What Is Phlebitis?

Phlebitis is a medical condition that occurs when a vein is inflamed. When a thrombus or blood clot causes the inflammation, the condition is called thrombophlebitis, which usually affects the veins located in the legs (1, 2). However, veins in the arms can also be affected. Other terms for phlebitis include superficial phlebitis, a blood clot in the arm or leg, thrombophlebitis, thrombus, and deep venous thrombophlebitis or deep vein thrombophlebitis.

There are two types of phlebitis: deep and superficial. Deep phlebitis involves larger and deeper leg veins. This type of phlebitis often occurs due to a blood clot in the leg, which can be potentially life-threatening if not early diagnosed and treated.

Superficial phlebitis, on the other hand, involves the veins that are on the surface of the skin. Unlike deep phlebitis, superficial phlebitis quickly resolves, can be easily treated, and is rarely life-threatening. However, in some cases, individuals who have this type of phlebitis also get to develop deep phlebitis. When this happens, it is important to be evaluated by your healthcare provider for proper diagnosis and prompt treatment.

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Symptoms of Phlebitis

Superficial phlebitis tends to display localized symptoms more slowly while deep phlebitis may or may not obviously display any symptoms right away. However, both deep and superficial phlebitis may produce similar symptoms, which include:

• Redness and warmth
• Swelling
• Itching
• Fever due to superinfection
• Tenderness, throbbing, or burning sensations
• Rope-like structure through the skin
• Noticeable red streak on the leg or arm
• Ulcers or skin discoloration (untreated and chronic cases)

When phlebitis is due to deep vein thrombosis (DVT), a more pronounced pain in your thigh or calf may be experienced, particularly when stretching or walking. However, not all people with DVT may develop symptoms. Those with asymptomatic DVT may only discover their condition until they experience serious complications like pulmonary embolism (3).

People with superficial phlebitis may experience worse symptoms when their affected leg is lowered. In certain cases, phlebitis develops on the site of a peripheral IV (intravenous) line and cause tenderness along the vein and its surrounding area.

Causes

Phlebitis is usually caused by an injury or local trauma to a vein, including:

• Intravenous drug use
• Skin burns
• Broken bone
• Serious injuries
• Varicose veins
• History of DVT
• Cancer
• Blood clotting disorders
• Connective tissue disorders
• Post-orthopedic surgery
• Prolonged bed rest (e.g., bedridden patients, hospitalized patients)
• Intravenous (IV) catheter insertion
• Lymph node removal for breast cancer
• Prolonged physical inactivity or sedentary lifestyle

Risk Factors

These conditions may also be aggravated by certain factors, such as:

• Pregnancy
• Obesity and being overweight
• Smoking
• Birth control pills or hormone replacement therapy (HRT)
• Major orthopedic surgery
• Surgery for cancer treatment

Complications

Superficial thrombophlebitis rarely causes complications. The risk of serious and potentially life-threatening complications becomes evident when people develop deep phlebitis or deep vein thrombosis (DVT). Phlebitis complications may include post-phlebitic syndrome and pulmonary embolism.

 

Post-Phlebitic Syndrome

Also called post-thrombotic syndrome, this condition often develops in people with a history of deep vein thrombosis (DVT). The symptoms of post-phlebitic syndrome include chronic swelling, leg pain, discoloration, and sores (4). It can develop within months to years after having DVT. The pain can be disabling and heavy when it is accompanied by leg swelling.

Pulmonary Embolism

Pulmonary embolism occurs when a deep vein clot, usually from the leg, breaks loose and travels to the lungs. This clot causes blockage in one of the lung arteries, which can potentially become life-threatening (5).

Diagnosing Phlebitis

Your healthcare provider can detect superficial phlebitis after conducting a physical examination. To confirm the diagnosis, a noninvasive imaging test called vascular ultrasound may be needed. It is extremely important for patients to have an ultrasound since studies have shown that people diagnosed with superficial thrombophlebitis are more susceptible to also having deep vein thrombosis (6, 7, 8).

Blood tests and other imaging tests may also be required for further evaluation and if the ultrasound result does not reveal clear remarks.

Treatment

If you are diagnosed by your healthcare provider with superficial phlebitis and without any other medical condition, you’ll likely go home with medications, such as anti-inflammatory drugs. These medications can help control the symptoms and relieve discomfort. An antibiotic will likely be prescribed if you have signs of infection. Your symptoms can also be managed by warm compresses and elevation of your leg or arm.

Anticoagulants or blood thinners may also be prescribed, especially if you have had deep vein thrombophlebitis in the past. Taking blood thinners for phlebitis may last up to six months. However, if your condition has developed into deep phlebitis, hospital admission may be required for further evaluation, monitoring, and treatment. 

The symptoms of phlebitis can also be relieved by wearing medical grade compression stockings (9). In most cases, knee-high and thigh-high compression socks are prescribed and recommended to help improve the flow of blood in the legs (10). Using compression socks can also provide the support you need as well as relieve both inflammation and pain caused by phlebitis.

Outlook and Prevention

Superficial phlebitis responds well to anti-inflammatory medications, including home remedies, such as warm compresses and elevation. If there are no complications, treatment usually lasts up to two weeks.

This condition also tends to completely heal without any long-term side effects. However, if you have been diagnosed with deep vein thrombosis (DVT) or have a history of DVT, you will likely require regular monitoring and treatment from your healthcare provider.

If you’re more prone to developing DVT, there’s no need to worry because there are preventive measures that can help prevent the formation of blood clots. The prevention of DVT includes any of the following strategies:

• Taking prescription medication from your healthcare provider, such as anticoagulants or blood thinners
• Eating healthy meals
• Avoiding a sedentary lifestyle and becoming more physically active
• Exercising regularly, such as walking
• Quitting smoking
• Losing weight if you are overweight
• Wearing medical grade compression socks as prescribed by your doctor
• Drinking plenty of water
• Wearing loose clothes, especially when traveling long-haul flights or driving long-distances
• Discussing the risk factors with your healthcare provider, particularly if you are pregnant, have recently had a child, taking birth control pills, undergoing hormone replacement therapy, or any type of surgery.
• Early walking after surgery

 

 

References

 

1. Superficial Thrombophlebitis | Cleveland Clinic. (January 2019). Cleveland Clinic. Retrieved from https://my.clevelandclinic.org/health/diseases/17523-superficial-thrombophlebitis

 

2. Thrombophlebitis: Background, Pathophysiology, Etiology. (August 2018). Retrieved from https://emedicine.medscape.com/article/1086399-overview

 

3. Overview, D. (2017). Deep vein thrombosis (DVT): Overview. Institute For Quality And Efficiency In Health Care (Iqwig). Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK425364/.

 

4. Vasquez S., & Kahn, S. (March 2010). Postthrombotic Syndrome. doi.org/10.1161/CIRCULATIONAHA.109.925651Circulation. 2010;121:e217–e219

 

5. Swaroop, M., & Tarbox, A. (2013). Pulmonary embolism. International Journal Of Critical Illness And Injury Science, 3(1), 69. doi:10.4103/2229-5151.109427

 

6. Binder, B., Lackner, H., Salmhofer, W., Kroemer, S., Custovic, J., & Hofmann-Wellenhof, R. (2009). Association Between Superficial Vein Thrombosis and Deep Vein Thrombosis of the Lower Extremities. Archives Of Dermatology, 145(7). doi:10.1001/archdermatol.2009.123

 

7. Roach, R., Lijfering, W., van Hylckama Vlieg, A., Helmerhorst, F., Rosendaal, F., & Cannegieter, S. (2013). The risk of venous thrombosis in individuals with a history of superficial vein thrombosis and acquired venous thrombotic risk factors. Blood, 122(26), 4264-4269. doi:10.1182/blood-2013-07-518159

 

8. Chengelis, D., Bendick, P., Glover, J., Brown, O., & Ranval, T. (1996). Progression of superficial venous thrombosis to deep vein thrombosis. Journal Of Vascular Surgery, 24(5), 745-749. doi:10.1016/s0741-5214(96)70007-1

 

9. W, P. (2019). Compression and walking versus bed rest in the treatment of proximal deep venous thrombosis with low molecular weight heparin. - PubMed - NCBI. Ncbi.nlm.nih.gov. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/11054217

 

10. Lim, C., & Davies, A. (2014). Graduated compression stockings. Canadian Medical Association Journal, 186(10), E391-E398. doi:10.1503/cmaj.131281