Deep vein thrombosis Information | Mount Sinai

Your provider will give you medicine to thin your blood (called an anticoagulant). This will keep more clots from forming or old ones from getting bigger.

Heparin is often the first medicine you will receive.

• If heparin is given through a vein (IV), you must stay in the hospital. However, most people can be treated without staying in the hospital.
• Low molecular weight heparin can be given by injection under your skin once or twice a day. You may not need to stay in the hospital as long, or at all, if you are prescribed this type of heparin.

One type of blood-thinning medicine called warfarin (Coumadin or Jantoven) may be started along with heparin. Warfarin is taken by mouth. It takes several days to fully work.

Another class of blood thinners works differently than warfarin. Examples of this class of medicines, called direct oral anticoagulants (DOAC), include rivaroxaban (Xarelto), apixaban (Eliquis), dabigatran (Pradax), and edoxaban (Savaysa). These drugs work in a similar way to heparin and can be used right away in place of heparin. Your provider will decide which medicine is right for you.

You will most likely take a blood thinner for at least 3 months. Some people take it longer, or even for the rest of their lives, depending on their risk for another clot.

When you are taking a blood thinning medicine, you are more likely to bleed, even from activities you have always done. If you are taking a blood thinner at home:

• Take the medicine just the way your provider prescribed it.
• Ask the provider what to do if you miss a dose.
• Get blood tests as advised by your provider to make sure you are taking the right dose. These tests are usually needed with warfarin.
• Learn how to take other medicines and when to eat.
• Find out how to watch for problems caused by the medicine.

In rare cases, you may need surgery instead of or in addition to anticoagulants. Surgery may involve:

• Placing a filter in the body’s largest vein to prevent blood clots from traveling to the lungs
• Removing a large blood clot from the vein or injecting clot-busting medicines

Follow any other instructions you are given to treat your DVT.

Complications of peripheral I.V. therapy

If you are administering I.V. fluids or medications to a patient through a peripheral I.V. site, be alert for signs and symptoms of complications, institute preventive measures, and know how to intervene when complications do occur. 
 
You may also want to review the following Nursing Pocket Card on…

IV Fluids

Infiltration

Infiltration occurs when I.V. fluid or medications leak into the surrounding tissue. Infiltration can be caused by improper placement or dislodgment of the catheter. Patient movement can cause the catheter to slip out or through the blood vessel lumen. 

Signs and symptoms

• Swelling, discomfort, burning, and/or tightness 
• Cool skin and blanching
• Decreased or stopped flow rate

Prevention

• Select an appropriate I. V. site, avoiding areas of flexion. 
• Use proper venipuncture technique.
• Follow your facility policy for securing the I.V. catheter.
• Observe the I.V. site frequently.
• Advise the patient to report any swelling or tenderness at the I.V. site.

Management

• Stop the infusion and remove the device.
• Elevate the limb to increase patient comfort; a warm compress may be applied.
• Check the patient’s pulse and capillary refill time.
• Perform venipuncture in a different location and restart the infusion, as ordered.
• Check the site frequently.
• Document your findings and interventions performed.

Extravasation

Extravasation is the leaking of vesicant drugs into surrounding tissue. Extravasation can cause severe local tissue damage, possibly leading to delayed healing, infection, tissue necrosis, disfigurement, loss of function, and even amputation.

Signs and symptoms

• Blanching, burning, or discomfort at the I.V. site
• Cool skin around the I.V. site
• Swelling at or above the I.V. site
• Blistering and/or skin sloughing

Prevention 

• Avoid veins that are small and/or fragile, veins in areas of flexion, veins in extremities with preexisting edema, or veins in areas with known neurologic impairment.
• Be aware of vesicant medications, such as certain antineoplastic drugs (doxorubicin, vinblastine, and vincristine), and hydroxyzine, promethazine, digoxin, and dopamine.
• Follow your facility policy regarding vesicant administration via a peripheral I.V.; some institutions require that vesicants are administered via a central venous access device only. 
• Give vesicants last when multiple drugs are ordered.
• Strictly adhere to proper administration techniques.

Management

• Stop the I. V. flow and remove the I.V. line, unless the catheter should remain in place to administer the antidote.
• Estimate the amount of extravasated solution and notify the prescriber.
• Administer the appropriate antidote according to your facility’s protocol.
• Elevate the extremity.
• Perform frequent assessments of sensation, motor function, and circulation of the affected extremity. 
• Record the extravasation site, your patient’s symptoms, the estimated amount of extravasated solution, and the treatment.
• Follow the manufacturer’s recommendations to apply either cold or warm compresses to the affected area.

Phlebitis

Phlebitis is inflammation of a vein. It is usually associated with acidic or alkaline solutions or solutions that have a high osmolarity. Phlebitis can also occur as a result of vein trauma during insertion, use of an inappropriate I.V. catheter size for the vein, or prolonged use of the same I. V. site.

Signs and symptoms

• Redness or tenderness at the site of the tip of the catheter or along the path of the vein
• Puffy area over the vein
• Warmth around the insertion site

Prevention

• Use proper venipuncture technique.
• Use a trusted drug reference or consult with the pharmacist for instructions on drug dilution, when necessary.
• Monitor administration rates and inspect the I.V. site frequently.
• Change the infusion site according to your facility’s policy.

Management

• Stop the infusion at the first sign of redness or pain.
• Apply warm, moist compresses to the area.
• Document your patient’s condition and interventions.
• If indicated, insert a new catheter at a different site, preferably on the opposite arm, using a larger vein or a smaller device and restart the infusion.

Hypersensitivity

An immediate, severe hypersensitivity reaction can be life-threatening, so prompt recognition and treatment are imperative.

Signs and Symptoms

• Sudden fever
• Joint swelling
• Rash and urticaria
• Bronchospasm
• Wheezing 

Prevention

• Ask the patent about personal and family history of allergies.
• For infants younger than 3 months, ask the mother about her allergy history because maternal antibodies may still be present.
• Stay with the patient for five to 10 minutes to detect early signs and symptoms of hypersensitivity.
• If the patient is receiving the drug for the first or second time, check him every five to 10 minutes or according to your facility’s policy. 

Management

• Discontinue the infusion and notify the prescriber immediately.
• Administer medications as ordered.
• Monitor the patient’s vital signs and provide emotional support.

Infection

Local or systemicinfection  is another potential complication of I.V. therapy. 

Signs and symptoms

• Redness and discharge at the I.V. site
• Elevated temperature

Prevention

• Perform hand hygiene, don gloves, and use aseptic technique during I.V. insertion. 
• Clean the site with approved skin antiseptic before inserting I.V. catheter.
• Ensure careful hand hygiene before any contact with the infusion system or the patient. 
• Clean injection ports before each use.
• Follow your institution’s policy for dressing changes and changing of the solution and administration set. 

Management

• Stop the infusion and notify the prescriber.
• Remove the device, and culture the site and catheter as ordered.  
• Administer medications as prescribed.
• Monitor the patient’s vital signs.

With careful attention and skill, you’ll be able to recognize, prevent, and manage these complications of peripheral I.V. therapy.

References

(2008). I.V. Essentials: Complications of Peripheral I.V. Therapy. Nursing Made Incredibly Easy!, 6 (1).

Smeltzer, S. (2010). Brunner and Suddarth’s Textbook of Medical Surgical Nursing, 12e. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

Spencer, S. & Gilliam, P. (2015). Teaching patients about their short peripheral I.V. catheters.  Nursing2015, 45 (2).

Vacca, V. (2013). TIME CRITICAL: Vesicant extravasation. Nursing2013, 43(9).

 

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Causes, Signs, Side Effects, Treatments

When an IV fails or “goes bad”, there are a variety of complications and side effects that may set in depending on how the IV failed and how long it takes to discover and treat the issue. IV failures involving severe complications like extravasation, particularly from chemotherapy drugs, can leave permanent damage, including third-degree burns or necrosis.

• Compartment Syndrome
• Skin Burns
• Necrosis
• Amputation
• Permanent Nerve Injury
• Medication Dosing Errors

Complications from infiltrations and extravasations can include:

Compartment Syndrome

Compartment syndrome is a painful and dangerous condition caused by pressure buildup from internal bleeding or swelling of tissues. Muscles in the patient’s hand, forearm, or lower leg are surrounded by tissue. These tissue bands create “compartments.” After infiltration, when too much fluid leaks into the tissue, a patient may experience compartment syndrome. Compartment syndrome may cause nerve, tissue or muscle damage. The condition often requires emergency surgery to decompress the affected area. Patients should expect more extensive rehabilitation and healing time. ⁵

Skin Burns, Necrosis and Amputation

Serious burns may require a skin graft – a surgeon removes unburned skin on the patient and places it over the affected area. Wounds with necrotic, or dead, tissue cannot heal and must be removed to allow healthy tissue to grow in its place. While amputating the area may create a much larger wound, it is sometimes the only way to treat the complication.

Injuries and complications can usually be minimized or completely eliminated when patients and healthcare providers carefully monitor and care for the IV site. If you ever experience a complication as a result of IV therapy, be sure to notify a nurse or doctor immediately, so they can try to mitigate any lasting effects.

Permanent Nerve Damage

Nerve damage from IV insertion is relatively rare. It can be caused by puncturing the nerve with the needle when an IV is started, or from compartment syndrome. Another potential cause is infiltration – when the fluid leaks into the tissue around the vein. If an infiltration is severe enough, it can cause compartment syndrome and lead to nerve damage. While this is a less common complication, it can cause numbness, tingling, and even loss of function in the limb.

Medication dosing errors

Delivering drugs or fluids directly into the vein is a fast and effective way to administer medications to a patient. Infiltrations mean patients don’t receive the appropriate amount of medicine into their bloodstream making treatment less effective. For some patients, proper medication dosages are integral to optimal care, and improper dosages could worsen their condition.

Read Barby’s Anesthesia Awareness Story.

Why Does my IV Hurt?

What should an IV feel like?

Many ask whether an IV will hurt when going into the vein. When an IV needle is placed, it can cause some slight discomfort. You may feel a small sting or pinch for a few seconds when the needle is inserted in your arm or hand. If you’re particularly sensitive to needles, you may want to ask for a numbing cream, so you don’t feel the needle when it goes in.

After the needle is pulled out and your IV begins, what stays in is a small, narrow plastic tube. The fluids and medications are administered through this tube. Once the tube has been placed, the IV site shouldn’t hurt, sting, or burn.

When the IV procedure is completed, some swelling and bruising at the site are common and not cause for concern. Most IV sites heal quickly in a few days.

What is abnormal IV pain?

As the needle is inserted, if you feel an electric-shock-type sensation radiating down your hand, your IV may have come into contact with a nerve.

Or, you may feel pain if the needle has gone beyond the vein into a muscle or tendon. If an IV hasn’t been inserted correctly, you may feel intense swelling and notice bruising.

This can be a sign of IV infiltration, which occurs when the fluids or medications are going into the tissue under your skin and not into your vein. In all cases, your care provider should stop the infusion and remove the IV line.

When should you alert your medical team about a painful IV?

During the IV procedure, tell your medical team right way if you feel pain at or around your IV site. After the procedure, if you have continued redness and swelling, the IV site may be infected. Infection is a serious complication and needs to be addressed immediately.

Bottom line, IVs shouldn’t be painful or uncomfortable – during or after insertion. If the procedure hurts beyond the initial sting, if your skin feels taut or cool to the touch, if you have a hematoma or bruise, and if you have prolonged edema or swelling afterwards, talk with your medical team right away as this could be a sign of your IV infiltrating. IV infiltrations are a common occurrence, with one in six IVs going bad due to infiltration. The faster you act, the better.

Learn more about how to detect IV infiltrations and the Causes, Signs, Side Effects and Treatments of IV Infiltration and Extravasation.

Infiltration and extravasation care

What is a peripheral IV device?

A peripheral IV is a catheter (a very thin, flexible tube) that is inserted into a small vein in the scalp, hand, arm, leg or foot. This is done to give fluids or medicines directly into the bloodstream. The IV is secured with tape or a type of dressing.

What is an infiltration or extravasation?

Sometimes, the fluid or medicine leaks into the tissue around the vein. The difference between an infiltration and extravasation is the type of medicine or fluid that is leaked.

• Infiltration – if the fluid is a non-vesicant (does not irritate tissue), it is called an infiltration.
• Extravasation – if the fluid is a vesicant (a fluid that irritates tissue), it is called an extravasation. Tissue damage from these fluids may or may not be seen at the time the leak occurs, and may take weeks or months to develop.

How does this happen?

• Catheters can become clogged over time
• Catheters can come out unexpectedly
• IV fluids can leak out of the vein or artery because of irritation

What are signs of an infiltration/extravasation?

• Redness around the site
• Swelling, puffy or hard skin around the site
• Blanching (lighter skin around the IV site)
• Pain or tenderness around the site
• IV not  working
• Cool skin temperature around the IV site or of the scalp, hand, arm, leg or foot near the site

What happens after an infiltration/extravasation?

• The site will be assessed and evaluated
• Depending on severity, additional health team members (such as a pharmacist or advanced practice nurse specializing in skin care) may be consulted to discuss treatment options
• The IV will be removed
• The site will be checked hourly until it returns to baseline

How is it treated?

Some possible treatments are:

• Elevate the site as much as possible to help reduce swelling.
• Apply a warm or cold compress (depending on the fluid) for 30 minutes every 2-3 hours to help reduce swelling and discomfort.
• Medication-If recommended, medicine for extravasations is given within 24 hours for best effect.

The most common medicine is hyaluronidase (Wydase®) and it is given in small amounts just under the skin.

What can I do to help prevent an infiltration/extravasation?

• Let your child’s health care team know if your child has had multiple attempts to place an IV in the past.
• If the IV dressing becomes loose, let the nurse know so it can be changed or appropriately reinforced.
• Be careful when moving your child to prevent the IV from being bumped, tugged, or dislodged.
• Do not allow your child to pull on the IV. Use distraction to take your child’s mind off of it. Ask Child Life for activities your child can do.
• If an immobilizer or soft tie is needed to help protect the IV site, leave it on.
• Keep bedding off of the IV site.
• If you are concerned that the IV might not be working or looks different, let the nurse know.

What else do I need to know?

Depending on the severity of the infiltration/extravasation, you may be instructed to monitor the affected area after discharge.

Call your clinic if the affected area is getting worse, such as:

• Increased swelling
• Blistering
• Skin opening up

Go to the Emergency Room right away if your child has any of the following:

• Temperature higher than 101.5° F
• Hand, arm, leg, or foot near the removed IV site changes color (blue-purple).
• Hand, arm, leg, or foot near the removed IV site changes temperature (becomes cold).
• Hand, arm, leg, or foot near the removed IV site becomes swollen and firm and cannot move fingers or toes.

Additional resources

Children’s Wound Ostomy Care Practitioners Team is a group of advanced practice nurses that can help with infiltrations and extravasations. They are available during business hours for follow-up outpatient visits. Appointments can be scheduled by calling 651-220-6530.

Questions?

This information is not specific to your child, but provides general information. If you have questions, please call your provider or clinic.

Last reviewed 7/2019

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When your patient develops phlebitis : Nursing2021

PHLEBITIS, OR INFLAMMATION of the vein, can have many causes, including irritation of the vein by a foreign body or irritating medication, injury of the vessel wall from the catheter, or infection linked to bacterial contamination of the I.V. system. Mechanical phlebitis, the most common type, may occur from a large catheter placed in a small vein, vein trauma during catheter insertion, or movement of an improperly secured catheter within the vein.

Chemical phlebitis can be caused by irritating I.V. drugs or fluids that are too acidic or too alkaline (pH less than 5 or greater than 9), and by hypertonic solutions (osmolality over 500 mOsm/liter). It may also develop when the skin preparation solution isn’t allowed to dry before venipuncture, and is tracked into the vein.

Bacterial phlebitis is caused by contamination of the I.V. system during catheter insertion or manipulation, or by poor skin antisepsis.

An inside look

When you introduce a catheter into a vein, you inevitably injure some of the endothelial cells lining the vein. If the catheter stays in place for a long time, especially if the infusate is irritating, the normal defense mechanism can become pathologic, resulting in phlebitis. (That’s why a peripheral catheter shouldn’t be left in place for more than 96 hours in adults, according to Centers for Disease Control and Prevention guidelines.)

When you remove the catheter, you may see pus at the puncture site, indicating infection. Even if the patient has no other signs or symptoms of systemic infection (such as fever or chills), send a drainage specimen for culture. Depending on the extent of injury, the patient may need surgical debridement or vein resection.

Phlebitis can lead to other serious complications, such as septicemia or endocarditis. And because phlebitis involves damage to the vein lining, the patient is also at risk for thrombus formation at the site, which can lead to thrombophlebitis, deep vein thrombosis, or pulmonary embolism.

To prevent phlebitis and its dangerous complications, monitor any patient with an I.V. device closely for problems. The first symptom of phlebitis may be discomfort at the insertion site or along the cannulated vein. Ask him to tell you if the I.V. site becomes uncomfortable. If he can’t communicate, watch for clues such as withdrawing or grimacing when you’re palpating the site during routine site checks. Assess for other signs of phlebitis, including erythema and warmth at the insertion site. If phlebitis progresses, you’ll find redness and warmth above the venipuncture site, limb edema, a palpable cord along the venous pathway, and low-grade fever.

Dealing with trouble

Whatever the cause of phlebitis, remove the catheter as soon as possible. Notify the patient’s health care provider. Monitor the patient’s vital signs and the I.V. site, and apply a warm, moist compress to the affected area as ordered. Continuous application of moist heat over 72 hours, along with administration of oral nonsteroidal anti-inflammatory agents, is the best treatment.

Report phlebitis as an adverse patient outcome. Document all suspected cases of phlebitis using the Infusion Nurses Society’s phlebitis scale (see Grading phlebitis) or according to your facility’s policy. Continue to monitor the site until all signs and symptoms of phlebitis have resolved.

You can prevent many instances of phlebitis by choosing the proper insertion site, I.V. device, and securement technique. Administer irritating solutions via a central line, not a peripheral line. Check an I.V. drug book or ask the pharmacist if you’re unsure how to safely administer a medication.

Grading phlebitis

The Infusion Nurses Society lists the following clinical criteria to grade phlebitis:

• 0—no symptoms
• 1—erythema at access site with or without pain
• 2—pain at the access site with erythema or edema
• 3—pain at the access site with erythema, streak formation, or palpable venous cord
• 4—pain at the access site with erythema, streak formation, palpable venous cord longer than 1 inch (2.5 cm), or purulent drainage.

Kelli Rosenthal is president and chief executive officer of ResourceNurse Continuing Education, Inc., of Long Beach, N.Y., and president of the Association for Vascular Access. This article is adapted from Phlebitis: An irritating complication, K Rosenthal, Nursing made Incredibly Easy! January/February 2004.

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

Post-injection phlebitis

Post-injection phlebitis is an inflammatory process in the veins, which often occurs as a result of the use of intravenous injections. When drugs are injected, a spasm occurs in the vein, which provokes a narrowing of the vascular lumen, slows down blood flow and can change the chemical composition of the blood. In addition, there is a risk of infection when inserting a needle into a vein. Post-injection phlebitis is treatable, but the main thing is to start therapy at an early stage and to prevent complications.

Causes and symptoms of post-injection phlebitis

The causes of post-injection phlebitis can be:

• long-term catheter insertion
• use of low-quality medical instruments (needles, catheters, syringes)
• violation of sanitary standards during the procedure
• too high dose and high concentration of the administered drug
• independent (home) installation of droppers or injections
• infections due to non-compliance with sterility

The first symptoms of post-injection phlebitis can appear within a few hours after the procedure and worsen within 2-3 days.It could be:

• Seal at the injection site
• onset of throbbing pain
• swelling and swelling of the injection site
• first redness in the affected area, then burgundy spots and blue discoloration
• increase in tumor and edema
• high body temperature
• pain on movement or difficult flexion of the limbs
• in advanced cases, inflammation of the lymph nodes and suppuration of the vascular walls is possible

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Methods for the diagnosis of post-injection phlebitis

In order to accurately diagnose post-injection phlebitis, in addition to the standard examination, a phlebologist may prescribe:

• blood and urine tests
• X-ray and ultrasound of the inflamed area
• coagulogram (blood clotting test)
• ultrasound duplex scanning (USDG) of the veins of the lower extremities

Methods for the treatment of post-injection phlebitis

• in the early stages use conservative treatment (drugs, ointments, compresses, physiotherapy)
• in case of complications, a surgical operation is performed (removal of suppuration)

If you notice symptoms of post-injection phlebitis, you urgently need to consult a doctor, as this inflammation develops very quickly and threatens with serious complications.

The Viva Surgical Center employs experienced phlebologists and surgeons who are ready to promptly provide first aid for phlebitis and prescribe a comprehensive course of treatment.

90,000 Local reactions to vaccine administration

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During the vaccination, the child must be healthy, be sure to inform the doctor about any severe allergic reactions to previous administrations of any vaccines, to food and medicines.There are vaccines that contain egg white and aminoglycazide antibiotics.

Of course, any vaccine can cause local adverse reactions in the form of redness, induration at the injection site (post-vaccination infiltration). Sometimes pain may be present. The reaction can be caused by the very fact of the injection and the administration of the drug, which takes time to dissolve; it may be a redness reaction to certain components of the vaccine.

Usually, induration and redness after vaccination does not last long and disappears on its own within 1-3 days: according to statistics, compaction appears in every fourth child (after some vaccinations – more often).If swelling, redness, pain increases and does not go away within 3-5 days, this is a reason to consult a doctor.

What vaccines cause local reactions

Local adverse reactions are caused by many vaccines. Some vaccines, for example, DPT, give pronounced reactions – we will briefly talk about them (only local reactions will be described here, a rise in temperature is described in another article).

Prevention of COVID-19

Local reactions to vaccination do not differ from reactions with the introduction of other vaccines.The same manifestations: redness, swelling. Discomfort at the injection site. There may be allergic manifestations on the skin and elsewhere, not necessarily at the injection site. In such cases, drugs are prescribed for allergies.

DTP

DPT is a complex vaccine that protects against several diseases at once, moreover, it is “famous” for the most frequent complications compared to other vaccines. Puffiness and redness are no exception and occur from 1 to 15%. There may be allergic manifestations on the skin such as a measles-like rash, not only at the injection site.Quincke’s edema is also possible.

The size of the induration and redness is usually small (2-3 cm, but not more than 5 cm). These manifestations should go away in 2-3 days. If the area of ​​compaction increases more than 5 cm and there is an exacerbation of other local and general reactions: high temperature (above 38.5 degrees), throbbing pain at the injection site, red and hot skin, it is better not to self-medicate, but immediately consult a doctor.

Prevention of whooping cough, hepatitis B, tetanus, poliomyelitis

ADS, ADS-M, Infanrix, Pentaxim, Poliorix, Regevak, Tetraxim can cause pain, redness and induration in the first 3 days.

Prevention of hepatitis A

After vaccines Avaxim, Khavrisk and others, soreness, swelling and redness are possible in the first 3 days.

Prevention of influenza

Like many other vaccinations, influenza vaccines (Influvac, Vaxigrip and others) can give a standard local reaction in the form of pain, redness and a slight induration at the injection site.

Prevention of tick-borne encephalitis

Common pain, induration and redness at the injection site during the first 3 days.

Prevention of meningococcal and pneumococcal infections

Also, during the first 3 days, pain, swelling and redness are possible after vaccines Prevenar, Hiberix, Meningo A + C and the like.

Prevention of HPV (human papilloma of viral infection)

Pain, swelling and redness after the Gardasil vaccine is possible within 5 days.

Prevention of rabies

Cocav (rabies culture concentrated purified inactivated vaccine) – swelling, redness, itching, soreness.

Prevention of yellow fever

Common local reactions within 3 days.

Prevention of typhoid fever

Vianvac – pain, induration and redness in the first 3 days.

Follow-up after vaccination

If the seal is small, does not increase, redness and pain do not increase and lasts no longer than 2-5 days – there is nothing to worry about. Many mothers start to worry when local manifestations grow or when they do not go away for a long time. In these cases, you should consult a doctor.It is important to pay attention to the well-being and behavior of the child, to regularly measure the temperature after vaccination for several days.

To know exactly what reactions are possible after vaccination, carefully read the instructions for the vaccine.

We advise you to observe the following rules after vaccination:

• Do not wet or heat the injection site, it must be dry. Choose clothing to keep the injection site from sweating.
• When washing, do not rub the injection site with a washcloth, it is better if the soap does not get on it.
• Do not treat the wound with anything: ointments, creams, brilliant green and iodine: by your actions, you can turn the body’s normal reaction to vaccination into an abscess.
• Do not let your child scratch the injection site.

When to see a doctor

In the overwhelming majority of cases, a small seal at the injection site is a completely normal reaction and it goes away within 2-5 days, but sometimes the reaction is delayed, and this is already a reason to consult a doctor:

• seal diameter increased by more than 5 cm.
• reaction does not go away for more than 5 days
• the injection site begins to become inflamed (the size of the swelling and redness increases, becomes denser, accompanied by pain).

Why injections have complications and how to avoid them | HEALTH: Medicine | HEALTH

But, perhaps, in life, none of us escaped injections: for various reasons, doctors prescribe this particular method of treatment. Effective – yes, but sometimes causing serious post-injection complications

Watch out, reefs!

The most “popular” injections that doctors prescribe for many diseases, the so-called intramuscular.Simply put, it is a shot in the buttock or thigh. At first glance, nothing complicated. In fact, this is not the case. This simple procedure has its own reefs. There are five main types of complications.

Bruise, or, in medical language, hematoma. This is one of the most “harmless” complications. This, as a rule, does not require treatment.

Consolidation or infiltration. It threatens to be a serious nuisance: the medicine does not get into the muscle, but into the subcutaneous fatty tissue. It dissolves for a long time, in some cases an abscess may form at the injection site.

Abscess, or, more simply, an abscess. Most often, it is provoked by microbes that enter through the skin during an injection.

This situation is dangerous: the first warning symptoms are redness, swelling, sometimes throbbing pain. Hurry up to the doctor – at the “initial” stage, conservative treatment can be dispensed with, but if you miss the moment, only the surgeon’s scalpel can help.

Nerve damage. An injection into the buttock can enter the sciatic nerve, which runs through the middle and lower part of the buttocks.Not only does it hurt, it can temporarily paralyze. The consequences are treated by a neurologist.

Allergic reaction – unfortunately, this option cannot always be foreseen. Allergy symptoms appear immediately: redness, swelling, itching at the injection site. Some people may have an allergic rhinitis or conjunctivitis. A doctor should be consulted immediately.

Why do they arise, these complications? There are many reasons. According to experts, the most common are violation of the “technology”, the wrong choice of syringe and needle, non-compliance with antiseptic measures, etc.e. The risk of complications increases sharply when the procedure is carried out independently, at home, and in our country, unfortunately, many people do it today, frivolously believing that an injection is a simple and safe manipulation.

Needle needle strife

Few people know that if you are prescribed a course of intramuscular injections (even if they are given by a nurse), it is better not to rely on government materials, but to buy syringes with certain needles at the pharmacy, taking into account your weight, gender and age. It is clear that thin and short needles are used for children.And for adults? Experts say: it all depends on gender, weight, physique. Because women and men have a different layer of subcutaneous adipose tissue, and, therefore, with intramuscular injections, it is necessary to use needles of different lengths.

It is also important to consider completeness: obese patients need longer needles. Otherwise, a big nuisance may arise: because of the short needle, the medicine cannot be injected deep enough, and it does not enter the muscle, but into the subcutaneous fatty tissue.Over time, the drug, of course, will “dissolve”, but, firstly, the effectiveness of treatment decreases (the drug does not enter the blood quickly), and secondly, a seal forms at the injection site, inflammation may occur, and pain appears. How to choose the right syringe and needles?

“Ideally, when prescribing a prescription for a particular drug, the doctor should write in the same place which syringes and needles the patient needs to purchase,” says Andrey Grishkovets, medical director of the Society for the Development of Medicine and Healthcare.- But, unfortunately, doctors do not do this. In the pharmacy, too, no one warns the buyer about this: pharmacists, when recommending a syringe, are guided only by its volume.

How to choose the right syringe and needles? Here is what the professional, chief nurse of the Federal State Institution “GNITS PM Rosmedtechnologies” Julia Arkhangelskaya advises:

● the volume of the syringe should be slightly larger than the volume of the prescribed single dose of the drug;

● the thickness of the needle should depend on the physical properties of the drug: the higher its viscosity (for example, an oil solution is prescribed), the larger the diameter of the needle should be;

● for hypodermic injections, a needle 20–25 mm long can be used, for intramuscular injections – the length of the needle depends on the injection site: if it is made in the thigh, 25 mm is enough, if in the buttock, a needle 30 mm long is needed;

● if the patient is overweight, that is, his body mass index (weight divided by the height squared) is above 30, the length of the needle must be at least 40 mm.

Law & Order

Unfortunately, if there is a chronic patient in the family (cancer or hypertensive patient), it is difficult to count on regular visits from a nurse. Even for money. The question is – where to learn how to give injections to help a loved one? There are, of course, medical aids, there is a “course” on the Internet. But this is a very serious risk, and the procedure itself requires training and skill. It would seem that it is possible to create paid master classes at the same clinics for those who wish, and for many the problem would be solved.But the law prohibits this. Doctors have no right to educate the population on injection techniques. This is illegal. An injection is a medical service that can only be provided by professionals with a medical education.

Law is law. But life has its own order. So there is only one way out: to ask the nurse, as they say, to conduct training privately. But keep in mind, the patient’s first independent injections should be done only under her supervision.

Your own director?

Even if you have been giving home injections at home for a long time and confidently, do not lose your vigilance and do not forget about the safety rules:

● Be sure to wash your hands thoroughly before handling, it is advisable to blot the skin with a clean gauze cloth, and not wipe it off with a daily hand towel.

● Be sure to check whether the name of the drug corresponds to the one you intend to inject into the patient, and also check the expiration date before opening the package.

● If the drug is in a sealed vial, after removing the protective cap, be sure to wipe the rubber cap with alcohol.

● When using the medicine in the ampoule, before opening it, be sure to wipe the glass with a cotton swab moistened with alcohol to prevent infection from getting on the needle when it comes into contact with the outside of the ampoule.

● Never use vodka to wipe the injection site – 40% alcohol solution does not kill harmful bacteria and microorganisms on the skin surface. But pure alcohol is also a bad option: it not so much disinfects as dries and tanns the skin.

● Before injection, by raising the syringe with the preparation vertically, release the air bubbles;

● If swelling, redness, etc. appear at the injection site, do not self-medicate – see a doctor immediately to prevent the development of a complication.

See also:

90,000 Symptoms that may occur after vaccination against COVID-19

https://ria.ru/20201203/vaktsinatsiya-1587443707.html Can occur after vaccination against COVID-19This follows from the memo with recommendations, … RIA Novosti, 03.12.2020

2020-12-03T06: 11

2020-12-03T06: 11

2020-12-03T08: 49

spread of coronavirus

society

russia

coronavirus covid-19

coronavirus in russia

satellite v vaccine

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https://cdn22.img.ria.ru/images/07e4/0c/02/1587379232_125 0:3067:1655_1920x0_80_0_0_3958d6d30d3b5e1dac0c0f3b7d1cffc6jpg

MOSCOW, Dec 3 – RIA Novosti. One in ten people vaccinated with the Sputnik V coronavirus vaccine may feel weak or nauseous. This follows from the memo with recommendations issued in Moscow. The RIA Novosti correspondent got acquainted with it. The manual says that in most cases the vaccination is well tolerated. If you feel unwell, you should not worry: this is a normal individual reaction of the body and one of the signs of the formation of immunity. Those who develop weakness, general fatigue and nausea are advised to reduce physical activity and get more rest.5.7 percent of the vaccinated may experience aches, chills or fever, headache or a temperature above 37 degrees. decreases within four hours after taking the medication, then you need to call a doctor, “the document says. 4.7 percent of those vaccinated have pain, itching, swelling and redness at the injection site.Usually, no treatment is needed, but allergy medication can be taken to reduce swelling and discomfort. One and a half percent of patients may feel a stuffy nose, a runny nose, or a sore throat. They are encouraged to gargle, drink plenty of fluids, and use nasal sprays. Less than one percent may have a faster heart rate or high blood pressure. Residents of Moscow who have already started being vaccinated with Sputnik V receive not only a reminder with recommendations, but also a certificate of the performed immunization.The day before, Vladimir Putin instructed Deputy Prime Minister Tatyana Golikova to start a large-scale vaccination of Russians against coronavirus next week. According to him, more than two million doses of the drug are already ready. Russia has registered the first two vaccines in the world against COVID-19: first “Sputnik V” from the center of Gamaleya, and later “EpiVacCoronu” from the center “Vector”. The first is based on the human adenovirus vector platform, the second on the basis of peptide antigens. Now both drugs are undergoing the third, post-registration phase of trials on volunteers (including the elderly and those suffering from chronic diseases).Sputnik V is 95% effective after a second interim analysis of research data and is on the list of ten vaccines in the world that are closest to reaching mass production.

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society, russia, coronavirus covid-19, coronavirus in russia, sputnik v vaccine

MOSCOW, Dec 3 – RIA Novosti. Every tenth person vaccinated with the coronavirus vaccine “ Sputnik V ” may feel weak or nauseous. This follows from the memo with recommendations, which is issued in Moscow . The correspondent of RIA Novosti got acquainted with it.

The manual says that in most cases the vaccination is well tolerated. If you feel unwell, you should not worry: this is a normal individual reaction of the body and one of the signs of the formation of immunity.

Those who develop weakness, general fatigue and nausea are advised to reduce physical activity and get more rest.

5.7 percent of those vaccinated may experience aches, chills or fever, headache, or fever over 37 degrees.

July 7, 2020 09:30 after taking medication, you need to call a doctor, “the document says.

4.7 percent of those vaccinated have pain, itching, swelling and redness at the injection site. Usually, no treatment is needed, but allergy medication can be taken to reduce swelling and discomfort.

One and a half percent of patients may experience a stuffy nose, runny nose, or sore throat. They are encouraged to gargle, drink plenty of fluids, and use nasal sprays.

Less than one percent may have a faster heart rate or high blood pressure.

Residents of Moscow who have already begun to be vaccinated with “Sputnik V” receive not only a memo with recommendations, but also a certificate of the performed immunization.

April 23, 2020, 10:43 am Spread of coronavirus You can’t take it with your bare hands: what is the new coronavirus afraid of

Infographics

View According to him, more than two million doses of the drug have already been prepared.

Russia has registered the first two vaccines in the world against COVID-19: first “Sputnik V” from the center of Gamalea, and later “EpiVacCoronu” from the center “Vector”. The first is based on the platform of the human adenovirus vector, the second is based on peptide antigens.

Now both drugs are undergoing the third, post-registration phase of trials on volunteers (including the elderly and those suffering from chronic diseases).

Sputnik V is 95% effective after a second interim analysis of research data and is one of the ten vaccines in the world that are closest to mass production.

12 August 2020, 13:36 InfographicsSatellite V: the first registered vaccine against COVID-19

Infographics

View 90,000 Gum inflammation – causes, treatment and prevention

Gum disease is a general concept that implies both superficial and deep inflammatory processes. Everyone faces this problem to one degree or another, and in the absence of proper attention to the state of the oral cavity, inflammation can lead to serious consequences, including the loss of healthy teeth.It is important to recognize in time not only the onset of inflammation, but also to assess the depth of its spread, to receive qualified dental care and to prevent complications.

Causes of gum inflammation

The gums can become inflamed for various reasons. The most common of these is improper, irregular oral hygiene. The accumulation of plaque and the active reproduction of pathogenic flora as a result of this leads to inflammatory reactions. Refusal to use rinses and dental floss, a brush with inappropriate bristles – all this leads to the fact that food particles remain in the interdental spaces, which are a breeding ground for microorganisms.

The accumulation of soft plaque further leads to the formation of hard dental plaque – tartar. It promotes the multiplication of bacteria, and the sharp edges of the formations injure soft tissues, provoking reactive inflammation.

Other factors can aggravate the situation:

• general weakening of the body’s defenses: in case of systemic diseases, previous operations and infections;
• decrease in local protective forces as a result of trauma: damage can be associated with the use of a brush with stiff bristles, the presence of orthopedic and orthodontic structures, sharp edges of fillings and dental crowns;
• weakening of tissues as a result of chemical or thermal burns;
• lack of vitamins D and group B, as well as other micronutrients: this can be associated with both a poor diet and impaired absorption of vitamins and microelements from food in diseases of the gastrointestinal tract;
• endocrine pathologies: diabetes mellitus, thyroid dysfunction;
• bad habits: smoking, alcohol consumption;
• taking certain medications: oral contraceptives, blood pressure normalizers, antidepressants, antibiotics, etc.

If the gums become inflamed, it is important to find out the causes of the condition. When contacting your dentist, tell him about the diseases you know, the surgeries and injuries you have received. Eliminating the cause will help prevent recurrence of the disease in the future.

Types of inflammation

There are two types of inflammatory processes in the gum area – gingivitis and periodontitis. Gingivitis is a superficial inflammation of the gums, in which the periodontal junction is not involved in the pathological process.Usually we are talking about inflammation of the papillae of the gums between the teeth, while the disease is not dangerous for the teeth themselves: it does not provoke their mobility. Gingivitis is classified as follows:

• desquamative: characterized by pronounced redness and noticeable sloughing of the upper layer of tissues of the inflamed gums;
• hypertrophic: this species is characterized by an increase in the size of the periodontal papillae, their color can vary from red to cyanotic. The severity is determined by the amount of gum growth – it can cover more than half the height of the tooth crowns.Common in adolescents, pregnant women;
• atrophic: unlike hypertrophic, this type of gingivitis is characterized by a decrease in the volume of gum tissue;
• ulcerative: this inflammatory process is distinguished by the presence of severe itching and the appearance of ulcers on the gums;
• acute necrotizing: recorded in the ICD separately. The cause of this inflammation is a bacterial infection. The disease is accompanied by the death of the tissues of the interdental papillae;
• Acute catarrhal: This is one of the most common types of gingivitis, characterized by redness, swelling and bleeding of the gums.

Lack of timely assistance can lead to the transition of acute inflammation to a chronic form, as well as lead to the development of periodontitis. Periodontitis differs from gingivitis in that the inflammatory process involves deeply located tissues that connect the roots of the teeth and the bone structure. In this case, the gum can peel off from the tooth, forming a periodontal pocket, where food debris and soft plaque accumulate, which aggravates the situation. Complications of periodontitis are purulent processes and tooth mobility with a high risk of tooth loss.

Both gingivitis and periodontitis can be local and generalized. In the first case, the inflammation is limited to a certain area, in the second, it covers all the teeth of the jaw. Local limited inflammation is most often associated with trauma, general – with the action of other adverse factors.

Main manifestations and symptoms

Recognizing gingival inflammation is not difficult. The following symptoms may appear:

• redness, swelling of the gums;
• hypersensitivity of soft tissues;
• bleeding associated with weakening of small blood vessels;
• characteristic loose gum surface;
• bad breath.

There are also specific manifestations: with advanced periodontitis, purulent discharge appears, body temperature may rise. With ulcerative gingivitis, ulceration is visible on the surface of the soft tissues. Atrophic gingivitis can lead to exposure of the necks of the teeth and hypersensitivity to cold and hot foods.

Diagnostic Features

If there is inflammation on the gums, it is necessary to consult a dentist. The periodontist deals with the treatment of periodontal diseases, but a dentist-therapist can diagnose many inflammatory gum diseases and provide first aid.Diagnostics includes several basic methods:

• Visual inspection. The doctor will assess the external condition of the gums, and can also detect the causes of inflammation: carious cavities, cracks and chips of enamel, improperly installed structures.
• Interview: a specialist will collect anamnesis, ask questions about lifestyle, past illnesses, general health.
• Instrumental research. In the presence of periodontal pockets, their depth is necessarily measured; for this, probing is used.Using tweezers, the doctor will determine the mobility of the teeth.
• Radiography, orthopantomography. These methods are used to determine the severity of periodontitis, the depth of the pathological process. The doctor can also verify the absence or presence of complications of purulent processes, such as periodontitis.

Sometimes it is advisable to perform bacteriological cultures to determine which pathogen triggered the inflammation. The method provides for the detection of antibiotic sensitivity.

Treatment methods

The gum treatment regimen is developed individually, depending on the identified disease, general health and the severity of the pathology. There are several methods of therapy that can be roughly divided into local and systemic methods of exposure.

Mouthwash

Dentists welcome mouthwash as a way to prevent diseases, but the drugs used for medicinal purposes differ in composition and action.Rinsing allows you to solve a number of problems: remove food debris and soft plaque, reduce the severity of unpleasant symptoms, and prevent pathogens from multiplying. It is better to use pharmacy products than to prepare solutions yourself. The doctor may prescribe one of the following solutions:

• based on chlorhexidine;
• based on herbal antimicrobial components;
• preparations with the addition of ethyl alcohol: used with caution, only in diluted form.

Self-preparation of solutions is associated with certain difficulties: it is more difficult to calculate the dosage and ensure the required concentration of substances, it is not recommended to store the finished product – you will have to prepare a fresh portion every time. Taking into account the frequency of rinsing up to 4-6 times a day, it will not be easy to follow the last recommendation. However, sometimes you can use decoctions of herbs: chamomile, calendula, sage, oak bark are used. It is important to remember that allergic reactions are possible to plant components, and oak bark, with prolonged use, can cause changes in the shade of tooth enamel.You also need to coordinate the use of the selected remedy with your doctor.

Local remedies: ointments, gels

If rinsing provides for a short-term effect on the tissue, then the application of ointments and gels allows you to achieve a longer exposure. Most pharmaceuticals do not have a pronounced systemic effect. There are several types of such medications for gum disease:

• anti-inflammatory: they contain antibacterial drugs, antiseptics such as metronidazole, chlorhexidine, etc.They are designed to stop the multiplication of pathogenic bacteria and destroy them;
• Healing and accelerating regeneration: based on regenerants and reparants in the composition, stimulate the process of restoring the normal structure of tissues;
• Antifungal: These are specific agents that are less commonly used in dental practice. They are used in the case of diagnosing a fungal or concomitant infection with which inflammation of the gums is associated;
• pain relievers: some ointments contain lidocaine or other local anesthetics, which can effectively cope not only with pain, but also with itching and hypersensitivity.

Most of the funds are combined: they combine several components at once, which makes it possible to simplify and speed up the treatment process.

Toothpastes

Toothpastes are not an independent treatment for inflammatory gum disease. However, in many cases it is advisable to use them in addition to the main course of therapy. The composition of pastes may include the following components:

• herbal extracts with anti-inflammatory and immunomodulatory effects: extracts of chamomile, sage, propolis, echinacea, etc.;
• mineral salts;
• anti-carious components;
• Hexetidine is an antiseptic.

Abrasive particles in these pastes are absent or extremely small. This allows you to gently clean your teeth without injuring the enamel surface and soft tissues. It is not recommended to use anti-inflammatory toothpastes on an ongoing basis; they can be used for up to 4-6 weeks.

Systemic drugs

What exactly medication to treat inflammation of the gums, the doctor will recommend.In some cases, local exposure is not enough, and a specialist may prescribe medications for oral administration. Main groups of drugs:

• Antibacterial drugs. They are used for generalized forms of inflammation, usually for periodontitis. Broad-spectrum antibiotics are used for unspecified infection, narrow – when performing certain bacteriological studies and the presence of accurate information about the causative agent of the pathology.
• Antifungal agents.They are used in the case of a fungal infection of the oral cavity.
• Immunomodulators. The doctor may recommend them as an independent remedy or as part of a complex therapy.
• Antihistamines. Allow to relieve swelling, stop allergic reactions, prevent the occurrence of unwanted reactions to other drugs.

As a supplement to the main course of treatment, the intake of vitamin and mineral complexes can be prescribed.

Treatment and prophylactic measures in the clinic

If the gums become inflamed after tooth treatment, crown or other construction, you can contact your doctor.In many cases, the correction of the filling or crown, grinding and polishing can eliminate the cause of the inflammatory reaction. In cases where inflammation does not occur immediately after dental procedures or the reaction is generalized, it is necessary to visit a periodontist. What can a doctor recommend? Options:

1. Professional oral hygiene. Even healthy people need to have their teeth cleaned by a hygienist twice a year. In case of acute inflammation, the procedure will have to be postponed, but after the painful symptoms subside, it is important to get rid of plaque and calculus.Today, ultrasonic cleaning is widely used to remove hard dental plaque, as well as the Air Flow method to eliminate soft plaque.
2. Physiotherapy. There are several types of physiotherapy procedures that help consolidate the results of the main course of treatment:
   • darsonvalization: it is used in the absence of purulent processes. Exposure to tissues with high-frequency currents allows you to improve blood supply and quickly cope with the disease;
   • electrophoresis: the method combines the effects of current and the use of drugs.Solutions of vitamins can be used to strengthen the vascular wall, improve blood flow;
   • massage: the effect on the tissues is performed using a vacuum apparatus. This is necessary to improve blood flow and outflow of lymph, eliminate puffiness.

Usually a course of physiotherapy consists of at least 5 sessions.

Methods of prevention

To minimize the risk of gum inflammation, it is important to use the correct toothpaste and brush, and to use dental floss.It is recommended to undergo professional hygiene twice a year. It can be combined with routine dental check-ups. When detecting dental diseases, it is necessary to start treating them as soon as possible.

If the disease has already manifested itself, it is important to choose the right remedies for gum disease. Many patients resort to traditional methods of treatment: rinsing with salt and soda solutions or decoctions of medicinal herbs. But it is important to remember that some methods are not only ineffective, but also fraught with danger.So, in case of inflammatory processes of any type, warming procedures, the use of alcohol tinctures, agents that can cause mucosal burns should be avoided.

Only a doctor can prescribe drugs. We do not recommend self-medication – contacting a qualified dentist will help you cope with the disease faster and more efficiently and prevent complications. Accurate diagnosis and an integrated approach are the most important conditions for a quick recovery. You can make an appointment with a doctor at the STOMA clinic by phone or through a special form on the website.

90,000 Inflammation after tooth extraction: symptoms, treatment of gum inflammation

03/05/2020

Inflammation after tooth extraction

1. Signs of inflammation after tooth extraction
2. Causes of alveolitis
3. Treatment of inflammation

Surgical treatment of dental pathology is associated with a violation of the integrity of the gum tissue and is almost always accompanied by pain. It usually gradually decreases and goes away within 1 to 2 days.With extensive interventions, pain may last longer, but it also tends to subside.

Another case, if inflammation joins after tooth extraction.

Signs of inflammation after tooth extraction

In this case, the pain increases, it can take on a pulsating character. Sometimes the pain radiates to the ear on the affected side. Many patients refuse to eat due to pain. Strong in intensity, it is not stopped by taking analgesics.Such symptoms after tooth extraction are a signal that you need to visit a dentist. Otherwise, complications may develop in the form of inflammatory lesions of the bone (osteomyelitis of the jaw), periostitis.

Causes of alveolitis of the tooth socket

Scientifically, inflammation of the gums after tooth extraction is called alveolitis, that is, an inflammatory lesion of the hole. This gingivitis can be caused by:

• General factors: decreased immunity, severe concomitant diseases, disorders of the blood coagulation system, exhaustion after previous infections, vitamin deficiency, old age;
• Local: taking hot drinks and food shortly after the dental procedure, intensive rinsing, the transition of the pathological process to the gum tissue from neighboring areas with severe caries.

All this leads to the fact that the healing process of the wound surface is disrupted. Normally, the consequence of the operation is the formation of a loose blood clot. It fills the space inside the hole, where loose, and later – dense connective tissue gradually grows. Most often, inflammation occurs after the extraction of a wisdom tooth. This is due to the fact that such operations are especially traumatic: they affect the bone structures of the jaw, and many small vessels are damaged.

Treatment of gum inflammation

If alveolitis occurs, treatment should be carried out by a specialist.

When examining the oral cavity after tooth extraction, alveolitis is diagnosed if it occurs:

• redness of the edges of the hole;
• absence of a blood clot;
• severe soreness of the wound;
• plaque gray or yellow.

Solid food debris, small fragments of bone and tooth can inflame the wound surface.Careful revision and removal of foreign bodies, washing the wound with antiseptics, antibiotic solutions create conditions favorable for healing. A swab dipped in a medicinal solution is placed in the well.

If necessary, prescribe general treatment: analgesics, physiotherapy procedures. Sometimes it is recommended to do local baths with antimicrobial drugs.

Inflammation of the gums after removal does not indicate poor quality services. This may be due to the individual characteristics of the patient’s body.It is important to understand: if the place continues to hurt for more than 2 days, you must resort to dental services. Another conclusion is that it is better to treat diseases of the oral cavity (periodontitis, caries) before surgery. Then, after the procedure, there is less risk that the patient will be bothered by toothache, or complications will develop.

Vaccinations Pentaxim

Vaccination according to the scheme

Primary vaccination is done by a course, the scheme of which involves three vaccine injections plus 1 revaccination.Immunization is carried out as follows: the introduction of 1 dose, after 45 days the introduction of 2 doses, after another 45 days – the introduction of 3 doses, and a year after that – the mandatory revaccination.

Vaccination is indicated for children from three months.

It is undesirable to violate the vaccination scheme, since the strength of the child’s immunity to the active substances of the vaccine may decrease. For children from 1 year of age and older, the administration of the Pentaxim vaccine with a hemophilic component is performed once, Prevention of polio, tetanus, pertussis and diphtheria in a child from 1 year of age and older is subsequently performed with the Pentaxim vaccine, but without the use of a hemophilic component.

Routine vaccination

In Russia, the National Calendar of Preventive Vaccinations has been approved, according to which the Pentaxim vaccination is given to children three times – 1 dose at the age of 3, 4, 5 and 6 months, and revaccination is performed at the age of 18 months. By order No. 51 of January 31, 2011, this calendar also includes a vaccination against hemophilus influenzae.

Simultaneous administration of the drug. Pentaxim with other vaccines

It is allowed to vaccinate Pentaxim for children at the same time as any other vaccines from the Russian calendar of preventive vaccinations – on the same day, but in different parts of the body.An exception is BCG vaccination.

On the ability to develop immunity (immunogenicity), the use of Pentaxim vaccination together with other vaccines has no effect. The number of adverse reactions does not increase, the tolerance of vaccinations does not become worse.

The administration of several vaccines on day 1 does not overload immunity.

You can use the Pentaxim vaccination at any stage of the vaccination course (completion, continuation), even if it was started with other vaccinations against hemophilus influenzae, tetanus, pertussis, poliomyelitis, diphtheria.Moreover, all vaccines for prophylactic vaccinations specified in the Russian calendar are interchangeable.

Adverse reactions

Pentaxim vaccination can cause general and local reactions.

Common reactions to vaccination in most cases are fever, subfebrile (up to 10% of children) or febrile (very rarely – up to 1% of children). Even less often, complications are more severe (less than 1%), manifested by compaction at the injection site, headache, irritability, itching, sleep disturbances, lymphadenopathy.

Local reactions are not common (up to 10% of children), of which soreness, swelling, redness at the injection site are most often manifested.

Contraindications

If you are going to vaccinate children with Pentaxim, you should take into account some contraindications:

• hypersensitivity (confirmed systemic reaction) to any of the constituents of the vaccine;
• exacerbation of chronic diseases, acute infectious diseases, an increase in body temperature due to illness – in any of these cases, the vaccine is transferred until complete recovery;
• Allergic reaction following previous vaccination against poliomyelitis, pertussis, tetanus, diphtheria and infection caused by Haemophilus influenzae type b.

Additional information

Vaccination Pentaxim does not give immunity against pneumonia and meningitis of other etiology, as well as against infections caused by other types of Haemophilus influenzae.

Vaccines with Pentaxim can only be made to completely healthy children; before vaccination, it is imperative to undergo an examination by a pediatrician in order to assess the child’s health and exclude infectious diseases. You cannot use the Pentaxim vaccine if the child has contraindications from the nervous system confirmed by a neurologist.

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