Phlebitis and Thrombophlebitis (cont.)
How is phlebitis diagnosed?
The diagnosis of superficial phlebitis can be made based
on the physical examination by a physician. Warmth, tenderness, redness, and
swelling along the course of the vein is highly suggestive of superficial
phlebitis or thrombophlebitis. An ultrasound of the area can help in making the diagnosis of
phlebitis or excluding it.
D-dimer is a useful
blood test that can suggest phlebitis. This is a chemical that is released by
blood clots when they start to degrade. A normal D-dimer makes the diagnosis of
thrombophlebitis unlikely. The limitation of this test is its lack of
specificity, meaning that an elevated D-dime level can be seen in other
conditions including recent surgery, fall,
pregnancy, or an underlying
cancer.
Conditions that mimic phlebitis include cellulitis
(superficial skin
infection), insect bites, or lymphangitis (swelling and inflammation of lymph
nodes) and can be distinguished by obtaining a careful medical history and
physical examination by a physician. Sometimes, a biopsy of the skin may be
required to establish the definite diagnosis.
How is phlebitis treated?
Treatment of phlebitis may depend on the location, extent, symptoms, and
underlying medical conditions.
In general, superficial phlebitis of the upper and lower
extremities can be treated by applying warm compresses, elevation of the
involved extremity, encouraging ambulation (walking), and oral anti-inflammatory
medications [ibuprofen
(Motrin, Advil), diclofenac
(Voltaren, Cataflam, Voltaren-XR), etc.]. Topical
anti-inflammatory medications may also be beneficial, such as diclofenac gel.
External compression with fitted
stockings is also a recommended for patients with superficial phlebitis of the
lower extremities.
If an intravenous catheter is the cause, then it should be removed. If the
phlebitis is infected, then antibiotics are used. In severe cases of infected
thrombophlebitis, surgical exploration may be necessary.
Superficial thrombophlebitis (blood clots) is evaluated
by an ultrasound to exclude deep venous thrombophlebitis, especially those
involving the saphenous vein. If deep venous thrombophlebitis is suspected or
diagnosed, or if its risk of developing is considerable, then anti-coagulation
(thinning of blood) may be necessary. This is typically done by injection of low
molecular weight heparin [enoxaparin
(Lovenox)] followed by oral
anti-coagulation with warfarin
(Coumadin) for about 3 to 6 months.
Recovery of symptoms from superficial phlebitis can last a few weeks. A
thrombophlebitis may take weeks to months to recover.
Next: What are the complications of phlebitis? »
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