweight or obesity
  • smoke
  • misuse alcohol
  • have varicose veins, which can increase your risk of superficial phlebitis
  • are over age 60

A doctor can often diagnose phlebitis based on your symptoms and a physical exam. You may not need any special tests.

However, if a blood clot is suspected as the cause of your phlebitis, your doctor could perform several tests in addition to taking your medical history and examining you. These tests may include:

  • Ultrasound. An ultrasound uses sound waves to show the flow of blood through your veins and arteries. It can be used to detect blockages or blood clots in the deep veins of the affected limb.
  • D-dimer blood test. This test measures levels of d-dimer, a substance that’s released when a clot breaks up. If your d-dimer test is negative, you likely don’t have a clot.
  • Venography. Your doctor performs a venogram by injecting a special dye into a vein in your foot. An X-ray is then taken as the dye flows up your leg. This allows your doctor to see the deep veins in your leg and check for the presence of a blood clot.
  • Imaging tests. Your doctor may perform an MRI scan or CT scan to help determine if a blood clot is present in your veins.

If a clot is detected, your doctor may want to take blood samples to test for blood clotting disorders that could have caused it.

Treatment for phlebitis may involve both self-care and medical treatment. Your treatment options may depend on whether you have superficial or deep vein phlebitis.

Self-care at home

There are steps you can take at home to help reduce the pain and swelling of phlebitis. These include:

  • applying a warm compress to the affected area
  • keeping your leg raised while resting
  • taking nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen. (If you also take a blood thinner, do not take NSAIDs unless prescribed by your doctor).

Medical treatment

Superficial phlebitis often improves within a few weeks using self-care measures. If phlebitis affects a deep vein or you’re at risk of developing DVT, your doctor may recommend additional treatments. These may include:

  • Anticoagulant blood-thinning medications. Anticoagulants reduce your blood’s ability to clot. This can help prevent an existing clot from becoming larger and reduce the risk of additional clots. These medications can be injected or taken orally.
  • Thrombolytic medications. Also called “clot busters,“ thrombolytics dissolve a clot. They’re typically used for more serious cases of DVT.
  • Varicose vein treatment. If you have recurrent superficial phlebitis in varicose veins, your doctor may recommend treatment for your varicose veins. Options may include sclerotherapy, laser treatment, or surgical removal of varicose veins.
  • Thrombectomy. This procedure may be performed if the DVT is very extensive and causes significant problems with blood return in your limb. A surgeon inserts a wire and catheter into the affected vein and either removes the clot, dissolves it with medications that break up the clot, such as tissue plasminogen activators, or performs a combination of both.
  • Vena cava filter. Insertion of a filter into one of your major blood vessels, the vena cava, may be recommended if you have a DVT and are at high risk of a PE but can’t take blood thinners. This filter won’t prevent blood clots from forming, but it will prevent pieces of the clot from traveling to your lungs.

Vena cava filters are typically removable because permanent filters can cause complications after being in place for 1 to 2 years. These complications can include:

  • infection
  • life threatening damage to the vena cava
  • enlargement of blood vessels around the filter, which allows clots to pass by the filter and into the lungs
  • clots up to, on, or past the filter within the vena cava, the latter of which can break off and travel into the lungs

Minimizing your risk factors for developing future DVTs will also be an important part of treatment. Some key prevention strategies include:

  • discussing your risk factors with your doctor, especially before a surgical procedure
  • getting up and walking as soon as possible after surgery
  • avoiding a sedentary (inactive) lifestyle
  • wearing compression socks
  • stretching your legs and drinking plenty of water when traveling
  • talking with your doctor about a smoking cessation program, if you smoke
  • maintaining a moderate weight
  • taking medications as instructed by your doctor, which may include blood thinners

Phlebitis is inflammation of a vein, caused by a blood clot or damage to the vein wall. Superficial phlebitis affects veins close to the surface of your skin. Deep vein phlebitis affects veins deep within your muscles.

Symptoms of phlebitis may include redness, pain, and swelling in the affected area. Self-care strategies such as applying a warm compress, keeping your leg raised while resting, and taking NSAIDs can help relieve these symptoms. Treatment options for phlebitis include anticoagulant medications or surgical removal of blood clots.

Superficial phlebitis often heals without lasting effects.

DVT, on the other hand, can be life threatening and requires immediate medical attention. It’s important to know if you have risk factors for developing a DVT and to receive regular medical attention from a doctor.

If you’ve experienced a DVT before, you may be more prone to experiencing another in the future. Taking proactive steps may help prevent DVT.

causes, symptoms, signs, diagnosis, treatment, prevention

Features

Causes

Symptoms

Diagnosis

Treatment

Phlebitis of the vessels – inflammation of the walls of the veins, acute or chronic. It accompanies varicose veins or occurs after various medical procedures: a single intravenous injection of drugs or the use of a catheter for multiple infusions. The disease is almost never primary, but becomes a complication of other conditions. Against the background of inflammation, thrombosis often occurs, which aggravates the course of the disease. Inflammation of the wall can develop in any part of the venous network, including in the brain.

Features of phlebitis

The structure of the veins is due to the slow flow of a large amount of blood under low pressure. Up to 70% of the total amount of human blood is constantly in the venous bed.

The wall of a vein consists of three layers:

  • adventitia – the outer layer, or membrane of collagen fibers that form a frame, does not allow the vessel to completely subside. In the same layer there is a small amount of muscle fibers located along the blood flow, as well as nerve endings;
  • muscular – smooth muscles are arranged in a spiral, and between them are elastic elastic crimped collagen fibers. The peculiarity is that when filled, such fibers straighten and the vein stretches;
  • intima, or inner layer, consisting mainly of endothelium.

This is a typical structure of muscular veins (below the level of the heart). Phlebitis of the veins develops most often in them. The muscle layer is necessary for pushing blood through gravity. These veins have valves (semilunar) that prevent blood from flowing back.

Muscleless veins are located in dense organs: bones, retina, placenta, dura mater. Vessels in these places do not fall down, because they are fused with neighboring tissues.

Causes of phlebitis

The study continues, several groups are distinguished:

  • due to the patient;
  • drug-induced;
  • associated with the physico-chemical properties of catheters (cannulas).

Phlebitis of the extremities is noted in half of the elderly, and women suffer slightly more than men (1% versus 0. 7%). In both sexes, risk factors include smoking, diabetes mellitus, diseases of the circulatory system – primarily arterial hypertension and atherosclerosis. Patients with pathology of peripheral nerves are also at risk – a violation of innervation automatically changes blood flow in small vessels. Trophic ulcers of the lower extremities are always accompanied by signs of inflammation.

Inflammation due to drug administration is rare because pH and blood osmolarity are taken into account in the formulation. The disease develops with an individual allergic reaction and a high rate of administration.

Large teflon catheters irritate the vein. If the catheter is in the vein for a long time, the risk increases. The needle damages the wall mechanically, and any hole can become the entrance gate of infection. Even the most careful care of the catheter does not always guarantee the absence of complications.

According to the ICD, phlebitis is allocated to a separate category (I80), which includes lesions of the vessels of the lower extremities, femoral vein, thrombophlebitis of all localizations.

According to the etiology (cause of occurrence), the following types of phlebitis are distinguished:

  • pain – postpartum of the lower extremities;
  • allergic;
  • cerebral – brain infectious;
  • migratory – young men get sick, relapsing form;
  • pylephlebitis – damage to the portal vein, complicates the pathological processes of the abdominal cavity;
  • infectious – possible in any organ.

The cause of damage can be blunt trauma (blow, severe bruising) or compression by an excessively tight bandage.

Symptoms of phlebitis

Inflammation of the superficial veins is manifested by general and local symptoms. Common are manifestations of intoxication: fever, general weakness, headache. Local manifestations of superficial phlebitis on the legs and arm are soreness and tension of the vein, redness and thickening of the skin, which becomes hot to the touch. Red streaks may appear along the course of the vessel. Deep vein inflammation is characterized by swelling and white (milky) skin color. In the hand, numbness without swelling is possible due to the fact that the skeletal nerve passes in the inflamed area.

Persistent headache and arterial hypertension are characteristic of cerebral phlebitis. A long-term process disrupts venous circulation, which is manifested by visual impairment.

Often in men the vessels of the penis are affected, the symptoms are as follows:

  • sharp pain at the projection site;
  • edema;
  • seal;
  • local redness.

The bluish-violet color of the penis is characteristic, which allows you to quickly distinguish inflammation from other diseases.

The portal vein is most severely damaged due to a purulent process. The portal vein is the “collector” of blood from all organs of the abdominal cavity, through which blood enters the liver. Growing deterioration of the general condition, fever, severe weakness. It hurts badly on the right under the ribs, there are jaundice and severe vomiting. The possibility of death cannot be ruled out.

Post-injection phlebitis (after a catheter) occurs immediately after infusion and presents with moderate pain and redness. After removal of the cannula with appropriate care, the disease quickly regresses.

The leading complication of all types of phlebitis is thrombosis (blood clot blockage). The risk increases with age, especially against the background of concomitant cardiovascular diseases. Self-administration of drugs that reduce blood viscosity can lead to fatal bleeding. Elderly patients are being treated for their underlying disease and are often overdosed.

Deep vein thrombosis can result in embolism – blockage of blood vessels in vital organs. Blockage of the vessels of the lungs (PE – pulmonary embolism) in some cases ends sadly. Survival of patients directly depends on the diameter of the clogged vessel. Often, against the background of thrombosis, purulent complications develop – abscess, phlegmon.

Phlebitis diagnostics

Detection of superficial processes does not cause difficulties, the place of the disease is accessible to visual inspection. Pointing out an injection or injury makes the task easier.

Vascular ultrasound or sonography is mandatory. The survey is based on the Austrian physicist Doppler effect – the reflection of an ultrasonic wave from various living structures. The following parameters are examined:

  • the state of the vascular wall, the severity or absence of differentiation of all layers;
  • diameter and location;
  • tortuosity;
  • blood flow rate;
  • obstruction to blood flow.

In some clinics, triplex scanning is available, when the vessel is examined in three projections, and the directions of blood flow are colored in different (blue and red) colors.

To determine the probability of life-threatening conditions (PE), various questionnaires are used (Wells scale, Geneva classification). All diseases, age, surgical interventions are taken into account. Clinical guidelines for phlebitis suggest performing a CT scan of the lungs with high scores.

Laboratory tests are used to determine the viscosity of the blood, a simple coagulogram is sufficient.

Phlebitis treatment

You need to contact a phlebologist or a vascular surgeon from the first days, and preferably hours, of the disease. Early assistance helps to avoid complications, and in the case of thrombosis, to preserve the limb and health in general.

Superficial veins are mostly treated at home (outpatient) with conservative methods. The limbs are given an elevated position, rest is needed, bed rest is desirable in the early days.

Medicines for phlebitis, including antibiotics, are used according to the situation. Various drugs against blood clots (heparin, other antiplatelet agents) are used. At the same time, medications are used that prevent inflammation, strengthen the wall of blood vessels.

For deep vein thrombosis or recurrence of a superficial process (at least twice in one area), surgical removal is used. This method prevents more severe complications.

After the end of the inflammatory process or surgery, it is mandatory to wear compression stockings that compensate for the insufficiency of the muscle pump and prevent reflux (reverse blood flow).

The best prevention of phlebitis is a complete examination, especially in case of hereditary burden. The doctor will identify vulnerabilities, recommend individual measures. It is important to maintain physical activity in order to avoid blood stasis – take a walk, wear compression underwear on a trip, perform venous gymnastics when sitting (roll your feet from heel to toe).

The author of the article:

Magomedov Maksud Gadzhievich

head of the inpatient department at Krasnye Vorota metro station, KMN, phlebologist, proctologist

work experience 21 years

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