Lump in hand after iv: Superficial thrombophlebitis Information | Mount Sinai

11.08.202309.07.2023 by alexxlab

Superficial thrombophlebitis Information | Mount Sinai

Thrombophlebitis – superficial

Thrombophlebitis is a swollen or inflamed vein due to a blood clot. Superficial refers to veins just below the skin’s surface.

Superficial thrombophlebitis is an inflammation of a vein just below the surface of the skin, which results from a blood clot. This condition may occur after recently using an IV line, or after trauma to the vein. Some symptoms can include pain and tenderness along the vein and hardening and feeling cord-like. Superficial thrombophlebitis is usually a benign and short-term condition. Symptoms generally subside in 1 to 2 weeks, but hardness of the vein may remain for much longer.

Shown here is erythema following the vascular pattern on a lower extremity. The superficial veins have become inflamed and dilated, causing the discoloration.

Causes

This condition may occur after injury to the vein. It may also occur after having medicines given into your veins. If you have a high risk for blood clots, you may develop them for no apparent reason.

Risks for thrombophlebitis include:

Cancer or liver disease
Deep vein thrombosis
Disorders that involve increased blood clotting (may be inherited)
Infection
Pregnancy
Sitting or staying still for a prolonged period
Use of birth control pills
Swollen, twisted, and enlarged veins (varicose veins)

Symptoms

Symptoms may include any of the following:

Skin redness, inflammation, tenderness, or pain along a vein just below the skin
Warmth of the area
Limb pain
Hardening of the vein

Exams and Tests

Your health care provider will diagnose this condition based mainly on the appearance of the affected area. Frequent checks of the pulse, blood pressure, temperature, skin condition, and blood flow may be needed.

Ultrasound of the blood vessels helps confirm the condition.

If there are signs of an infection, skin or blood cultures may be done.

Treatment

To reduce discomfort and swelling, your provider may recommend that you:

Wear support stockings, if your leg is affected.
Keep the affected leg or arm raised above heart level.
Apply a warm compress to the area.

If you have a catheter or IV line, it will likely be removed if it is the cause of the thrombophlebitis.

Medicines called NSAIDs, such as ibuprofen, may be prescribed to reduce pain and swelling.

If clots in the deeper veins are also present, your provider may prescribe medicines to thin your blood. These medicines are called anticoagulants. Antibiotics are prescribed if you have an infection.

Surgical removal (phlebectomy), stripping, or sclerotherapy of the affected vein may be needed. These treat large varicose veins or to prevent thrombophlebitis in high-risk people.

Outlook (Prognosis)

This is usually a short-term condition that does not cause complications. Symptoms often go away in 1 to 2 weeks. Hardness of the vein may remain for much longer.

Possible Complications

Complications are rare. Possible problems may include the following:

Infections (cellulitis)
Deep vein thrombosis

When to Contact a Medical Professional

Contact your provider for an appointment if you develop symptoms of this condition.

Also contact your provider if you already have the condition and your symptoms worsen or do not get better with treatment.

Prevention

In the hospital, swollen or inflamed veins can be prevented by:

The nurse regularly changing the location of your IV line and removing it if swelling, redness, or pain develop
Walking and staying active as soon as possible after surgery or during a long-term illness

When possible, avoid keeping your legs and arms still for long periods. Move your legs often or take a stroll during long plane trips or car trips. Try to avoid sitting or lying down for long periods without getting up and moving about.

Cardella JA, Amankwah KS. Venous thromboembolism: prevention, diagnosis, and treatment. In: Cameron AM, Cameron JL, eds. Current Surgical Therapy. 13th ed. Philadelphia, PA: Elsevier; 2020:1072-1082.

Wasan S. Superficial thrombophlebitis and its management. In: Sidawy AN, Perler BA, eds. Rutherford’s Vascular Surgery and Endovascular Therapy. 9th ed. Philadelphia, PA: Elsevier; 2019:chap 150.

Last reviewed on: 5/10/2022

Reviewed by: Deepak Sudheendra, MD, MHCI, RPVI, FSIR, Founder and CEO, 360 Vascular Institute, with an expertise in Vascular Interventional Radiology & Surgical Critical Care, Columbus, OH. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Pain, Inflammation and a Nodule After IV Medication

Vol. 13 •Issue 7 • Page 21
Pain, Inflammation and a Nodule After IV Medication

by Andrew Craig, NP

Elizabeth, a 20-year-old college student, presented to the student health center where I work in January 2005. She reported having a painful vein on her right forearm since an intravenous medication injection a month prior. She had gone home over the Christmas break, become ill with gastroenteritis and sought medical treatment in the emergency department of a large teaching hospital near her home.

She received intravenous promethazine (Phenergan) and recalled that it burned considerably as it was administered. Elizabeth said that when she mentioned this to the staff member giving her the medication, the person told her she was “fine” and that she should apply warm compresses to the area if her discomfort persisted.

By the time she presented to the student health center, Elizabeth had been following this regimen for a month without relief and still had a tender, hard area on the vein above her right wrist. Her pain was constant and moderate in severity, made worse by contact and only slightly better with the warm compresses. She said she recently noticed a “knot” on her right arm just below her elbow.

Elizabeth had no fever, chills, shortness of breath, chest pain or cough. She reported no injury to the area. Her past medical history was unremarkable; she took no medications other than oral contraceptives and had no drug allergies. She was a nonsmoker.

Exam and Diagnostic Tests

On exam, Elizabeth was alert, afebrile and in no distress. On the dorsal aspect of her distal right forearm were two swollen, tender, inflamed areas along the track of her basilic vein. One area was approximately 4 cm long and just proximal to her right wrist. The other was approximately 1 cm long and just proximal to the first inflamed segment. I palpated a 0.5-cm, somewhat firm nodule on the dorsal proximal right forearm about 2 cm distal to the medial condyle. This appeared similar to the epitrochlear node but was not in the classic position for it.

I diagnosed Elizabeth with superficial phlebitis. Since she reported no history of gastrointestinal bleeding or ulcers, I prescribed oral naproxen sodium (Naprosyn) 500 mg every 12 hours with food. I also instructed her to take one 81-mg enteric-coated aspirin daily for its antiplatelet properties and wrote a referral for venous Doppler study to rule out thrombophlebitis. I instructed her to continue the warm compresses 4 to 6 times daily and to elevate her arm as much as possible. I further instructed her to report to the emergency department should she develop any shortness of breath, chest pain or hemoptysis. She was discharged home with further follow-up to be determined once the Doppler study results were in.

Elizabeth had her Doppler study a week later, and the results indicated a localized venous thrombosis in the right basilic vein just distal to the elbow. The radiologist noted that a superficial vein on the dorsum of the right hand demonstrated marked wall thickening but had good flow and compressibility, probably due to chronic thrombophlebitis. Based on these results, I referred Elizabeth to a local surgeon who evaluated her and instructed her to return for local excision in 2 months if the clot did not resolve.

Epidemiology

Superficial thrombophlebitis occurs frequently, yet it does not get much attention in the literature.¹ This lack of attention is probably because the condition is often relatively mild and self-limiting. The list of risk factors is long (Table 1).

In contrast to deep vein thrombosis (DVT), which may result from hereditary blood disorders or chronic illness, superficial thrombophlebitis is typically the result of trauma (e.g., IV insertion and infusion of irritating medicines) or infection.^1,2 This condition is common, occurs most frequently in young to middle-aged adults, and is slightly more frequent in women. ¹

Superficial thrombophlebitis does not typically cause significant morbidity or mortality unless the condition extends to the deep venous system. When this occurs, it can be the source of a pulmonary embolus (PE). Superficial thrombophlebitis is an acute inflammatory condition. Unlike DVT (which is typically not associated with inflammation), superficial thrombi adhere firmly to the inside of vessel walls and generally do not form emboli.^3,4

Patients with thrombophlebitis frequently have alterations in one or more components of Virchow’s Triad: damage to the intimal wall of the vessel, venous stasis and altered coagulation.⁴ In this case, Elizabeth probably developed intimal damage as a result of the peripheral intravenous catheter. She had also received intravenous promethazine, and this nausea medication can induce the formation of antiphospholipid antibodies, another risk factor for thrombophlebitis.⁵

Differential Diagnosis

Signs and symptoms of superficial thrombophlebitis include tenderness, warmth and heat along the course of the affected vein, along with swelling in the affected extremity. ^1,3,5 The vein may have a palpable cord or knot. Table 2 lists differential diagnoses.

Examination should include the affected area, the regional lymph nodes and a cardiovascular exam if you suspect PE. Measurement of extremity circumference will objectively quantify any limb swelling. Measure at the same point on both extremities. I typically choose a bony landmark and measure from that landmark to the area of greatest circumference. I make sure that I measure from that same point on the other extremity. For example: “Arm circumference was 20 cm on the left and 18 cm on the right, measured 10 cm distal to the lateral condyles.”

Diagnostic tests distinguish thrombophlebitis from phlebitis and rule out thrombi of the deep venous system. Additional tests may be needed to evaluate for pulmonary embolism if DVT is present or you suspect PE. Several tests are available:²

Compression ultrasonography. This is the noninvasive test of choice; it uses sound waves to generate pictures inside an extremity and can identify superficial and deep thrombi. The patient in this case had this test.

Contrast venography. Although venogram is the gold standard, this is no longer the initial study of choice because of its invasive nature. The test involves threading a catheter into the affected vein and injecting contrast dye, which enables veins (and clots) to show up on x-ray.

Magnetic resonance imaging. Although not as widely used as venography and ultrasound, this may be useful when the patient cannot tolerate intravenous dye (e.g., dye allergy, pregnancy, renal failure).

While blood tests for coagulation disorders and blood dyscrasias are indicated in cases of DVT, my review of the literature did not find a similar recommendation for cases of uncomplicated superficial thrombophlebitis.

When PE is a concern, relevant diagnostic tests include ventilation or perfusion lung scanning, spiral CT of the chest and serum d-dimer level.

Treatment

Most cases of superficial thrombophlebitis are self-limiting and respond to conservative measures. Warm compresses and nonsteroidal anti-inflammatory drugs (NSAIDs) are mainstays of therapy.

While aspirin may be of benefit as an NSAID, its use as an antiplatelet agent is of little benefit because superficial thrombophlebitis is due to inflammation and fibrin clot, not platelet aggregation.¹

Anticoagulants (e.g., heparin), while useful in the management of DVT, are not typically used in superficial cases of thrombophlebitis. Removal of an offending intravenous catheter and initiation of antibiotics are indicated in cases of thrombophlebitis caused by infection. Culture the catheter tip to identify the specific bacteria involved.

Follow-Up and Referral

Symptoms that do not resolve after 4 weeks require follow-up. In such cases, refer the patient to a general or vascular surgeon for excision of the clot under local anesthesia. Patients also should return if their symptoms worsen or if additional thrombi form, and they should seek emergency care for any signs or symptoms of pulmonary embolus (chest pain, shortness of breath, tachypnea, cough or hemoptysis).

References

1. Johnson G Jr. Superficial thrombophlebitis. eMedicine 2005. Available at: http://www.emedicine.com/med/topic3201.htm.

2. Lip GY, Pineo GF, Bauer KA. Patient information: venous thrombosis. UpToDate 2005. Available with subscription at: http://www.utdol.com.

3. Beers MH (ed.) Superficial thrombophlebitis. In The Merck Manual of Medical Information Online (2^nd ed.) 2004. Available at: http://www.merck.com/mmhe/sec03/ch036/ch036c.html.

4. McMorran J, Crowther DC, McMorran S, et al. Superficial vein thrombosis. GPnotebook 2005. Available at: http://www.gpnotebook.co.uk/simplepage.cfm?ID=275447823.

5. Bauer KA, Lip GY. Evaluation of the patient with established venous thrombosis. UpToDate 2005. Available with subscription at: http://www.utdol.com.

Andrew Craig, NP, is a family nurse practitioner at The University of North Carolina-Charlotte’s Student Health Center and an NP in the U. S. Naval Reserve. He is also a member of the ADVANCE for Nurse Practitioners editorial advisory board and is the journal’s technology consultant.

Table 1: Risk Factors for Thrombophlebitis^1,2,4

• Previous surgery

• Pregnancy

• Obesity

• Age older than 60 years

• Use of oral contraceptives, hormone replacement therapy or tamoxifen

• Immobilization, extended travel (“economy class syndrome”)

• Smoking

• Presence of an intravenous catheter

• Injection of caustic or irritating substances

• Previous thromboembolism

• Chronic medical conditions such as heart failure, renal disease or cancer

• Blood disorders such as polycythemia vera

• Elevated blood homocysteine; positive antiphospholipid antibodies

Table 2: Differential Diagnosis¹

• Cellulitis

• Suppurative thrombophlebitis, a serious condition associated with intravenous infection and septicemia, manifested by purulence in the affected vein

• Migratory thrombophlebitis, recurrent, progressive thrombi along the course of a vein, usually in the lower extremities, associated with carcinoma

How to remove bumps from injections

Likbez

Health

May 11, 2021

There are four signs that a seal is dangerous.

After any injection, small, sometimes painful lumps may occur where the needle entered the skin. And that’s okay.

Why injection bumps appear

This is an individual reaction. Perhaps this is how – with local swelling and irritation – your body personally reacted to a microtrauma from a needle, an injected drug, or both at the same time.

The risk of getting a painful bump increases if the injection technique is violated: for example, the needle is inserted at the wrong angle or does not hit the right place the first time.

What to do if a bump appears after an injection

As a rule, nothing needs to be done. In most cases, seals are unpleasant but harmless. And they pass pretty quickly on their own.

In a few hours or a maximum of a day or two after the injection, there will be no trace of the bump.

If the injection site is not only thickened, but also aches or itches, you can get rid of discomfort like this.

Apply a cold compress to the bump. It can be a cloth soaked in ice water, or an ice pack wrapped in a thin cloth.
Try an over-the-counter pain reliever for pain relief. For example, based on ibuprofen.
If you want to relieve itching, use an over-the-counter antihistamine.

When to see a doctor urgently

In some cases, a lump at the injection site may be caused by an infection that got under the skin with an unsterile needle, or an allergy to the injected drug. Both of these conditions are potentially dangerous. And, if you’re not lucky, they can cost you your life.

Here are four signs, each of which tells you to immediately consult a therapist or even call an ambulance.

1. A high fever that you attribute to a recent injection

Fever (a temperature above 38.3°C) is not always dangerous: it may be one of the expected side effects of the medicine or vaccine you have been given. But sometimes it is the rise in temperature that manifests itself as allergies and infections.

Prescription drugs and antibiotics may be needed to stop the disease process. Which ones, the doctor will tell you – after he makes an accurate diagnosis.

2. Severe pain at the injection site that does not subside

The bump formed after the injection often hurts. However, normally, the pain gradually decreases and within a few hours or a maximum of a couple of days completely disappears. Situations are considered abnormal when:

Pain does not decrease with time. And even more so if it intensifies.
The pain seems to spread all over the body.
The bump looks inflamed and hurts not only at the surface of the skin, but also somewhere deep.
Pain accompanied by fever above 38.3 °C.

These signs do not necessarily indicate something dangerous. This may be an expected side effect of the drug you were injected with. But there is a risk that increased pain is associated with an infection that needs to be diagnosed and treated before it spreads throughout the body.

3. Thickening and swelling that does not go away after a couple of days

If the bump does not disappear, becomes denser, increases in size or changes color, this can also be a sign of infection.

Be especially careful if the lump feels soft, mushy, hot and sore. This may indicate a developing abscess – an accumulation of pus in a cavity under the skin.

Never try to pop the boil out. If it breaks under the skin, the infection can enter the bloodstream and lead to deadly blood poisoning.

If the bump is small and you’re not sure it’s an abscess, take a pen or marker and trace around the perimeter of the lump. And then watch. A nodule that does not decrease during the day, and even more so one that grows beyond the outlined boundaries, is a clear reason for an urgent consultation with a doctor.

4. Unusual symptoms not related to the injection site

Induration at the injection site may be caused by an allergy to the injected drug. In some cases, it spreads to the entire body. Doctors call this process an anaphylactic reaction. Sometimes it is deadly.

The first signs of anaphylaxis, as a rule, are similar to seasonal allergies: a runny nose appears, watery eyes, an itchy rash appears on some areas of the skin, similar to inflammation after a nettle burn.

However, additional symptoms may appear very quickly:

cough;
chest tightness;
shortness of breath;
irregular heartbeat;
swelling not related to the injection site, eg swelling of the hands, tongue, face.
dizziness.

If you notice unusual symptoms, do not hesitate to contact your doctor. Perhaps anaphylaxis will not be confirmed. But if this is her, it is important to get qualified medical care in time.

This article was first published in July 2017. In May 2021, we updated the text.

FMBA therapist told how to quickly get rid of bumps after injections

Lifestyle

Injections are not the most pleasant procedure, especially if the doctor prescribes a multi-day course. Many are afraid of them since childhood – it hurts. In addition, after such treatment, bruises or bumps often remain on the body, which resolve for a long time.

August 21, 20218

Source:: pixabay.com

Bumps from injections are a pathological reaction of the body to the administration of a drug. Doctors call them “post-injection infiltrates.” According to the therapist Yulia Kochanova, such bumps are formed due to the accumulation of lymph and blood cells under the skin.

– The infiltrate is preceded by the traumatic effect of a penetrating needle, as well as several other common factors. For example, too fast administration of the drug, as a result of which the drug does not spread through the tissues. Also on the list of reasons is the oily structure of the drug, an allergy to the components of the drug, a small needle length that does not penetrate muscle tissue, or muscle tension during the injection, the specialist explains.

A recent study showed that more than 70% of Russians are afraid of injections. After a survey of residents of 21 cities, it turned out that the most shy people live in Moscow, Novosibirsk and Kazan. Petersburgers turned out to be bolder than many — the city took only 18th place in this rating.

It does not take long for the bumps to appear – they form within 1-2 hours after the injection. Vaccination is no exception.

– Any vaccine, like the COVID-19 vaccine, can cause swelling or a bump at the injection site. The cause of the infiltrate may be an adverse reaction – hypersensitivity to the components of the vaccine, as well as other common factors, – explains the doctor.