Superficial thrombophlebitis

Definition

Superficial thrombophlebitis is inflammation of a vein due to a blood clot in a vein located just below the skin's surface.

Alternative Names

Thrombophlebitis - superficial

Causes, incidence, and risk factors

Superficial thrombophlebitis may occur after injury to the vein or the recent use of an intravenous (IV) line. It may also develop for no apparent reason in persons at risk for the condition.

Risks for superficial thrombophlebitis include:

• Chemical irritation of the area
• Disorders that involve increased blood clotting
• Infection
• Pregnancy
• Sitting or staying still for a prolonged period
• Use of birth control pills
• Varicose veins

Superficial thrombophlebitis may be associated with:

• Abdominal cancers (such as pancreatic cancer)
• Deep vein thrombosis
• Factor V Leiden
• Prothrombin gene mutation
• Thromboangiitis obliterans

Other rare disorders associated this condition include Antithrombin III (AT-III), Protein C and Protein S deficiencies.

Symptoms

• Skin redness or inflammation along a vein that's just below the skin
• Warmth of tissue
• Tenderness or pain along a vein that's just below the skin -- pain is worse when pressure is applied
• Limb pain
• Hardening of a the vein (induration)

Signs and tests

Your health care provider will diagnose superficial thrombophlebitis based mainly on the appearance of the affected area. Frequent checks of the pulse, blood pressure, temperature, skin condition, and blood flow may be needed.

The following tests can help confirm the condition:

• Doppler ultrasound
• Duplex ultrasound
• Venography

If there are signs of an infection, skin or blood cultures may be performed.

Treatment

The goals of treatment are to reduce pain and inflammation and prevent complications.

To reduce discomfort and swelling, support stockings and elevation of the affected extremity are recommended.

A catheter or IV line should be removed if it is shown to have caused the thrombophlebitis.

Medications to treat superficial thrombophlebitis may include:

• Blood thinners given through a vein (IV) followed by those taken by mouth to help reduce the chances of blood clots
• Nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation
• Painkillers

If deeper clots (deep vein thrombosis) are also present, your provider may prescribe medicines to dissolve an existing clot. Antibiotics are prescribed if you have an infection

Surgical removal (phlebectomy), stripping, or sclerotherapy of the affected vein are occasionally needed to treat large varicose veins or to prevent further episodes of thrombophlebitis in high-risk patients.

Expectations (prognosis)

Superficial thrombophlebitis is usually a short-term condition that does not lead to complication. Symptoms generally go away in 1 to 2 weeks, but hardness of the vein may remain for much longer.

Complications

Complications of superficial thrombophlebitis are rare. Possible problems may include the following:

• Infections (cellulitis)
• Gangrene (tissue death)
• Septic shock
• Deep vein thrombosis
• Pulmonary embolism (often without symptoms)

Calling your health care provider

Call for an appointment with your provider if symptoms indicate superficial thrombophlebitis may be present.

Call your provider if you have been diagnosed with superficial thrombophlebitis and your symptoms do not improve with treatment, or if your symptoms worsen. Call the provider if any new symptoms occur, such as entire limb becoming pale, cold, or swollen, or if chills and fever develop.

Prevention

If you need to have an IV, the risk of superficial thrombophlebitis may be reduced by regularly changing the location of the IV and by immediately removal of the IV line if signs of inflammation develop.

Whenever possible, avoid keeping your legs and arm still for long periods of time. Move your legs often or take a stroll during long plane trips, car trips, and other situations in which you are sitting or lying down for long periods of time. Walking and staying active as soon as possible after surgery or during a long-term medical illness can also reduce your risk of thrombophlebitis.

References

Freischlag JA, Heller JA, Venous disease. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 68.

Bauer KA. Hypercoagulable states. In: Hoffman R, Benz EJ, Shattil SS, et al, eds. Hematology: Basic Principles and Practice. 4th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2005:chap 127.

Deitcher SR. Diagnosis, treatment, and prevention of cancer-related venous thrombosis. In: Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKena WG, eds. Clinical Oncology. 3rd ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2004:chap 46.