Dictionary:

phlebitis

  (flĭ-bī'tĭs)

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Inflammation of a vein.

An inflammation of a vein. Individuals with phlebitis typically experience tenderness, redness, and hardness along the course of the vein. The cause of the inflammation may be related to injury of the vein or infection. The presence of varicose veins and the long-term use of indwelling intravenous catheters or irritating intravenous solutions place individuals at risk of developing phlebitis. In addition, those with certain diseases, including systemic lupus erythematosus, vasculitis, or malignancy, are at increased risk. Two varieties of phlebitis are recognized: phlebothrombosis and thrombophlebitis.

Phlebothrombosis is a condition in which a blood clot develops within an inflamed vein. As the clot enlarges, it may detach and travel to the lung, becoming a pulmonary embolism. Thrombophlebitis begins with an inflammatory reaction in the vein wall. When the lining of the vein is damaged, three reactions influence the development of thrombosis. Initially, damage to the lining results in adherence of white blood cells, coagulation, and a loss of the lining's nonthrombogenic characteristics. Subsequently, the deep lining of the vein is exposed, bringing it into contact with blood and allowing platelets to adhere and aggregate. Finally, the exposed lining and activated platelets result in changes in coagulation, causing more platelets to interact with deep-lining structures. These factors are influenced by the velocity of blood flow in the affected area. See also Embolism.

Symptomatic thrombophlebitis usually results in a clot which is firmly adherent to the vein wall with a decreased risk of embolizing. Some individuals may develop symptoms suggestive of deep venous thrombosis such as pain and swelling, and should undergo noninvasive ultrasound examination of the deep veins of the leg. In the absence of deep venous thrombosis, the goal of treatment of superficial phlebitis is symptomatic relief. Analgesics, warm compresses and elevation of the affected limb may be beneficial. Late effects of phlebitis include damage to the vein wall and destruction of the venous valves or obliteration of the vein. When the deep veins of the lower extremity are involved, many individuals develop chronic venous insufficiency and its associated morbidity. See also Circulation; Inflammation.

Inflammation of a vein. See also thrombophlebitis.

Definition

Thrombophlebitis is the inflammation of a vein, with blood clots forming inside the vein at the site of inflammation. Thrombophlebitis is also known as phlebitis, phlebothrombosis, and venous thrombosis.

Description

There are two aspects of thrombophlebitis, inflammation of a vein and blood clot formation. If the inflammation component is minor, the disease is usually called venous thrombosis or phlebothrombosis. Thrombophlebitis can occur in both deep veins and superficial veins, but most often occurs in the superficial veins of the extremities (legs and arms). Most cases occur in the legs. When thrombophlebitis occurs in a superficial vein, one that is near the surface of the skin and is visible to the eye, the disease is called superficial thrombophlebitis. Any form of injury to a blood vessel can result in thrombophlebitis. In the case of superficial thrombophlebitis, the blood clot usually attaches firmly to the wall of the affected blood vein. Since superficial veins do not have muscles that massage the veins and help the blood to circulate, blood clots in superficial veins tend to remain where they form and seldom break loose. When thrombophlebitis occurs in a deep vein, a vein that runs deep within muscle tissue, it is called deep venous thrombosis. Deep venous thrombosis presents the threat of producing blood clots that will break loose to form emboli. Emboli are clumps of cells that are carried by the circulation to other tissues where they can lodge and block the blood supply. Emboli typically come to rest in the lungs and cause tissue damage that can sometimes be serious or fatal.

Causes & Symptoms

The main symptoms of phlebitis are tenderness and pain in the area of the affected vein. Redness and/or swelling may also be seen. In the case of deep venous thrombosis, there is more swelling than is caused by superficial thrombophlebitis, and the patient may experience muscle stiffness in the affected area. There are many causes of thrombophlebitis. The main causes can be grouped into three categories: injury to veins, increased blood clotting, and blood stasis. When blood veins are damaged, collagen in the vein wall is exposed. Platelets respond to collagen by initiating the clotting process. Damage to a vein can occur as a consequence of in-dwelling catheters, trauma, infection, Buerger's disease, or the injection of irritating substances. Increased tendency of the blood to clot can be caused by malignant tumors, genetic disorders, high-fat diets, and oral contraceptives. Stasis, in which the blood clots due to decreased blood flow in an area, can happen following surgery, as a consequence of varicose veins, as a complication of postpartum states, and following prolonged bed rest. In the case of prolonged bed rest, blood clots form because of inactivity, allowing blood to move sluggishly and stagnate (collect) in the veins. Stasis can lead to blood clots. These clots (also called emboli) are sometimes released when the patient stands up and resumes activity. Emboli can present a problem if they lodge in vital organs. In the case of postpartum patients, a fever developing four to 10 days after delivery may indicate thrombophlebitis. It is also known that thrombophlebitis in some patients involves hereditary factors, including mutations of genes that control the amount of clotting factors in the blood.

Questions have been raised in recent years as to whether frequent long-distance air travel increases the risk of thrombophlebitis in airline pilots and passengers. As of 2001, studies of the effects of long-distance flights on blood circulation in human test subjects have yielded conflicting results.

Diagnosis

In superficial thrombophlebitis, the location of the clot can sometimes be seen by the unaided eye. Blood clots are hard and can usually be detected by a physician using palpation (massage). Deep venous thrombosis requires specialized diagnostic instruments to detect the blood clot. Among the instruments a physician may use are ultrasound and x ray, coupled with dye injection (venogram).

Treatment

While patients have to rely on conventional medicine to resolve major blood clots in the veins, alternative therapies help prevent future blood clots and bring relief from pain due to superficial thrombophlebitis.

Physical Therapy

Physical therapy helps prevent blood clots in patients who are temporary bed-ridden after a major surgery or accidents. Physical therapists help patients exercise their arms and legs while they are restricted in bed, use massage to stimulate muscles, and encourage them to regain their mobility as soon as possible.

Nutritional Therapy

The following dietary changes may help prevent phlebitis and further vein damage:

• Limit fat intake. Saturated and hydrogenated fats are associated with increased risk of thrombosis and poor blood circulation.
• Eat a heart-healthy, high-fiber diet with emphasis on fruits, vegetables, grains, beans, nuts and seeds, and fish.
• Eat lots of garlic, ginger, onions, and hot pepper. These spices have blood-thinning activity and prevent clot formation.
• Increase consumption of cherries, blueberries, and blackberries. They contain chemicals called proanthocyanidins and anthocyanidins that help improve vein function and keep veins healthy.
• Take nutritional supplements. Supplements that help prevent blood clots and keep veins healthy include B-complex vitamins, especially folic acid (2,500 mg/day), vitamin B₆ (25 mg/day) and vitamin B₁₂ (2 mcg/day); vitamin C (500 - 3,000 mg/day) and vitamin E (800 - 1,200 IU).

Herbal Therapy

Several herbs help keep veins healthy and strong and/or prevent blood clots. They include:

• Butcher's broom (Ruscus aculeatus)
• Gingko biloba
• Gotu Kola (Centella asiatica)
• Horse chestnut (Aesculus hippocastanum)
• Bromelain (a natural enzyme found in pineapple that inhibits clot formation therefore preventing thrombophlebitis).

Allopathic Treatment

Superficial thrombophlebitis usually resolves without treatment. Application of heat or anti-inflammatory drugs (aspirin or ibuprofen) can help relieve the pain. It can take from several days to several weeks for the clot to resolve and the symptoms to completely disappear. Rarely, anticoagulant drugs may be administered.

Deep venous thrombosis is a serious condition. To prevent pulmonary embolism, anticoagulant drugs are given and the patient's limbs are elevated. The primary objective in treating deep venous thrombosis (DVT) is prevention of a pulmonary embolism. The patient usually is hospitalized during initial treatment. The prescribed anticoagulant drugs limit the ability of blood clots to grow and new clots to form. Sometimes, a drug that dissolves blood clots is administered. Recent advances in drug treatment of DVT include the use of low molecular weight heparin (LMWH), which is safer for use in pregnant women and also allows more patients with DVT to be treated on an outpatient basis.

Surgery may be used to treat DVT if the affected vein is likely to present a long term threat of producing blood clots that will release emboli. The affected veins are either removed or tied off to prevent the release of the blood clots. Tying off superficial blood veins is an outpatient procedure that can be performed with local anesthesia. The patient is capable of immediately resuming normal activities.

Expected Results

Superficial thrombophlebitis seldom progresses to a serious medical complication, although non-lethal embolisms may be produced. Deep venous thrombosis may lead to embolism, especially pulmonary embolism. This is a serious consequence of deep venous thrombosis, and is sometimes fatal.

Prevention

To prevent phlebitis, people should eat a high-fiber, heart-healthy diet and engage in regular physical exercises such as walking, bicycling, or running. If temporarily bedridden, they should stretch their arms and legs frequently and try to become mobile as soon as possible.

Resources

Books

Alexander, R.W., R. C. Schlant, and V. Fuster, eds. The Heart, 9th edition. New York: McGraw-Hill, 1998.

Berkow, Robert, ed. Merck Manual of Medical Information. Whitehouse Station, NJ: Merck Research Laboratories, 1997.

Larsen, D.E., ed. Mayo Clinic Family Health Book New York: William Morrow and Company, Inc., 1996.

Murray, Michael T., and Joseph Pizzorno. "Varicose Veins." In Encyclopedia of Natural Medicine, revised 2nd ed. Rocklin, CA: Prima Publishing, 1998.

"Phlebitis." In Prevention's Healing with Vitamins: The Most Effective Vitamin and Mineral Treatment for Everyday Health Problems and Serious Disease-From Allergies and Arthritis to Water Retention and Wrinkles. Emmaus, PA: Rodale Press, Inc., 1996.

"Phlebitis/Venous Thrombosis." In Reader's Digest Guide to Medical Cures & Treatments: A Complete A-to-Z Source-book of Medical Treatments, Alternative Options, and Home Remedies. Canada: Reader's Digest Association, Inc., 1996.

Periodicals

Egermayer, Paul. "The 'economy class syndrome': Problems with the assessment of risk factors for venous thromboembolism." Chest 120 (October 2001): 1047-1048.

Evans, A. D. B., and R. V. Johnston. "Venous Thromboembolic Disease in Pilots." Lancet 358 (November 17, 2001): 1734.

Ulutin, T. A., J. Altinisik, H. O. Ates, et al. "Screening of Factor V Leiden (G1691A), Prothrombin G20210A and Protein C Mutations in Thrombosis Patients." American Journal of Human Genetics 69 (October 2001): 430.

Zoler, Mitchel L., and Winnie Anne Imperio. "Drug Update: Outpatient Treatment of Deep Vein Thrombosis." Internal Medicine News 34 (December 1, 2001): 24.

[Article by: Mai Tran; Rebecca J. Frey, PhD]

For more information on phlebitis, visit Britannica.com.

Inflammation of a vein.
Phlebitis is not serious when the inflammation is located in a superficial vein since these veins are numerous enough to permit the flow of blood to be rechanneled, so that the inflamed vein is bypassed. When a deep vein is involved, however, phlebitis is potentially more dangerous. It can also have serious consequences if it leads to cerebral abscesses.
The common causes in animals are omphalophlebitis and injection phlebitis caused by the inadvertent injection of irritant substances or the prolonged use of intravenous catheters. The vein is swollen and painful and the blood flow obstructed.

Phlebitis
Classification & external resources

The popliteal vein.
ICD-10	I80.
ICD-9	451
DiseasesDB	13043
eMedicine	emerg/581  emerg/582 med/3201
MeSH	D010689

Phlebitis is an inflammation of a vein, usually in the legs.

When phlebitis is associated with the formation of blood clots (thrombosis), usually in the deep veins of the legs, the condition is called thrombophlebitis.

Etiology

• Bacterial: Pathogenic organisms can gain access and stimulate inflammation.
• Chemical: caused by irritating or vesicant solutions.
• Mechanical: physical trauma from the skin puncture and movement of the cannula into the vein during insertion; any subsequent manipulation and movement of the cannula; clotting; or excessively large cannula.
• Medications including Celebrex, antidepressants, and others.
• Lupus
• Genetic as it is known to run in families.

Signs and Symptoms

• Redness (erythema) and warmth with a temperature elevation of a degree or more above the baseline
• Pain or burning along the length of the vein
• Swelling (edema)

• Vein being hard, and cordlike
• If occurring due to an intravenous infusion line, then slowed infusion rate

Notable cases

• Former United States President Richard Nixon and former Vice President Dan Quayle suffered from phlebitis.
• Truman Capote, famed author of In Cold Blood and many other works, suffered from phlebitis. Pablo Neruda, the famous poet, also suffered from it.
• During the shooting of Sense and Sensibility (1995), actress Kate Winslet, who played the role of Marianne Dashwood, suffered from phlebitis.
• Mario Lanza suffered from phlebitis, and his cause of death in 1959 was from a blood clot going from his leg to his heart.
• In the 2005 WWE Hall of Fame Induction Ceremony, Ric Flair was telling stories of his days traveling with Roddy Piper in which the two of them had a drinking contest with fellow wrestler Brian Knobbs which ended up with him missing the flight due to checking into the hospital with phlebitis.

Cultural references

• The condition was detailed in The Dharma Bums and other writings by Beat author Jack Kerouac, who suffered from the disease probably brought on by years of benzedrine and alcohol abuse.
• In Henry Morton Robinson's best selling 1949 novel "The Cardinal", (later made into a motion picture by Otto Preminger), a severe case of phlebitis is a prominent plot device as sustained by the main protagonist Stephen Fermoyle.
• In the Seinfeld episode The Shower Head Jerry's Mother tells Jerry that Morty's "Phlebitis is acting up."
• In The Simpsons episode Bart Gets an F, the school nurse believes Bart has phlebitis.
• In All in the Family episode Too Good Edith, Edith has phlebitis.
• Peter Boyle's character on Everybody Loves Raymond suffers from phlebitis. Or at least it is used as an excuse for getting out of undesirable family functions.
• In King Of The Hill, when Mr. Strickland took bible study class in the pool with Luanne, Hank noted that it was "good for his phlebitis".
• In the M*A*S*H episode "The Young and the Restless", Colonel Potter suffers through a bout of phlebitis, aggravated by his initial refusal to acknowledge his condition.
• In Futurama, Richard Nixon reminisces about his "republican body" which was "riddled with phlebitis."

See also

• Collapsed vein

References

Intravenous Infusion Therapy for Nurses (Second Edition) by Dianne L. Josephson (ISBN 1-4018-0935-9)

External links

• Phlebitis at MotherNature.com
• eMedicine Health: Phlebitis provides an overview of phlebitis and its causes, symptoms, and treatment.

Circulatory system pathology (I, 390-459)
Hypertension	Hypertensive heart disease - Hypertensive nephropathy - Secondary hypertension (Renovascular hypertension)
Ischaemic heart disease	Angina pectoris (Prinzmetal's angina) - Myocardial infarction - Dressler's syndrome
Pulmonary circulation	Pulmonary embolism - Cor pulmonale
Pericardium	Pericarditis - Pericardial effusion - Cardiac tamponade
Endocardium/heart valves	Endocarditis - mitral valves (regurgitation, prolapse, stenosis) - aortic valves (stenosis, insufficiency) - pulmonary valves (stenosis, insufficiency) - tricuspid valves (stenosis, insufficiency)
Myocardium	Myocarditis - Cardiomyopathy (Dilated cardiomyopathy, Hypertrophic cardiomyopathy, Loeffler endocarditis, Restrictive cardiomyopathy) - Arrhythmogenic right ventricular dysplasia
Electrical conduction system of the heart	Heart block: AV block (First degree, Second degree, Third degree) - Bundle branch block (Left, Right) - Bifascicular block - Trifascicular block Pre-excitation syndrome (Wolff-Parkinson-White, Lown-Ganong-Levine) - Long QT syndrome - Adams-Stokes syndrome - Cardiac arrest Arrhythmia: Paroxysmal tachycardia (Supraventricular, AV nodal reentrant, Ventricular) - Atrial flutter - Atrial fibrillation - Ventricular fibrillation - Premature contraction (Atrial, Ventricular) - Sick sinus syndrome
Other heart conditions	Heart failure - Cardiovascular disease - Cardiomegaly - Ventricular hypertrophy (Left, Right)
Cerebrovascular diseases	Intracranial hemorrhage/cerebral hemorrhage: Extra-axial hemorrhage (Epidural hemorrhage, Subdural hemorrhage, Subarachnoid hemorrhage) - Intra-axial hematoma (Intraventricular hemorrhages, Intraparenchymal hemorrhage) - Anterior spinal artery syndrome - Binswanger's disease - Moyamoya disease
Arteries, arterioles and capillaries	Atherosclerosis (Renal artery stenosis) - Aortic dissection/Aortic aneurysm (Abdominal aortic aneurysm) - Aneurysm - Raynaud's phenomenon/Raynaud's disease - Buerger's disease - Arteritis (Aortitis) - Intermittent claudication - Arteriovenous fistula - Hereditary hemorrhagic telangiectasia - Spider angioma
Veins, lymphatic vessels and lymph nodes	Thrombosis/Phlebitis/Thrombophlebitis (Deep vein thrombosis, May-Thurner syndrome, Portal vein thrombosis, Venous thrombosis, Budd-Chiari syndrome, Renal vein thrombosis, Paget-Schroetter disease) - Varicose veins (Hemorrhoid, Esophageal varices, Varicocele, Gastric varices, Caput medusae) - Superior vena cava syndrome - Lymph(Lymphadenitis, Lymphedema, Lymphangitis)
See also congenital (Q20-Q28, 745-747)

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