PHLEBITIS

WHAT IS PHLEBITIS

Phlebitis is a generic term meaning "inflammation" of the vein. It is often used interchangeably with thrombophlebitis, which means a clotted vein. It can occur spontaneously or as a result of an I.V. or trauma. The most common site of phlebitis is in the leg veins, although other sites are possible. PRESENTATION OF PHLEBITIS

The presentation is of a red, hard, and hot area that appears along the course of a vein. Often, it involves an area of varicose veins legs. The redness and irritation can spread up or down the course of the affected vein. Typically, there is not significant swelling present in the leg, unless there is deep vein involvement. In the arm veins, similar findings are noted. It is much rarer to have phlebitis of veins apart from the leg veins. Rarely, one can develop septic thrombophlebitis. This process is usually due to an indwelling I.V. and is different from regular phlebitis in that the inflammation is an infective process, usually due to Stap or Strep species of bacteria. In this situation, the infected vein usually drains pus, and the process can be accompanied by fevers or chills. Deep venous thrombosis (DVT) will be discussed in a seperate page.

The diagnosis of phlebitis is made with detailed history and physical examination, paying attention to the timing of the event, the present or absence of varicose veins, or recent hospitalization and/or I.V. placement. The physical findings are typically of a red, hard streak that feels like a rubber ball. The process can extend up or down the leg. Doppler ultrasound will not only confirm the process, but also make sure that there are no deep vein clots, since a small percentage of deep vein clots present with superficial phlebitis.

TREATMENT OF SUPERFICIAL PHLEBITIS

Superficial phlebitis is usually a self limited process. The treatment plan includes warm packs, elevation of the involved extremity, non-steroidal anti-inflammatory agents such as ibuprofen, and time. The process can last several weeks to months, and even after if has resolved, one might skin feel a cord or knot under the skin with careful examination. Antibiotics are prescribed if there is significant inflammation around the area. Septic phlebitis requires antibiotics and someimes debridement or excision of the infected vein. Again, this latter process is rare, even after an I.V. The long-term outlook is good, although one should be aware that once one has had phlebitis, one is at an increased risk for further episodes. If there are repeated episodes of phlebitis with an incompetent greater saphenous vein, then EVLT will reduce further risks for phlebitis