Introduction
Phlebitis is the inflammation
of a vein, which can occur in superficial veins (Superficial Phlebitis)
or deep veins (Deep Vein Thrombophlebitis - DVT). It is often associated
with clot formation, pain, and swelling in the affected limb.
Incidence
- More common in people with varicose veins, prolonged IV therapy,
and immobility.
- Higher risk in hospitalized patients, post-surgical cases, and
smokers.
- Superficial phlebitis is common in IV catheter use, while
DVT-related phlebitis can be life-threatening.
Definition
Phlebitis is the inflammation
of a vein caused by infection, trauma, or clot formation, leading to
pain, swelling, and redness of the affected vein.
Types of
Phlebitis
1. Based on
Depth
- Superficial Phlebitis – Involves veins near
the skin surface, usually in the legs or arms.
- Deep Vein Thrombophlebitis (DVT) – Involves deeper veins,
causing serious complications like pulmonary embolism (PE).
2. Based on
Cause
- Mechanical Phlebitis – Caused by IV
catheters, prolonged cannulation.
- Chemical Phlebitis – Due to IV drugs
(chemotherapy, irritant solutions like potassium chloride, hypertonic
saline).
- Bacterial Phlebitis – Infection-related, often
linked to contaminated IV lines.
- Post-Surgical Phlebitis – After surgical
procedures, trauma, or prolonged immobilization.
Etiology
(Causes & Risk Factors)
1. Risk Factors
(Mnemonic: "THROMBUS")
- T – Trauma or IV catheter use.
- H – Hypercoagulable state (Pregnancy, Cancer, Smoking).
- R – Reduced mobility (Post-surgery, Paralysis).
- O – Obesity (Increased pressure on veins).
- M – Medications (IV irritant drugs, hormone therapy).
- B – Blood clot disorders (Factor V Leiden, Protein C/S deficiency).
- U – Underlying varicose veins.
- S – Sepsis or infection-related phlebitis.
Pathophysiology
of Phlebitis (Mnemonic: "CLOT")
- C – Clot formation or irritation of the vein wall.
- L – Leukocyte infiltration → Inflammatory response.
- O – Obstruction of blood flow → Swelling & redness.
- T – Thrombus formation → Risk of embolization in deep veins.
Clinical
Features (Mnemonic: "PAINFUL VEIN")
1. Superficial
Phlebitis
- P – Pain and tenderness along the vein.
- A – Area appears red and warm.
- I – Induration (hardened cord-like vein).
- N – No systemic symptoms (usually localized).
- F – Fever (in infectious phlebitis).
- U – Usually self-limiting, resolves in 1-2 weeks.
- L – Lump-like swelling over the vein.
2. Deep Vein
Thrombophlebitis (DVT)
- V – Very painful and swollen leg.
- E – Edema of the affected limb.
- I – Increased risk of Pulmonary Embolism (PE).
- N – No visible redness (Deep veins affected).
Complications
- Pulmonary Embolism (PE) – If a clot dislodges from
deep veins.
- Post-Phlebitic Syndrome (PPS) – Chronic pain, swelling,
skin changes.
- Septic Phlebitis – Infection-related
phlebitis leading to sepsis.
- Venous Ulcers – Due to chronic venous
insufficiency.
Laboratory
Investigations
1. Blood Tests
- D-Dimer Test – Elevated in deep vein
thrombosis (DVT).
- Complete Blood Count (CBC) – Elevated WBC count in
septic phlebitis.
- Coagulation Profile (PT, APTT, INR) – To
assess clotting disorders.
- Blood Culture – If bacterial infection is
suspected.
2. Imaging
- Doppler Ultrasound (Gold Standard for DVT) – Detects
clot & venous obstruction.
- Venography – Used in difficult cases
for visualizing vein structure.
Management of
Phlebitis
General Measures
(Mnemonic: "VEIN CARE")
- V – Varicose vein management (if present).
- E – Elevation of the affected limb to reduce swelling.
- I – Ice packs (for early inflammation) or warm compress (for
resolution phase).
- N – No prolonged standing or sitting (improves circulation).
- C – Compression therapy (Stockings) to prevent complications.
- A – Antiseptic wound care (if infection suspected).
- R – Rest & hydration to promote healing.
- E – Encourage early ambulation to prevent DVT progression.
Allopathic
Treatment (Mnemonic: "CLOT RELIEF")
- C – Compression stockings for venous support.
- L – Low molecular weight heparin (LMWH) for DVT.
- O – Oral anticoagulants (Warfarin, Rivaroxaban, Apixaban).
- T – Thrombolytics (Alteplase, Streptokinase) in severe cases.
- R – Rest & limb elevation.
- E – External warm compress to relieve symptoms.
- L – Local NSAIDs (Ibuprofen, Diclofenac) for pain relief.
- I – IV antibiotics (for septic phlebitis).
- E – Early ambulation to prevent clot progression.
- F – Fluid intake to reduce blood viscosity.
Surgical
Treatment
- Vein stripping or ligation for chronic, recurrent
cases.
- Thrombectomy (surgical removal of clot
in severe DVT cases).
Homeopathic
Treatment
- Hamamelis Virginiana
- Best remedy for venous inflammation & phlebitis.
- Aching, bruised sensation in the affected veins.
- Varicose veins with dark bluish discoloration.
- Bleeding tendency from affected veins.
- Useful for both superficial phlebitis &
venous congestion.
- Vipera Berus
- Extreme swelling of the affected limb.
- Sensation as if the veins are going to burst.
- Pain relieved by keeping limbs elevated.
- Used in deep vein thrombophlebitis (DVT).
- Lachesis
- Bluish discoloration & venous congestion.
- Symptoms worsen after sleep.
- Intolerance to tight clothing.
- Highly indicated in septic phlebitis.
- Arnica Montana
- Phlebitis due to trauma or injury.
- Bruised, sore sensation in the affected vein.
- Reduces clot formation post-surgery.
- Used for IV-induced phlebitis.
- Calcarea Fluorica
- Hard, knotty veins in chronic phlebitis.
- Promotes vein elasticity & prevents clot
formation.
- Indicated for recurrent thrombophlebitis.
Mnemonic for
Homeopathic Treatment (H-V-L-A-C)
- H – Hamamelis (Venous inflammation, varicose veins).
- V – Vipera Berus (Extreme swelling, bursting pain).
- L – Lachesis (Septic phlebitis, intolerance to tight clothing).
- A – Arnica (Post-trauma phlebitis).
- C – Calcarea Fluorica (Hard, knotty veins, chronic cases).
