Phlebitis of the vein: Phlebitis (superficial thrombophlebitis) – NHS

13.06.202214.07.2023 by alexxlab

Phlebitis (superficial thrombophlebitis) – NHS

Phlebitis is inflammation of a vein near the surface of the skin. It’s not usually serious and often gets better on its own after 1 or 2 weeks.

Phlebitis is also sometimes known as superficial thrombophlebitis or superficial vein thrombosis.

Check if you have phlebitis

Phlebitis usually affects the veins in the legs, but you can also get it in your arms or neck.

The main symptoms are:

pain, tenderness or swelling in the affected area
warm and itchy skin over the affected area
changes to the colour and texture of the surrounding skin – for example, the skin may be red and it may be thick and hard

Phlebitis is common in people with varicose veins.

Credit:

DR P. MARAZZI / SCIENCE PHOTO LIBRARY

https://www.sciencephoto.com/media/258602/view

Phlebitis can be harder to see on brown and black skin.

Credit:

Emory University, Dr. Thomas F. Sellers: https://phil.cdc.gov/Details.aspx?pid=1345

Urgent advice: Ask for an urgent GP appointment or get help from NHS 111 if you have:

throbbing or cramping pain in your leg, arm or neck
sudden swelling in your leg, arm or neck
warm skin around the painful area
red or darkened skin around the painful area
swollen veins that are hard or sore when you touch them

It’s important to get these symptoms checked in case it’s something more serious like deep vein thrombosis (a type of blood clot).

You can call 111 or get help from 111 online.

Treatments for phlebitis

Treatment for phlebitis may not be needed if your symptoms are mild.

But treatment may be recommended if your symptoms are severe or do not go away.

Treatments may include:

anti-inflammatory medicines – cream or gel can be used if the affected area is small
compression stockings – these increase blood flow to the legs but are only suitable for some people with phlebitis
blood-thinning medicine to reduce the risk of blood clots and help stop phlebitis coming back

Things you can do to ease the symptoms of phlebitis

There are things you can do to help ease the pain and discomfort of phlebitis.

Do

continue using the affected leg or arm
raise your leg or arm while resting
put a warm, moist flannel over the affected area
take paracetamol or ibuprofen – if you’ve been prescribed blood-thinning medicine, do not take ibuprofen unless advised to by your doctor

Causes of phlebitis

It’s not always clear what causes phlebitis.

Often the inflammation is linked to:

varicose veins (swollen and enlarged veins, usually in the legs)
conditions that cause the blood to clot more easily like thrombophilia
autoimmune conditions like Behçet’s disease (a rare condition that causes inflammation of the blood vessels)
having injections or a small plastic tube (cannula) inserted into a vein

Other things that can increase your chances of getting phlebitis include:

getting older
being obese
being pregnant
having cancer
having phlebitis in the past

Page last reviewed: 20 December 2022
Next review due: 20 December 2025

Thrombophlebitis (Superficial and Migratory): Symptoms, Causes, Treatment

Written by WebMD Editorial Contributors

What Are the Types of Thrombophlebitis?
What Are the Symptoms of Thrombophlebitis?
What Causes It?
Who’s at Risk?
How Is It Diagnosed?
How Is Thrombophlebitis Treated?
Complications
Can It Be Prevented?
More

Thrombophlebitis is when a blood clot forms in one of your veins and slows the blood flow in the vein. It most often affects your legs, but it can also happen in your arms or other veins in your body. Thrombophlebitis can happen right under the skin or deeper in your leg or arm.

“Thrombo” means clot, and “phlebitis” means inflammation in a vein. That’s the swelling and irritation that happen after an injury.

Phlebitis and thrombosis of the lower extremity superficial veins. You might also hear this called superficial phlebitis or superficial thrombophlebitis. It’s a blood clot in the vein just below the surface of your skin. It doesn’t usually get to your lungs, but superficial thrombophlebitis can be painful, and you may need treatment.

Deep vein thrombosis (DVT). It’s a blood clot in a vein deep in your body that can occur with or without phebitis. Most happen in your lower leg or thigh, but they may happen in other parts of your body. A clot like this can get loose and travel through your bloodstream. If it gets to an artery in your lungs and blocks blood flow, it’s called a pulmonary embolism, which can damage your lungs and cause death. This is what makes DVTs are more dangerous than superficial vein thrombosis. DVTs require blood thinners.

Migratory thrombophlebitis. Also called Trousseau’s syndrome or thrombophlebitis migrans, it’s when the clot comes back in a different part of your body. It often goes from one leg to the other. It’s often linked to cancer, especially of the pancreas or lung.

If the blood flow to one of your veins is slowed because of a clot, you might have:

Red, swollen, and irritated skin around the affected area
Pain or tenderness that gets worse when you put pressure on the affected area
A swollen vein that feels like a tough “cord” under your skin
Pain when flexing your ankle (keep in mind that thrombophlebitis can happen in other parts of the body, but it usually happens in the legs)
A swollen foot or ankle

If you have any of these symptoms, see your doctor right away.

Call 911 if you have leg pain or swelling or any of the following symptoms:

One leg seems warmer than the other or is swollen, red, painful, or irritated
The affected limb becomes pale or cold, or you start feeling chills and fever
Sudden coughing, which may bring up blood
Sharp chest pain or chest tightness
Pain in your shoulder, arm, back, or jaw
Rapid breathing or shortness of breath
Pain when you breathe
Severe lightheadedness
Fast heartbeat

First, a blood clot forms. This can be due to several things. Most often, it’s caused by blood not moving the way it should through the leg veins. This can happen because of:

Long-term bed rest, such as after a major illness or surgery.

Sitting for a long time, as you would in a car, on a plane, or in some other place where you can’t stretch your legs.

Varicose veins. They cause your blood vessels to stretch too much. This allows blood to pool in the vessel instead of flowing straight through in one direction. This can lead to blood clots.

Anyone who has poor circulation in their legs may be more likely to have this condition. This could include women who may get thrombophlebitis during or after pregnancy. People who’ve been kept in the hospital on an IV are at risk, too. Hospital staffers try to lower this risk by changing the spots where IV lines are placed in the body.

Other things that raise your chances of having this condition include:

Certain cancers
Use of the hormone estrogen for birth control or hormone replacement
Being over age 60
Obesity
Smoking
A family or personal history of blood clots
Catheters placed in central veins of the arm or leg
Anyone who has a hypercoagulable state
if you have had trauma
Are immoboloized
Have had surgery and are immobolized

The doctor will start by asking about your symptoms and taking a look at veins near the surface of your skin. They’ll do a physical exam. They may also do blood and circulation tests or imaging exams like a CT scan or MRI. They might also do tests like:

Duplex ultrasound. This painless imaging test doesn’t have radiation the way an X-ray does. It uses sound waves to create a picture of your legs. The doctor spreads warm gel on your skin and then rubs a wand over the area where they think the clot is. The wand sends sound waves into your body. The echoes go to a computer, which makes pictures of your blood vessels and sometimes the blood clots.

A radiologist will review the images and send a report to your primary care doctor or to the doctor who requested the ultrasound.

D-dimer test. This is a blood test to look for a protein, called D-dimer, that’s made when a blood clot breaks down. Your doctor will order this test if they think you’ve got a dangerous clot, like a deep vein thrombosis (DVT) or pulmonary embolism (PE).

If your D-dimer level is high, it could mean a clot is breaking down. If your results are negative, it means you probably don’t have a clot. But even if the results are positive, that still doesn’t mean you have a clot. Your doctor will need to order imaging studies to visualize the clot.

MR Venography and CT Venography. If the results of your ultrasound aren’t clear, your doctor will use these imaging studies to confirm the presence of a clot. They will inject a dye into your vein and the image will show up on an X-ray. Possible side effects include pain and an allergic reaction to the dye.

MR angiography (MRA). This test takes a detailed picture of your veins using a large MRI machine. Your doctor will inject a special dye into your veins. It’ll allow them to see your blood vessels. They’ll also be able to see anything that looks unusual, like plaque buildup in your arteries.

CT scan. If your doctor is concerned that a deep vein clot has moved to your lung, they might order this test to get a better image.

Most cases of thrombophlebitis that happen in the shallow veins begin to go away by themselves in a week or two. But on rare occasions, these blocked veins can lead to infection. They can even cause tissue damage from the loss of healthy circulation.

If you need treatment, your doctor will probably give you something to relieve swelling and pain. They may recommend that you keep your leg raised or take over-the-counter aspirin or ibuprofen. They might also suggest you apply heat to the affected leg or arm for 15 to 30 minutes, two to three times daily.

Antibiotics. You might get them if poor circulation leads to an infection.

Blood thinners. These medications are usually reserved for thrombosis with a high risk of embolization to the lungs or brain. Deep vein thrombosis requires anticoagulation for this reason. You can give yourself heparin and enoxaparin (Lovenox) at home through shots under your skin. They help keep the clot from getting bigger. You may also have to take an oral drug like warfarin (Coumadin) for several months or longer to keep clots from coming back. Your doctor will give you regular blood tests to make sure the meds are working.

Blood thinners, like direct thrombin inhibitors and factor Xa inhibitors, are also available. But doctors don’t normally recommend them as the main treatment for thrombophlebitis because they cost more and may cause uncontrollable bleeding. They include apixaban (Eliquis), dabigatran (Pradaxa), edoxaban (Savaysa), and rivaroxaban (Xarelto).

Compression stockings. After the clot has resolved and you are on blood thinners, you may be advised to wear a compression stocking on the leg that was affected. This reduces the risk of post-thrombotic or post-phlebitic syndrome.
They decrease swelling of the leg which decreases pressure in the veins and reduces risk of varicose veins..

Filter. This has much more limited use than suggested here. An IVC filter is used on people who can not safely take anticoagulation and are at risk for DVTs which put the person at risk for pulmonary embolism. The vena cava is the main vein in your abdomen. The IVC filter prevents clots in your legs from breaking loose and traveling to your lungs. You’ll need surgery for this treatment. They are ideally removed within 3 months after placement.

Varicose vein stripping. This can help with veins that cause pain or recurring thrombophlebitis. The doctor makes small cuts to remove a long vein. It doesn’t affect circulation. Veins deeper down can handle more blood.

They’re rare, but you could have:

Pulmonary embolism. If the clot breaks loose, it could move to your lungs and block an artery. This condition can be life-threatening.

Postphlebitic syndrome. It can show up months or years after DVT. It often causes pain, swelling, and a feeling of heaviness in the affected leg or arm. You might hear it called post-thrombotic syndrome, venous stasis syndrome, or chronic venous insufficiency.

Sitting on long drives or flights is a major cause of blood clots. To prevent them:

Walk around. Get up for a stroll every hour.
Keep moving. Don’t just sit there. Flex your ankles. Or press your feet against the floor or footrest about 10 times an hour.
Keep it loose. Don’t wear tight clothing.
Stay hydrated. Drink plenty of fluids, but avoid alcohol.
Blood thinners. If you have had a clot previously or are at high risk for one, blood thinners may be prescribed prophylactically.

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The information provided on this page should not be used for self-treatment or self-diagnosis. If you suspect a disease, you should seek help from a qualified specialist. Only your doctor can diagnose and prescribe treatment.

Article content:

Causes
Classification
Symptoms of venous phlebitis
Diagnostics
Treatment of phlebitis
Prophylaxis
Complications

What is phlebitis?

Phlebitis is an inflammation of the venous wall. Most often, the disease is a consequence of varicose veins of the legs. It can occur in acute or chronic form. Pathology is rarely isolated.

As a result of inflammation, changes occur in the venous wall, which, if left untreated, lead to the formation of blood clots and the development of thrombophlebitis. To diagnose the disease to the doctor of the medical clinic, instrumental methods such as duplex scanning and ultrasound scan help. How to cure the disease? Clinical recommendations include physiotherapy and anti-inflammatory drugs.

Causes

The main reasons for the development of this pathological condition are:

1. Varicose veins.

2. Infections. The development of the disease can provoke viruses, bacteria, fungi. The most common causative agent is streptococcus. This is an opportunistic pathogen that is normally always present in the human body in small quantities. But with a decrease in immunity and the presence of optimal conditions, the bacterium begins to multiply intensively, provoking inflammation.

3. Allergic reaction.

4. Chemical or physical factors. An inflammatory reaction may occur in response to the introduction of the drug into the vein or be the result of an incorrect puncture when taking blood for analysis.

5. Pregnancy, difficult childbirth. During pregnancy, the vessels in the lower abdomen are compressed by the fetus, which leads to the development of congestion and can cause inflammation of the vein. During childbirth, a woman pushes hard, the pressure in the vessels increases, which can lead to damage and inflammation.

6. Other reasons. Inflammation can be provoked by a sedentary lifestyle, increased physical activity, obesity, bad habits, prolonged fixation of a limb in a fixed position in case of fractures Source:
Thrombophlebitis (superficial vein thrombosis): modern standards for diagnosis and treatment. Bogachev V.Yu., Boldin B.V., Jenina O.V., Lobanov V.N. Stationary-replacing technologies: Ambulatory Surgery, 2016. pp.16-23.

Depending on the etiology, the following types of phlebitis are distinguished:

1. Against the background of varicose veins.

2. Not associated with varicose veins:

allergic – is a consequence of the pathological reaction of the veins to the allergen;
post-injection – occurs due to mechanical injury or irritation of the vessel wall by the injected chemical, accompanied by hyperemia and pain at the site of inflammation.

The following types of phlebitis are distinguished by localization:

penis;
portal vein;
hand veins;
cerebral;
migratory.

In addition, the following forms of phlebitis are distinguished:

primary – the inflammatory process begins directly in the veins;
secondary – systemic inflammation, usually caused by pathogenic microflora.

According to the location in the vein, the following forms of the disease are distinguished:

periphlebitis – inflamed outer shell;
endophlebitis – the inner shell is affected;
panphlebitis – all the membranes of the veins become inflamed.

Symptoms of venous phlebitis

What does phlebitis look like? Clinical signs of the disease depend on its type and form.

When the superficial veins are affected, the following clinical picture is observed:

the affected vein becomes very painful, tense;
red stripes appear on the skin along the course of the vessel;
the skin in the lesion is hot, red, indurated.

Acute and chronic inflammation of deep veins are manifested by the following clinical signs:

edema, pain in the foci of inflammation;
general increase in body temperature of the patient;
milky white skin tone.

The following symptoms are observed in case of damage to cerebral vessels:

increased pressure;
headaches of various localization;
neurological syndrome.

Diagnosis

A preliminary diagnosis is made at the first appointment, based on the patient’s questioning and examination. Additional examinations may be prescribed for its confirmation and differential diagnosis:

blood tests;
USDG of affected veins;
duplex scanning of arteries and veins of extremities.

Based on the results of these studies, a final diagnosis is made, pathologies with similar symptoms are excluded, the causes of the disease and the exact localization of the inflammatory process are established.

Treatment of phlebitis

How to treat phlebitis? The doctor develops a therapy regimen individually for each patient, depending on the cause of inflammation, the severity of the pathological process, age, and characteristics of the patient’s body.

The following groups of drugs are most often prescribed:

NSAIDs;
antihistamines;
blood thinners;
vein health products;
analgesics;
anti-clotting agents;
antibacterial preparations.

External treatment includes the use of special anti-inflammatory ointments. If the disease occurs after unsuccessful injections, then various ointment and alcohol dressings are used as auxiliary medicines. Physiotherapy techniques give a good effect.

Most of the patients are treated at home, only people with severe forms are admitted to the hospital. The affected limb must be kept calm. It is recommended to wear elastic bandages, compression stockings. In some forms of the disease, symptomatic drug therapy is performed, which includes taking NSAIDs and applying compresses to the affected areas to relieve inflammation and pain, prevent complications and exacerbations.

How is pathology treated if conservative therapy fails? Surgical intervention is rarely required, in extreme cases. Most often, these are emergency operations for the intersection and ligation of the saphenous vein, the planned removal of an irreversibly changed vein.

If, after an unsuccessful injection, purulent inflammation occurs, as well as with severe damage to deep veins, the development of thrombophlebitis is also indicated for surgical intervention. Source:
Standard of care for patients with phlebitis and thrombophlebitis. Problems of standardization in health care No. 7, 2007. pp. 46-51.

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Prevention

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proper nutrition;
giving up a sedentary lifestyle;
regular sanitation of foci of chronic infection in the body;
strengthening of immune protection;
quitting smoking, alcohol abuse, drugs;
physical education classes;
prevention of influenza and SARS;
regular preventive examinations will help to identify possible pathological changes at an early stage, which will greatly facilitate treatment and improve the prognosis.

Complications

Inflammatory process in the veins reduces the patient’s quality of life, as pain causes limitation of mobility.

If untreated, the following complications may develop:

abscess;
thrombosis, thrombophlebitis;
chronic venous insufficiency;
blockage by a pulmonary artery thrombus.

The most dangerous complication is venous thrombosis. The likelihood of its development increases with age. If you do not help a person in time, then a blood clot can come off, clog the lumen of a large vessel, which can cause death.

Thrombophlebitis (superficial vein thrombosis): current standards for diagnosis and treatment. Bogachev V.Yu., Boldin B.V., Jenina O.V., Lobanov V.N. Hospital-replacing technologies: Ambulatory surgery, 2016. p.16-23
Standard of care for patients with phlebitis and thrombophlebitis. Problems of standardization in health care №7, 2007. p.46-51

Article published on : 09/02/2016
Last updated : 02/01/2023