ombosis is ultrasound. It is less expensive than alternatives and highly reliable. In many settings, however, it is simply not available 24 hours per day.
D-dimer is a useful blood test that can suggest phlebitis. This is a chemical that is released by blood clots when they start to degrade. A normal D-dimer makes the diagnosis of thrombophlebitis unlikely. The limitation of this test is its lack of specificity, meaning that an elevated D-dime level can be seen in other conditions including recent surgery, fall, pregnancy, or an underlying cancer.
Conditions that mimic phlebitis include cellulitis (superficial skin infection), insect bites, or lymphangitis (swelling and inflammation of lymph nodes) and can be distinguished by obtaining a careful medical history and physical examination by a physician. Sometimes, a biopsy of the skin may be required to establish the definite diagnosis.
How is phlebitis treated?
Treatment of phlebitis may depend on the location, extent, symptoms, and underlying medical conditions.
In general, superficial phlebitis of the upper and lower extremities can be treated by applying warm compresses, elevation of the involved extremity, encouraging ambulation (walking), and oral anti-inflammatory medications (ibuprofen [Motrin, Advil], diclofenac [Voltaren, Cataflam, Voltaren-XR], etc.). Topical anti-inflammatory medications may also be beneficial, such as diclofenac gel. External compression with fitted stockings is also a recommended for patients with superficial phlebitis of the lower extremities.
If an intravenous catheter is the cause, then it should be removed. If the phlebitis is infected, then antibiotics are used. In severe cases of infected thrombophlebitis, surgical exploration may be necessary.
Superficial thrombophlebitis (blood clots) is evaluated by an ultrasound to exclude deep venous thrombophlebitis, especially those involving the saphenous vein. If deep venous thrombophlebitis is suspected or diagnosed, or if its risk of developing is considerable, then anti-coagulation (thinning of blood) may be necessary. This is typically done by injection of low molecular weight heparin (enoxaparin [Lovenox]), or by injection of fondaparinux (Arixtra). It can be done by treatment with therapeutic dosages of unfractionated heparin (usually in the form of an intravenous drip), followed by oral anti-coagulation with warfarin (Coumadin) for about 3 to 6 months. Newer anticoagulants may replace Coumadin in certain circumstances.
Patients with extensive deep vein thrombosis (DVT) may be appropriately treated with catheter-directed thrombolysis in selected cases, but will still require maintenance anticoagulation for 3 to 6 months.
Selected patients with DVT may require placement of inferior vena cava filters to help prevent pulmonary embolus. In a subset of patients, it may be appropriate to remove the filter at a future date.
Recovery of symptoms from superficial phlebitis can last a few weeks. A thrombophlebitis may take weeks to months to recover.
What are the complications of phlebitis?
Complications of phlebitis may include local infection and abscess formation, clot formation, and progression to a deep venous thrombosis and pulmonary embolism. When pronounced deep venous thrombophlebitis has seriously damaged the leg veins, this can lead to post-phlebitic syndrome. Post-phlebitic syndrome is characterized by chronic swelling of the involved leg and can be associated with leg pain, discoloration, and ulcers.
Can phlebitis be prevented?
Simple measures can be taken to prevent phlebitis, although, sometimes it cannot be avoided.
Preventive measures of phlebitis include:
- early mobilization after surgery,
- leg exercises during a long car travel or airplane ride,
- good nursing hygiene and prompt removal of intravenous catheters, and
- smoking cessation.
Compression stockings are required in many patients after an episode of phlebitis, especially deep venous phlebitis. These, and other measures, reduce post-phlebitic swelling and the risk of recurrent phlebitis. In most hospitalized patients who