Phlebitis
What is Phlebitis?
An inflammation of a vein, usually in the legs and sometimes in the arms, is called Phlebitis. The patient experiences pain and irritation due to the thrombus (clot) in the vein. Phlebitis can occur in both the surface (superficial) or deep veins. When blood clots are formed in deeper veins of the legs it is called Thrombophlebitis.
Symptoms of Phlebitis
Phlebitis basically means a venous blood clot in the legs. The venous system is divided into deep veins and superficial veins systems. One can have a clot in either of the systems. Usually a clot occurs in only one of the systems, but in rare cases clotting can occur in both of the systems at the same time. The common symptoms of Phlebitis are:
1) Swelling (edema) in the affected vein
2) Hardness of the vein with a cordlike appearance
3) Throbbing and burning along the length of the vein
4) Redness of skin around the affected vein
5) Slowed infusion rate
6) Tenderness, itchiness and swelling of skin around the vein
7) Fever
8) Breathlessness and chest pain (in Deep Vein Thrombophlebitis)
Diagnosis of Phlebitis
A blood test alone will not be sufficient for an accurate detection and diagnosis of Phlebitis, but an X-ray would show a blood clot if it exists.
D-dimer test: With this test, chemical is released into the blood which causes a blood clot to disintegrate; which shows the presence of a blood clot. An elevated D-dimer may be due to Disseminated Intravascular Coagulation (DIC). But it may also be due to a recent surgery, trauma, or infection. Elevated levels are also seen with liver disease, pregnancy, heart disease and some cancers.
This is not a very accurate way of testing for Phlebitis because the results of the test may be positive in the absence of a clot in the case of bruises or recent surgery. Also, the test does not show the exact location of the blood clot to indicate whether it has reached the lungs and may prove fatal.
Ultrasound: A small hand-held probe is pressed against the patient’s skin to detect the presence and location of a blood clot, especially in the upper leg veins. This is a painless and non-invasive test and gives more accurate results than D-dimer test.
Magnetic Resonance Phlebogram: The MR Phlebogram (a kind of X-ray procedure) is undertaken usually where Deep Vein Thrombophlebitis is suspected.
Causes of Phlebitis
Phlebitis can occur spontaneously or as a complication of some other medical treatment. The various causes are:
Heredity: The genetic framework of a person would make the person more or less susceptible to Phlebitis. Those who are at risk from varicose veins and gout are more prone to Phlebitis. If it is a recurring condition without obvious reason, the blood should be checked to eliminate the possibility of rare congenital hypercoagulability such as seen in deficiency in factor S, protein C, antithrombin III, or presence of lupus anticoagulant.
Obesity: Overweight and obese persons are at a greater risk from Phlebitis
Lifestyle: Sedentary habits and lack of activity too can be a major cause of this disease. These habits allow the blood to accumulate and clot. Situations like long-distance travel, lengthy periods of rest after an illness, etc are some causes.
Surgery: Sometimes a surgical procedure could increase the risk of forming a blood clot. After 40 years of age, surgery for cancer, hip, urological procedures, brain and gynecological surgery can be causes for Deep Vein Thrombophlebitis.
Local trauma: An injury or local trauma to the veins can increase the risk of Phlebitis or Deep Vein Thrombophlebitis.
Tobacco: Buerger’s disease is inflammation and thrombosis of the veins caused by cigarette smoking.
HRT: Phlebitis can occur as a side effect of Hormone Replacement Therapy in some cases.
Pregnancy: Increase in weight during pregnancy can be one of the causes of this disease.
Blood disorders: Vasculitis (inflammatory destruction of blood vessels) like lupus can be another cause of this disease. Also, leukemia and other blood disorders can be a cause.
Pathogens: Bacterial organisms can stimulate inflammation of the veins and result in Phlebitis.
Chemicals: Phlebitis can be caused by some irritating and vesicant solutions like chemotherapeutic agents, dopamine and noradrenaline.
Alcohol: Alcohol abuse is another major cause of Phlebitis.
Travel: Frequent long-distance travel by road or air can also be a cause of Phlebitis, especially Deep Vein Thrombophlebitis. In fact, this disease is also called ‘economy-class syndrome’ or ‘coach-class syndrome’. People who have a history of cardiovascular disease or stroke are at greater risk of getting blood clots in their legs during airplane flights of 10 to 12 hours.
Types of Phlebitis
1) Deep Vein Thrombophlebitis: This type of Phlebitis affects the larger blood vessels deep in the legs. It is found in the deep veins of the calf but can extend into the deep veins of the thigh and even beyond. Blood clots (thrombi) can form, which may break off and travel to the lungs. The noticeable signs are redness, warmth, swelling and pain throughout the entire limb. But swelling and pain are more in the ankles and calf muscles. It can also cause breakdown of the surrounding skin. The clot can travel to the lungs (pulmonary embolism) and become a life-threatening condition.
2) Superficial Vein Phlebitis: This affects superficial veins, i.e. the veins on the surface of the skin. Varicose veins are the main reason for getting this disease. Lack of physical activity sometimes causes the blood to collect into tiny pools in the veins thus forming blood clots. This condition is not life threatening and can be cured successfully and rapidly. But if neglected, it can become Deep Vein Thrombophlebitis therefore prompt medical attention is very essential.
Treatment of Phlebitis
The treatment would depend on the severity of the disease, but there are some common measures that need to be taken to treat either type of Phlebitis:
1) Keeping the afflicted arm or leg raised (but resting for too long aggravates the condition)
2) Compression stockings (knee or thigh high) improve blood flow and relieve pain
3) Oral anti-inflammatory medications like Ibuprofen are prescribed.
Superficial Phlebitis can be treated at home. Besides the common care that needs to be taken for both types of Phlebitis, some cases of Superficial Phlebitis may require treatment with oral antibiotics, especially if there are signs of bacterial infection.
Deep Vein Thrombophlebitis, being more severe, requires more medication. Treatment with injectible anticoagulant (blood thinner) like enoxaparin would be needed for a period of three to six months. This is given along with warfarin oral blood thinner to reach effective level of blood thinning. Coumadin tablets are administered for approximately 6 months. To adjust the proper dose hospitalization for a few days up to a week is advisable.
Living with Phlebitis
Phlebitis in the superficial veins is rarely serious and usually responds to pain control, elevation of the limb and warm compresses for one to two weeks. Deep Vein Thrombophlebitis is potentially life threatening, hence needs more care. The treatment of anticoagulants could extend to six months. Also, the enforced inactivity (enforced by elevation of affected limb) can increase the restlessness and emotional stress of the patient. Damage to the deep vein valves by the retracting clot can, over the months, lead to venous circulatory problems in the subsequent years. This needs to be treated with compression or can turn into skin ulceration.
People who have survived one episode of Deep Vein Thrombophlebitis may develop chronic swelling and pain in the affected leg due to blockage of blood flow through the vein. This can reduce their ability to live a full, active life. They would also be prone to more episodes of Deep Vein Thrombophlebitis.
Prevention of Phlebitis
There are various measures that could prevent Phlebitis:
1) Lifestyle changes should be made to avoid leading a very sedentary life. Lack of movement of the limbs increases the chances if there are heredity factors for Phlebitis or in the case of obesity.
2) Sufficient exercise is a must. This will improve the circulation of blood in the veins of legs/arms and prevent clotting of blood.
3) To avoid Phlebitis following surgical procedure, the doctors should use mechanical compressive devices and subcutaneous injections of pharmacological products instead of intravenous.
4) Avoid very frequent long distance travel by road or air that can aggravate the problem.
A coalition comprising leaders and representatives of 40 countries was formed as a result of the Public Health Leadership Conference on Deep-Vein Thrombosis in 2003 Their first conference was held in February 2003 in Washington, D.C. The basic need for this coalition was the prevention of Deep Vein Thrombophlebitis and to reduce mortality rates.
