Phlebitis

Definition

Phlebitis is a general term to describe the inflammation of a vein. Very often, the inflammation is accompanied by formation of a clot (thrombus), which occludes the blood flow through the vein. This condition is known as thrombophlebitis or venous thrombosis.

Description

There are two general types of thrombophlebitis: a superficial condition that is painful but not life-threatening; and deep thrombophlebitis, a potentially serious condition involving an interior blood vessel.

About 300,000 Americans are hospitalized each year because of deep thrombophlebitis, the major danger being that a portion of the clot will break away and travel through the venous system to the lungs, forming a pulmonary embolism. If one of the large pulmonary vessels is blocked, death may result.

Superficial phlebitis is most likely to develop in people with varicose veins, patients who are bedridden, or in pregnant women. There may be obvious swelling and a red streak along the involved vein; there may also be heaviness and pain in the leg. The discomfort is usually eased when the leg is elevated and worsened when it is lowered.

Deep thrombophlebitis is more likely to cause pain, tenderness, and swelling of the entire limb. Unfortunately, deep thrombophlebitis may occur without producing symptoms until a pulmonary embolism signals its presence.

Causes and Risk Factors

It occurs most commonly as a result of trauma to the vessel wall, hypercoagulability of the blood, infection, prolonged sitting, standing, immobilization, or after a long period of intravenous catheterization.

Treatment

Superficial thrombophlebitis is generally treated with periods of rest with the leg elevated, non-steroidal anti-flammatory drugs and if needed, antibiotics. Warm compresses may ease the inflammation, and elastic stockings or bandages may be recommended to reduce the swelling.

Deep thrombophlebitis is usually treated with anticoagulant drugs to reduce the formation of clots and to permit the clots that have already formed to dissolve. Bedrest with the leg elevated may be necessary.

Anticoagulant drugs may be prescribed for up to several months to prevent recurrence. If these drugs are used for long-term treatment, patients are cautioned not to take any other medication, especially drugs like aspirin that may interact with them.

Patients on anticoagulants should have periodic blood tests and also should be alert for any signs of abnormal bleeding, such as bloody or tarry stools, blood in the urine, or excessive bleeding of the gums or small cuts.

Anticoagulant therapy and streptokinase may be administered, and moist heat is applied to the affected area; intense heat, which may burn edematous skin, is avoided. Every four hours the blood pressure, temperature, pulse, respiration, circulation of the affected extremity, skin condition, and pulses in all extremities are checked. The patient is kept warm and dry and is helped to turn, cough and deep breathe every two hours.

Observations for signs of pulmonary embolism, myocardial infarction, cardiovascular accident, or decreased renal function is constant. As inflammation subsides, the use of support or anti-embolic stockings is demonstrated and an exercise program is begun. The patient is instructed to alternate exercise with bedrest, never to dangle the legs, walk 10 minutes every hour, avoid prolonged standing, avoid becoming overweight, and when sitting, elevate the legs and avoid constricting circulation in the groin or crossing the legs at the knees.

Prevention

Thrombophlebitis is often a complication of treatments and conditions in the hospitalized patient. Much routine nursing care is directed towards avoiding thrombophlebitis. Early postoperative and postpartum ambulation, range of motion exercises for the immobilized patient, good technique in intravenous catheterization, attention to fluid balance, and proper positioning of the patient are common nursing measures to promote good circulation and reduce venous stasis (stoppage or diminution of flow), and the development of thrombophlebitis.

People susceptible to phlebitis (or any other circulatory or cardiovascular problem) should not smoke since this promotes clot formation. Moderate physical activity is recommended to maintain muscle tone and promote circulation.

Questions to Ask Your Doctor

What type of phlebitis is it and what is the cause?

How serious is it? What are the dangers of this phlebitis?

What type of treatment will you be recommending?

If bedrest is necessary, how long should the legs be elevated and for how many days?

Will you be prescribing any medications? What are the side effects?

Are there any signs or symptoms that the doctor should be notified of?