Generality
Phlebitis is the medical term that indicates the presence of an inflammation in a vein.
Supported in most cases by the presence of a thrombus, phlebitis recognizes various causes; among these, special mention should be made of: damage to venous walls (which may, for example, arise from trauma or infection), prolonged immobility, the phenomenon of varicose veins and congenital disorders of blood coagulation.
Phlebitis mainly affects the veins of the lower limbs and can be superficial (if it strikes a vein near the skin surface) or deep (if it affects a vein located in the most intimate layers of the skin); between the superficial phlebitis and the deep phlebitis, the surely more dangerous one is the second one.
Phlebitis can be symptomatic or asymptomatic; when it is symptomatic, phlebitis produces, where it takes place, the classic manifestations of inflammatory episodes, namely: pain, redness, swelling, heat and a feeling of soreness.
The diagnosis of phlebitis is mostly clinical, that is based on the patient's telling of symptoms, physical examination and history.
The treatment of phlebitis is variable and depends on factors such as: the location of the involved vein (if it is superficial or deep), the anatomical area of interest, the symptomatology and the basic medical condition.
What is phlebitis?
Phlebitis is the term by which doctors indicate inflammation of a vein.
More precisely, with the word "phlebitis" the experts intend the result of an inflammatory process that involves the intimate habit of a venous vessel.
Short review of what a Vein is
In human anatomy, the list of veins includes any blood vessel responsible for transporting blood from the periphery (where the body's tissues and organs are meant for the periphery) to the heart .
Contrary to what many people think, in the veins NOT only non-oxygenated blood flows (ie oxygen-free); to confirm what has just been said are the so-called pulmonary veins, ie the venous vessels intended to carry oxygen-rich blood from the lungs to the heart, so that the latter can then spread it to the periphery.
The veins differ from the arteries from the structural point of view: compared to the second, the former are less extensible and less thick.
Causes
Phlebitis recognizes various causes / favoring factors, including:
- Damage to venous walls, which can result from trauma, infection, use of intravenous catheters or needles;
- The phenomenon of varicose veins ;
- Changes in blood coagulation related to some congenital condition;
- Intravenous injection of certain drugs (eg antitumorals) or irritants ;
- Pregnancy
- A sedentary lifestyle ;
- The prolonged immobility to which people who travel a lot by car or plane are forced, or those who, due to a serious medical condition, are obliged to stay in bed;
- Burns ;
- The presence of a tumor ;
- The lack of adequate lymphatic drainage in people who, due to a tumor, had to undergo surgery to remove a group of lymph nodes.
What Favors Phlebitis: Risk Factors Who is at Higher Risk of Phlebitis?
The subjects most at risk of phlebitis are:
- The obese;
- Sedentary people, those who travel for many hours in cars or airplanes and individuals forced to immobility in a bed, because of some illness;
- Smokers
- Pregnant women;
- Who underwent a medical procedure, which included the use of the venous catheter and some venous injection;
- Women who take the contraceptive pill (because it promotes thrombus formation);
- Victims of strong limb traumas;
- People born with some alteration in blood coagulation;
- People with varicose veins.
Pathophysiology: what triggers phlebitis?
In phlebitis, we see irritation and sometimes damage to the intimate tunic of a venous vessel.
This irritation and damage are, in most cases, the result of thrombotic processes ( thrombophlebitis ) and, in a smaller number of circumstances, the result of chemical-biological events ( chemical phlebitis ), infectious ( bacterial phlebitis ) or mechanical ( mechanical phlebitis ).
- Thrombophlebitis: it is the term that describes all those cases of phlebitis, sustained by the presence of a thrombus inside a vein, which closes the lumen and irritates the intimate habit.
Thrombophlebitis is a condition that, when located in the deepest veins (deep vein thrombosis or deep thrombophlebitis), can represent an important danger for human beings.
- Mechanical phlebitis: it is the medical expression that refers to the episodes of phlebitis resulting from friction produced by a vascular access towards the venous endothelium.
- Chemical phlebitis: it is the phlebitis resulting from the use of drugs or solutions which, once injected into a vein, have had an irritating effect against the venous intimate habit.
- Bacterial phlebitis: it is the expression that indicates all those cases of phlebitis resulting from the action of bacterial toxins conveyed, for example, by instruments for injections or infusions.
Types
Doctors recognize two types of phlebitis: superficial phlebitis and deep phlebitis .
Surface phlebitis
Superficial phlebitis is phlebitis that has as its object a vein or a group of veins located near the skin surface.
Superficial phlebitis is not a particularly serious condition (it resolves very often with a simple treatment), however it produces very annoying symptoms.
In most cases, the onset of superficial phlebitis is related to a small blood clot or irritation caused by the use of the venous catheter.
Deep phlebitis
Deep phlebitis is phlebitis affecting a vein or a group of veins located in the deeper layers of the skin.
Deep phlebitis is generally due to the presence of a thrombus, which is why experts tend to identify it with the aforementioned deep thrombophlebitis (or deep vein thrombosis ).
Deep phlebitis is a very feared condition, because it can have serious and sometimes lethal consequences.
For further information: Deep Venous Thrombosis: What it is, Causes, Symptoms, Complications and Therapy »Symptoms and Complications
Depending on the circumstances, phlebitis can be symptomatic (ie characterized by symptoms) or asymptomatic (ie without symptoms).
When it is symptomatic, phlebitis produces, where it takes place, the classic manifestations of inflammatory episodes (after all it is an inflammation), that is:
- Ache;
- Redness;
- Swelling (or edema);
- Heat;
- Sense of soreness.
The symptomatic nature of phlebitis (ie the presence of symptoms in a context of phlebitis) does not depend on the severity of the current condition; indeed, in a good number of cases (around 50%), deep phlebitis sustained by the presence of a thrombus (which are the most dangerous phlebitis) are asymptomatic.
When it hits a vein in the lower limbs, phlebitis can make walking difficult, due to the pain it causes.
Most common locations of Phlebitis
Any vein of the human body can undergo phlebitis; however, it is a fact that the veins of the limbs, in particular the veins of the lower limbs (therefore of the thigh and leg ), suffer the most from this inflammatory condition.
Did you know that ...
A vein of the lower limbs particularly subject to phlebitis (in particular to thrombophlebitis) is the saphenous vein .
For further information: Vena Safena: What it is, Anatomy, Function, Clinical Use and Pathologies »Complications
Phlebitis is a condition from which complications can arise, when it depends on the presence of a thrombus (therefore when it is a thrombophlebitis).
SURFACE TROMBOFLEBITE
Although rarely understood, superficial thrombophlebitis can give rise to complications such as:
- Infections of the cutaneous area surrounding the vein subject to inflammation;
- Abscesses during inflammation;
- Blood infections ( sepsis ).
It is also important to note that, if they involve a superficial vein communicating with a deep vein, superficial thrombophlebitis can turn into deep thrombophlebitis, with all the potential consequences of the case (see the next paragraph).
DEEP THROMBOFLEBITIS (OR DEEP VENOUS THROMBOSIS)
In the absence of adequate care, deep thrombophlebitis has a marked tendency to degenerate into a potentially lethal condition: pulmonary embolism ; specifically, this happens when the thrombus present at the venous level flakes, giving rise to a mobile blood clot ( embolus ), free to travel in the blood to the heart and to the pulmonary arteries.
The occurrence of a pulmonary embolism is associated with unequivocal symptoms, including:
- Shortness of breath (dyspnea);
- Chest pain, which increases in intensity during deep breathing;
- Cough with blood emission (hemoptysis);
- Increased respiratory rate;
- Syncope or pre-syncope;
- Increased heart rate.
Short review of what pulmonary embolism is
The expression "pulmonary embolism" indicates the medical condition characterized by the obstruction of one of the pulmonary arteries, which are the blood vessels responsible for transporting deoxygenated blood from the right ventricle of the heart to the lungs, in order to oxygenate it.
From this it follows that the pulmonary embolism compromises the process of oxygenation of the blood at the lung level and, consequently, the availability of oxygenated blood fundamental for the well-being of the organism.
Pulmonary embolism is a medical emergency, so it requires immediate care.
Diagnosis
The diagnosis of phlebitis is mainly clinical, that is based on investigations such as the patient's account of symptoms, the medical evaluation of the signs and symptoms present (physical examination ), and the medical history (or clinical history ).
When to use Instrumental Exams?
In case of doubt or if there is a suspicion of thrombophlebitis, the doctor may follow the so-called clinical diagnosis with an instrumental examination such as the ecodoppler (an ultrasound examination that evaluates the blood flow inside the vessels) and, if this last was not enough, imaging test with even greater diagnostic power, such as venography, CT and / or MRI (clearly of the body part affected by the inflammatory condition).
Therapy
The treatment of phlebitis varies in relation to several factors, including: localization (superficial or deep), anatomical position (upper limbs, lower limbs etc.), symptomatology and basic medical condition (in other words, the cause).
Surface phlebitis: the cure
For those suffering from superficial phlebitis, the therapy usually consists of:
- Elevation of the affected limb (remember that phlebitis mainly affects the limbs, in particular the lower ones).
What is it for? Reduces blood stasis in the affected vein, favoring blood circulation.
- Repeated application of wet and hot compresses on the area involved;
What is it for? Reduces edema and inflammation.
- Compression of the affected area (this countermeasure is particularly useful in the presence of a phlebitis in the lower limbs).
What is it for? Promotes blood circulation, reducing swelling and, in the presence of superficial thrombophlebitis, the risk of deep vein thrombosis (which is a possible complication).
- Oral or topical intake of a NSAID, ie a non-steroidal anti-inflammatory (eg: ibuprofen).
What is it for? Reduces inflammation and relieves pain.
- Practicing the movement (especially if the condition concerns the lower limbs).
What is it for? It reduces pain and, in superficial phlebitis associated with the presence of a thrombus, reduces the risk of the latter moving into a deep vein.
To this, it should be added that:
- If superficial phlebitis is associated with an infection, antibiotic therapy must be implemented;
- If superficial phlebitis is due to an intravenous catheter, its removal is essential.
Brief in-depth analysis: how to implement compression?
In the presence of a phlebitis in the lower limbs, the compression of the latter occurs through the use of special stockings, called graduated compression stockings .
Deep Phlebitis: the Cure
Being usually due to the presence of a thrombus, deep phlebitis generally requires a treatment aimed at eliminating the abnormal blood clot, in order to restore normal blood circulation and avoid complications such as pulmonary embolism.
The implementation of a treatment with such purposes may include medical and / or surgical therapies.
MEDICAL TREATMENT OF DEEP FLEBIT
The medical treatment of episodes of deep phlebitis is based on the oral intake of drugs, such as:
- Anticoagulants (eg: warfarin or heparin). These medicines have the power to thin the blood, making the formation of abnormal blood clots less likely;
- Thrombolytics (eg: streptokinase, anesthesiology, tenecteplases, etc.). Also known as thrombolytic agents or fibrinolytic agents, these medicines have the ability to dissolve thrombi and emboli present in blood vessels;
- Analgesics and NSAIDs . These medicines are used to reduce pain and reduce inflammation.
Did you know that ...
Thrombolytic drug treatment is called thrombolysis .
To learn more: Thrombolysis: What it is, Indications, Preparation, Procedure and Results »SURGICAL TREATMENT OF DEEP FLEBITIS
In the presence of a deep phlebitis, the doctors resort to surgery, when they consider the aforementioned medical therapy insufficient or when the latter is not feasible.
Among the surgical practices useful to counteract a deep phlebitis, there are:
- Thrombectomy . It is the angioplasty operation, by which the performing doctor removes the thrombus responsible for the inflammatory condition.
The use of thrombectomy is particularly useful when the only therapy based on anticoagulants and thrombolytics is not very effective (it happens, for example, when the present thrombus is very large);
- The caval filter . It is the procedure of inserting a small filter into the abdominal vena cava, in order to retain the emboli that could originate from the thrombus responsible for the condition and reach the heart (then giving pulmonary embolism).
The use of the caval filter is indicated when anticoagulants and thrombolytics cannot be administered.
Important!
The caval filter does not prevent the formation of thrombus, but prevents the parts resulting from the cleavage of a thrombus to reach the heart and lungs.
Prognosis
The localization of the inflamed vein (ie the fact that the phlebitis is superficial or deep) influences every discourse related to the prognosis of a phlebitis:
- Superficial phlebitis is usually a condition of benign evolution, from which the patient can heal without any consequence;
- Deep phlebitis, on the other hand, is a medical emergency, which, if not properly treated, can lead to complications with a fatal outcome.
Healing Times
The time taken to recover from a phlebitis varies from a few weeks, if the condition affects a superficial vein, at several months, in the event that the inflammation concerns a deep vein.
It is essential to follow the doctor's instructions regarding the therapy to the letter.
Recurrences: what are they favored from?
In the absence of a control of risk factors, phlebitis appears to be a leading condition for relapses; in particular, we note the tendency to relapse that characterizes phlebitis associated with varicose veins.
Prevention
Phlebitis prevention focuses on the control of modifiable risk factors; in practical terms, this means that, to reduce the risk of phlebitis, it is essential:
- Avoid prolonged immobility, after a surgery that includes a period of rest;
- Practice mobility exercises for the lower limbs during long journeys by car or plane (NB: it takes just a few minutes of light activity at regular intervals);
- Not smoking;
- Avoid standing for long periods of time (if some situations in life require you to stand for a long time, it would be advisable to carve out a few minutes of rest, during which to raise the lower limbs);
- Maintain body weight;
- Wear graduated compression stockings, if there is a predisposition to thrombotic phenomena and you have to face periods of prolonged immobility (eg: a long journey by plane).
It is important to emphasize that the countermeasures described above are limited to reducing (therefore not completely canceling) the risk of phlebitis.
