Superficial thrombophlebitis

Definition

Thrombophlebitis involves inflammation of a vein caused by a blood clot inside. With superficial thrombophlebitis, the clot is in a vein just below the surface of the skin.

Causes

Superficial thrombophlebitis may occur after the recent use of an intravenous (IV) line, after trauma to the vein, or for no apparent reason in persons at risk for thrombophlebitis.

Risks for superficial thrombophlebitis include the following:

• Disorders that involve increased blood clotting
• Infection
• Varicose veins
• Chemical irritation of the area
• Sitting or being immobilized for a prolonged period

The risk is also increased in women who are or were recently pregnant, and by the use of oral contraceptives.

Superficial thrombophlebitis may be associated with Factor V Leiden, prothrombin gene mutation, and, occasionally, abdominal cancers (such as carcinoma of the pancreas), deep vein thrombosis, and thromboangiitis obliterans

Symptoms

• Skin redness or inflammation along a superficial vein
• Warmth of tissue around a superficial vein
• Tenderness or pain along a superficial vein (worse when pressure is applied)
• Limb pain
• Hardening of a superficial vein (induration) -- the vein feels cord-like

Exams and Tests

Your health care provider will diagnose superficial thrombophlebitis based primarily on the appearance of the extremity. Frequent checks of the pulse, blood pressure, temperature, skin condition, and circulation may be required.

The diagnosis of superficial thrombophlebitis may be confirmed with the following tests:

• Doppler ultrasound
• Duplex ultrasound
• Venography

If infection is suspected, cultures of the skin or blood cultures may be performed.

Superficial thrombophlebitis may be associated with deficient blood levels of:

• Antithrombin III (AT-III)
• Protein C (PC)
• Protein S (PS)

Treatment

The goals of treatment are reduction of pain and inflammation, and prevention of complications.

If a catheter or IV line produced the thrombophlebitis, it should be removed.

To reduce discomfort and swelling, support stockings and elevation of the affected extremity are recommended.

Medications to treat superficial thrombophlebitis may include the following:

• Analgesics for pain
• Nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation
• Intravenous anticoagulants followed by oral anticoagulants to reduce the likelihood of clotting

If deeper clots (deep vein thrombosis) are also present, your provider may prescribe thrombolytic drugs to dissolve an existing clot. Antibiotics are prescribed if infection is present.

Surgical removal (phlebectomy), stripping, or sclerotherapy of the affected vein are occasionally needed to treat large varicose veins or to prevent further episodes of thrombophlebitis in predisposed patients.

Outlook (Prognosis)

Superficial thrombophlebitis is usually a benign and short-term condition. Symptoms generally subside in 1 to 2 weeks, but hardness of the vein may remain for much longer.

Possible Complications

Complications of superficial thrombophlebitis are rare. Possible problems may include the following:

• Infections (cellulitis)
• Gangrene (tissue death)
• Septic shock
• Deep vein thrombosis
• Pulmonary embolism (often without symptoms)

When to Contact a Medical Professional

Call for an appointment with your provider if symptoms indicate superficial thrombophlebitis may be present.

Call your provider if you have been diagnosed with superficial thrombophlebitis and your symptoms do not improve with treatment, or if your symptoms worsen. Call the provider if any new symptoms occur, such as entire limb becoming pale, cold, or swollen, or if chills and fever develop.

Prevention

If an intravenous line is in use, the risk of superficial thrombophlebitis may be reduced by routine rotation of the IV site and immediate removal of the IV line if signs of inflammation develop.

Whenever possible, limb immobilization should be avoided.