What is Phlebitis?
Phlebitis is an inflammation involving the vein which commonly occurs in the legs, but may also arise in the arm. This condition can lasts longer and even for years, however, if it persists for a long time, the inner lining of the inflamed vein could be irritated to a certain extent where a number of blood elements are deposited, leading to the formation of clots.
When a blood clot is in the vein, it causes pain and irritation and obstructs the flow of blood in the veins. (Thrombophlebitis) when it circulates in the bloodstream, it can lead to a serious circulatory obstruction. It is fatal when phlebitis is related to blood clot formation as clots may travel to the lungs leading to a pulmonary embolism. If any of the large pulmonary vessels is blocked, death may result.
Phlebitis can occur in both the surface or in deep veins. It can be classified as superficial or deep vein thrombophlebitis.
Superficial Phlebitis
Superficial phlebitis is a rarely serious form of phlebitis which only involves veins found on the skin surface. It is most likely to develop in individuals with varicosities, bedridden or pregnant. Its presence does not necessarily mean that there is an underlying deep venous thrombophlebitis. Typically, superficial thrombosis in the upper and lower limbs is a benign condition and has a positive prognosis. When thrombus is in the saphenous vein, it may be associated with an underlying DVT. With prompt and proper treatment, the condition typically resolves rapidly. However, a medical evaluation must be made as individuals with superficial phlebitis can also have deep vein thrombophlebitis.
Deep Vein Thrombophlebitis
Deep vein thrombophlebitis is a form of phlebitis affecting larger vessels which are more deeply situated blood vessels of the legs. In this condition, blood clots or thrombi are formed, which can break away and move to the lungs. Pulmonary embolism results and this is potentially life-threatening.
Phlebitis Symptoms
Patients suffering from a mild phlebitis can be asymptomatic or can also exhibit a number of symptoms. Hereunder are the following clinical manifestations of the condition.
General manifestations
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- Localized pain and burning sensation along the length of the vein
- Tenderness
- Redness / erythema which follows the course of the vein under the skin
- Edema or bulging of the vein
- Drainage of an exudates or pus due to an infection
- Hyperthermia
- A vein being hard and cord like in characteristic indicates that there is a superficial clot present on the area.
- If it happens because of an intravenous infusion line, slowed infusion rate can be noticed.
- Walking becomes challenging in patients with DVT as the affected extremity will become painful and tender.
Phlebitis Causes
Phlebitis can be due to the following factors:
- Presence of a confined vein damage
- Pathogenic organisms can gain access and cause inflammation
- Immobility and inactivity; examples include when the individual is in long driving or is sitting on a plane ride for extended hours.
- Prolonged standing
- Hypercoagulability of blood
- Irritating or vesicant solutions.
- Phlebitis can be provoked by IV insertion such as when the cannula is excessively large, subsequent manipulation and movement of cannula.
- Post-surgical phase particularly in surgeries involving the musculoskeletal system
- Prolonged immobility, as in hospitalized or bed-ridden patients
- Valvular insufficiency and varicosities
- Malignant neoplasm and bleeding disorders
- Interference in the usual venous system drainage because of removal of lymph nodes, for example, after mastectomy for breast cancer
- Intravenous drug use
- Patients with burns
- Hereditary conditions
- IV can cause arm vein phlebitis, while certain medications such as phenergan can cause phlebitis
- Alcohol Abuse
- Surgical operation and childbirth
Phlebitis Risk Factors
- Trauma to the arm or leg can cause an injury the underlying vein
- Prolonged immobility – Normally, blood that is collected in the veins of the lower extremities is pumped toward the heart as lower leg muscles contract. If the contraction of the leg muscles becomes restricted because of extended hours of immobility, the blood becomes stagnant in the vein and clots may form.
- Hormone therapy
- Birth control pills
- Atherosclerosis
- Pregnancy
- Cigarette smoking
- Obesity
- There are a number of cancers which are in hypercoaguable state can increase the risk of an individual to clot formation by causing abnormalities in the normal coagulation pathway.
Phlebitis Prevention
Preventive measures for phlebitis can be easily taken, but in some cases, this can’t be avoided. Oftentimes, thrombophlebitis is a complication of treatments and conditions of a hospitalized individual.
Measures include the following:
- Early postoperative and postpartum ambulation
- Throughout a long car travel or airplane ride, legs must be exercised
- Good nursing hygiene
- Prompt removal of intravenous catheters
- Smoking habit must be put to stop as it can promote clot formation
- Compression stockings may be advantageous in individuals who have frequent phlebitis
- Attention to fluid balance
- Range of motion exercises for the immobilized patient
- Proper positioning of the patient are common nursing measures to promote good circulation
- To maintain muscle tone and promote circulation, moderate physical activity is suggested.
- Most hospitalized individuals who have restricted mobility or had a recent orthopedic surgery, blood thinners such as heparin or enoxaparin are given in low dose.
- Massaging the affected area is contraindicated as the nature of massage manipulations can cause clots to break loose which could lead to a clot travelling to the lungs and heart.
Phlebitis Treatment
Management of the condition will depend on the location, degree of severity, symptoms, and its underlying medical conditions.
Superficial thrombophlebitis
Generally for individuals with superficial thrombophlebitis, they are treated with the following;
- Periods of rest
- Elevation of the involved extremity
- Non-steroidal anti-inflammatory drugs such as ibuprofen and diclofenac and antibiotics as needed
- Warm compresses may ease the inflammation
- External compressions such as elastic stockings or bandages may be recommended to reduce the swelling
- If caused by an intravenous catheter, it must be removed.
Deep thrombophlebitis
- Usually, deep thrombophlebitis can be treated with anticoagulant drugs. These medications can help lessen the clot formation and allow the already formed clots to dissolve.
- Bedrest with leg elevation
Phlebitis Pictures
