Phlebitis - Types, Causes, Symptoms, Risk, Diagnosis, and Treatment

What Are Veins?

Veins are the blood vessels that carry deoxygenated blood from different body parts to the heart. The blood from the heart, which is low in oxygen level, is transported to the lungs. In the lungs, the blood is purified and made oxygen-rich, which is sent back to the heart. The heart then pumps this oxygenated blood to different body parts.

Depending on the relation to the skin surface, veins are classified into:

• Superficial Veins: These are present close to the skin's surface and are not accompanied by superficial arteries.

• Deep Veins: Deep veins are situated inside the muscles. Close to them, a corresponding artery is usually present.

Depending on their location, they are divided into:

• Systemic Veins: These are present throughout the body and help transport deoxygenated blood from all body parts, including the arms, trunks, legs, etc.

• Pulmonary Veins: Pulmonary veins carry the blood from the right ventricle of the heart to the lungs for carrying out purification.

What Is Phlebitis?

Phlebitis is a condition characterized by inflammation of the veins. Any damage to the vein walls or blockage of the vein caused by a blood clot can bring about phlebitis. Although legs are the most commonly affected site, phlebitis can occur in any part of the body.

What Is Thrombophlebitis?

When the presence of a blood clot is the cause of venous inflammation, it is called thrombophlebitis. It is characterized by pain and swelling at the site of clot formation.

Thrombophlebitis is divided into two types based on their location:

• Superficial Thrombophlebitis:

In this type, there is clot formation just below the skin surface. As they cannot travel to the lungs, superficial thrombophlebitis is comparatively less dangerous. However, there may be severe pain associated.

• Deep Vein Thrombophlebitis:

It is also called deep vein thrombosis, and it is characterized by blood clots present in the deeper tissues. These types of thrombophlebitis require immediate medical attention as they can result in pulmonary embolism (the blood clot travels and reaches the lungs), which, if left untreated, can lead to death.

What Are the Types of Phlebitis?

Both superficial and deep veins may be affected by phlebitis. The following are the two types of phlebitis:

• Superficial Phlebitis:

Superficial phlebitis is a less severe inflammation of the superficial veins caused by irritation due to an intravenous catheter or a blood clot. Superficial phlebitis can bring about wounds and infections of the bloodstream and skin adjacent to the clot. However, not a severe condition, an evaluation with a medical professional is needed to rule out the chances of deep vein phlebitis.

• Deep Vein Phlebitis:

In most cases, deep vein phlebitis is caused due to the presence of a blood clot in larger and deeper veins. The blood clots may break and move to the lungs, resulting in a fatal condition called pulmonary embolism. Unlike superficial phlebitis, it is a severe condition that needs to be treated as soon as possible to prevent severe complications.

What Causes Phlebitis?

In general, injury to the vein, irritation, and a blood clot in the vein are the causes of phlebitis.

Superficial phlebitis is caused by the following:

• Infection.

• Irritation caused by an intravenous catheter.

• Presence of small clot.

• Intravenous administration of irritating medications.

• Soft tissue injury.

Below are the causes of deep vein phlebitis:

• Prolonged immobility after surgery.

• Reduction in the blood flow that can occur due to lack of movement, such as on bed rest or sitting in a particular position for an extended period of time.

• Medications that can increase the ability of blood to clot.

• Chronic medical conditions like genetic clotting disorders, cancer, and connective tissue disorders.

• Physical trauma like fracture, surgery, or injury can bring about irritation or injury.

What Are the Symptoms of Phlebitis?

The signs and symptoms of phlebitis vary depending on the type. The most common symptoms of phlebitis, pain, and swelling, usually affect the areas where the inflamed vein is present.

Following are the symptoms of superficial phlebitis:

• Tenderness on the skin of inflamed veins.

• Redness, warmth, and swelling involving the affected area.

• A visible cord-like structure can be seen on the skin.

• Reddish streak-like appearance of the skin.

Below are the manifestations of deep vein phlebitis:

• Pain, which becomes more intense when walking.

• Swelling, warmth, and discoloration of the skin.

While in the case of pulmonary embolism, the following are the symptoms:

• Rapid heart rate.

• Lightheadedness.

• Chest pain.

• Shortness of breath.

• Pain associated with deep breathing.

• Coughing up of blood.

If you have phlebitis and experience any of the above symptoms of pulmonary embolism, seek immediate medical attention.

What Increases the Risk of Developing Phlebitis?

The following are the risk factors of phlebitis:

• Obesity.

• Prolonged hours of immobility reduce the amount of muscle contractions that help pump the blood from the legs to the heart.

• Trauma.

• Individuals on hormone therapy or contraceptive pills.

• Pregnancy.

• Orthopedic surgeries.

• Primary or secondary blood disorders that promote clotting.

• Smoking.

• Family history of blood clot formation.

• People with varicose veins.

• Sitting in one position for extended periods of time.

• Alcoholism.

• People above the age of 60 years.

• Cancers which bring about an alteration to the clotting mechanism.

• Individuals with varicose veins.

How Is Phlebitis Diagnosed?

Diagnosis of phlebitis is based on medical history and physical examination.

• Physical Examination:

The presence of redness, warmness, tenderness, and swelling along the venous course is an important characteristic feature that helps diagnose phlebitis.

In addition to the physical examination, the following tests are used to diagnose phlebitis:

• Blood Tests:

These blood examinations determine any underlying blood clotting disorder that might have caused the condition.

• Ultrasound Scan:

In an ultrasound, the blood flow within the veins is detected using sound waves. This is the most commonly used yet very much reliable diagnostic test. It diagnoses the presence of blood clots in the deeper veins. Also, it is cheap as compared to other tests.

• Venography:

A special dye is injected into the leg vein. Following this, an X-ray is taken to visualize blood flow up from the legs. This helps in diagnosing the blood clots.

• Other Imaging Tests:

Magnetic resonance imaging (MRI) scan and computed tomography (CT scan) are other imaging tests helpful in diagnosing the clots present in the veins.

• D-Dimer Blood Test:

D-dimer is a chemical substance released from the clots during their breakdown. In this test, the D-dimer values are measured. A negative value of D-dimer indicates an absence of blood clots. However, a false-positive test result is also possible in conditions like pregnancy, the presence of cancer, and recent trauma or surgery.

What Is the Treatment for Phlebitis?

In most cases, superficial phlebitis is an improving condition and does not require treatment other than a few self-care methods. However, in persons with deep vein phlebitis or those with an increased risk of developing deep vein thrombosis, treating phlebitis is needed.

The following are the available treatment modalities for phlebitis:

• Blood Thinners:

Anticoagulant medications or blood-thinning medications are recommended in people with phlebitis. They are given either orally or intravenously. These medications prevent the chances of a new clot formation. Also, an existing clot is prevented from getting more significant.

• Fibrinolytics:

It is also called thrombolytics or clot busters. These drugs help disrupt the already formed clot and are recommended in people with severe cases of deep vein thrombosis.

• Thrombectomy:

In patients with severe deep vein thrombosis where problems exist with the return of blood from the lower extremities to the heart, thrombectomy is suggested. The clot is removed in one of the below two ways, or sometimes a combination of both methods is used. The clot is removed by inserting a catheter into the affected vein and blowing the catheter's balloon. Medications like tissue plasminogen activators may be employed in some cases to break the clot. Even in patients who have undergone thrombectomy, a maintenance dose of anticoagulants should be given.

• Treatment for Varicose Veins:

Individuals who have an inflamed varicose vein may need treatment for the varicose veins like laser therapy, sclerotherapy, or surgical correction. This can help in treating phlebitis.

• Vena Cava Filter:

In patients where administration of blood-thinning medications is not recommended, a vena cava filter is inserted into the affected vein. Although it cannot prevent blood clot formation, it can reduce the risk of developing pulmonary embolism, a potentially fatal complication of phlebitis. These types of filters should be kept in place only for upto a couple of years to prevent the risk of complications like infection blood vessel enlargement, which creates a space between the filter and the vein, making it possible for the clot to traverse through, formation of clots in other areas, and damage to the vena cava.

What Are the At-Home Measures for Managing Phlebitis?

At-home treatment is recommended only in people with superficial phlebitis and those who do not exhibit any risk of developing deep vein thrombosis. These can reduce the pain and swelling associated with phlebitis.

The following at-home treatment measures may help manage superficial phlebitis, however, only after the advice from a treating physician:

1. Warm compression to the affected area.

2. Keep your legs in a raised position at rest.

Note:

Although many individuals might take a non-steroidal anti-inflammatory drug like Ibuprofen for their pain, using it with an anticoagulant is not recommended. Do consult with your doctor before starting any medicine.

What Are the Complications of Phlebitis?

The following are the complications of phlebitis:

• Infection that might lead to abscess formation.

• Deep vein thrombosis.

• Pulmonary embolism.

• Post-phlebitic syndrome, which presents with swelling, pain, discoloration of the leg, and ulcer formation.

How Can We Prevent Phlebitis?

The following preventive measures can be helpful:

• Smoking cessation.

• Mobilizing the legs as soon as possible after surgery.

• Doing leg exercises when traveling for long distances.

• Intravenous catheters should be removed adequately, and proper hygiene should be maintained.

• In patients with a history of phlebitis, using compression stockings can help prevent further episodes.

Conclusion:

Phlebitis or inflamed veins is a condition that can bring about serious complications when treatment is not sought. However, prompt treatment can help in reducing the symptoms and preventing the complications like deep vein thrombosis and pulmonary embolism. Taking adequate measures can help prevent the occurrence or halt the progression of the disease. Do reach out to health care providers at the earliest when symptoms arise.