How is phlebitis managed and 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]), or by injection of fondaparinux (Arixtra). It can be done by treatment with therapeutic dosages of unfractionated heparin (usually in the form of an intravenous drip), followed by oral anti-coagulation with warfarin (Coumadin) for about 3 to 6 months. Newer anticoagulants may replace Coumadin in certain circumstances.
Patients with extensive deep vein thrombosis (DVT) may be appropriately treated with catheter-directed thrombolysis in selected cases, but will still require maintenance anticoagulation for 3 to 6 months.
Selected patients with DVT may require placement of inferior vena cava filters to help prevent pulmonary embolus. In a subset of patients, it may be appropriate to remove the filter at a future date.
Recovery of symptoms from superficial phlebitis can last a few weeks. A thrombophlebitis may take weeks to months to recover.