Phlebitis

introduction

Phlebitis, also called superficial thrombophlebitis in medical jargon, is the inflammation of a superficial vein. This is caused, among other things, by damage to the venous valves in the area of ​​the blood vessel. In particular, long periods of sitting and immobility, as well as smoking, can lead to increased inflammation of the veins. The phlebitis may be caused by a blood clot (thrombus) accompanied. Such a clot is often observed in connection with phlebitis, but does not necessarily have to be present in every case. Phlebitis is typically spatially limited, that is, localized only in a certain section of the vein. In most cases (around 90%), superficial thrombophlebitis affects a blood vessel in the legs. Patients complain of redness and swelling in the leg veins. They are often tender on pressure and also painful when moving. Often times, resting and putting the leg up is good for the patient.

causes

The cause of an inflammation vein is in most cases in one Slowing down of blood flow through this vessel. The increased standing of the blood (at a slower flow rate) leads to more frequent small blood clots, which lie as a kind of foreign body inside the vein and subsequently become a Inflammatory response can trigger. Such a reduction in the speed of blood flow is, for example, very pronounced Varicose veins (Varices), but also in patients who bedridden are or a Heart failure have given.

Another conceivable cause for the development of a phlebitis is the opposite way: in the first step there is an inflammatory reaction of the vascular wall. This can be, for example, smaller or larger Injury to the vein (Trauma) or through chronic inflammatory diseases to be triggered. As possible Cause of injury and thus the source of ignition is in any case also to the Puncture of a vein think through medical staff. As a result of this inflammation, a thrombus then develops in the vessel in a second step. Most thrombophlebitis can be justified with one of the two explanations above.

Other rare diseases are also known to be possible causes: If a patient suffers from frequent phlebitis that changes location without varicose veins being visible, it could be one Thrombophlebitis migrans (Latin, wandering phlebitis), which can occur in the context of the so-called paraneoplastic syndrome (often with pancreatic cancer or the small-cell form of lung cancer).

More common than this special case, but still rare Thrombangitis obliteranswhich are just beginning to be typical Phlebitis makes noticeable. With this disease, which is characterized by intermittent inflammation of the vessels due to the body's own immune complexes, the patient group immediately catches the eye: almost all patients who suffer from this disease are male, between 20-40 years old and strong Smoker. The exact cause of the thrombangitis obliterans is still unclear. A combination of various genetic factors and smoking are believed to be the trigger.

Last is also the so-called Mondor's disease to be mentioned as a possible cause; it is a cord-shaped superficial thrombophlebitis which after an injury or one infection occurs and is mostly localized on the trunk.

Phlebitis on the arm and forearm

Arm / forearm As already described, an injury to the vein, for example through puncture or other trauma, is also possible. In the arm area in particular, phlebitis caused by doctors or other medical personnel is a relatively common cause, since the forearm is easily accessible for blood sampling or other purposes and the veins in this area are usually used for diagnostic steps or therapeutic measures. Indwelling vein cannulas or catheters, which may have to remain in the vein for a long time to allow infusions or medication, are also often attached to the patient's arm. Although the material for such venous indwelling cannulas is of course sterile packed and everyone will endeavor to work hygienically and carefully, the foreign material always remains foreign material and is therefore a potential source of infection for invading bacteria or other pathogens.

Unfortunately, in the area of ​​the forearm, superficial thrombophlebitis occurs again and again, which is due to a bacterial infection. Of course, it cannot be strictly ruled out that other causes trigger phlebitis in the arm as well. However, the vein irritation unintentionally caused by medical products may not be avoidable.

You can find more information on this topic at: Phlebitis in the arm.
Phlebitis on the arm is not uncommon after infusions. We therefore also recommend: Phlebitis after an infusion

Phlebitis after blood collection

After a simple blood test without the additional installation of an indwelling venous cannula, pronounced phlebitis rarely occurs. The indwelling cannula inserted in the same work step is usually the factor that irritates the vein. Pain that occurs in the area of ​​the puncture after a blood sample is usually caused by an acute injury to the skin and blood vessels or by a small bleeding that has not yet stopped. Bruises (hematomas) that can occur at the puncture site are also sometimes extremely painful. In the case of existing risk factors for developing phlebitis (varicose veins, strong tendency to thrombosis, ...), on the other hand, a blood sample may only be the drop that makes the barrel overflow and triggers the superficial thrombophlebitis. In the case of frequent or unusual phlebitis, a more detailed explanation of the cause should therefore be carried out.

Symptoms

Characteristic symptoms of phlebitis are the classic signs of inflammation that can be observed in all inflamed tissues: the affected area is reddened, overheated, painful.

A hardened vein cord may be palpable. These signs are known as calor, dolor, rubor, tumor (Latin color, painfulness, warmth, induration). With a phlebitis, there is usually no swelling or edema in the affected parts of the body. Such an inflammatory reaction may be accompanied by a fever. However, this rarely happens overall.

In the following article you can read about other symptoms that you can use to recognize phlebitis:
You can recognize phlebitis by these symptoms

diagnosis

The diagnosis of phlebitis is made either by the clinical picture or by an ultrasound examination. Redness and painful courses due to the leg veins raise the suspicion of thrombophlebitis.

Phlebitis must always be differentiated from what is known as phlebothrombosis, i.e. deep vein thrombosis that often affects leg and pelvic veins. This is noticeable through swelling of one leg, which can be painful when exercising or at rest. A distinction must also be made from the erysipelas, i.e. the infection of a wound by bacteria. An erysipelas, which is mostly caused by streptococci, shows up when bacteria can penetrate through small injuries to the skin, with a clearly defined reddening and high fever. Affected people appear limp, tired and exhausted.

If, after carefully questioning the patient and the physical examination, there is no clear picture, a special form of ultrasound examination can also be used. In this examination, which is known as duplex sonography, one assesses the flow rate of the blood in the veins and can thus detect a possibly existing thrombus in a deep leg or pelvic vein, which speaks for a phlebothrombosis and against a superficial phlebitis.

Phlebitis therapy

So what to do if phlebitis becomes noticeable?
The therapy initially consists in relieving the symptoms of the disease as quickly as possible in order to bring relief to the patient: anti-inflammatory and / or anticoagulant ointments have a local effect and are applied to the affected skin areas (see ointment). The part of the body that is affected should also be well cooled. This simple action will quickly and effectively relieve the pain caused by the inflammation.

In addition, the attending physician prescribes stronger or less strong pain medication if the patient needs it. However, these should only be taken in the event of severe, acute pain and not without reason. The most important and also most effective measure for the treatment of acute superficial thrombophlebitis is long walks or lots of exercise. Patients with phlebitis in the leg veins should walk as much as possible. Long standing should be avoided. In addition, you can think about the purchase of support stockings, which show very effective results, especially with existing varicose veins. A good education about possibilities to avoid the repetition of the event and (if available) a removal / treatment of the cause of the phlebitis are obligatory.

If the phlebitis has not been around for a long time (less than 7 days) and large clots can be felt in the vessel, a doctor can also try to remove the thrombi by pricking the vein. The further treatment then proceeds as described above. Patients often experience immediate pain relief from clot removal.

If a bacterial infection seems likely to be the cause of the phlebitis (e.g. phlebitis that is associated with a high fever or occurs after a wound is known to be contaminated), antibiotic therapy is carried out in addition to symptomatic therapy. If possible, this is then done in tablet form and not burdening additional veins via an infusion system and an indwelling venous cannula. Unfortunately, this is not always possible.

L.Read more about the treatment options for phlebitis on the following page: Treatment of phlebitis

ointment

Because one Phlebitis most of time spatially limited occurs, local therapy is also sensible and possible. The problem of superficial thrombophlebitis is superficial, i.e. relatively close to the surface of the skin.

This is also why the inflammation is involved Anointwhose active ingredients penetrate the skin from the outside, are very treatable. There are several options for ointment therapy for phlebitis: on the one hand, the cause of the pain, i.e. the inflammation, can be treated. This is done using anti-inflammatory (anti-inflammatory) Anoint like for example Voltaren®. Another option is to treat the bleeding disorder associated with phlebitis. On the one hand, you want to dissolve any blood clots that may have triggered the inflammation and, on the other hand, you want to prevent further thrombi from forming as a result of the inflammation. Ointments that slow blood clotting can be used for this. Frequently, for example Ointments with heparin used. Applied as a cream directly to the skin, this ingredient still has an effect on the affected area, but no longer in the entire body circulation as after a heparin injection.

Is a severe coagulation disorder The cause of frequently recurring phlebitis, however, should be discussed Injection of heparin think.

Homeopathy for phlebitis

In addition to the general medical measures, which can usually be used to successfully treat phlebitis, there are also some homeopathic approaches that can be used to treat this type of inflammation. Mainly homeopathic medicines with the name Arnica in different dilutions (potentization) are used here. As a rule of thumb, you should stick to a dosage of "5 globules three times a day". In addition, a treatment attempt with Echinacea or Mercurius Solub H. is often suitable. To select the right homeopathic substance, some accompanying symptoms that are present should be considered. Another homeopathic medicine can be useful for certain accompanying complaints.

Also read the article: Home remedies for phlebitis.

The prognosis and duration of phlebitis

Acute phlebitis is usually self-limiting, which means that it can heal after a while without therapy. Despite the mostly mild course of the disease, some complications are known: Statistically speaking, the inflammation of the superficial veins in one out of five patients spreads to the deeper leg veins as the disease progresses. Especially then, the risk of deep vein thrombosis is extremely high. In these cases, anticoagulant therapy should be considered early to prevent clots from forming in all veins.
In the context of a bacterial infection, inflammation, abscesses and other symptoms associated with it rarely occur. Above all, fever, tiredness and the feeling of being limp should be mentioned here. Phlebitis lasts only a few days in most cases. The patient soon experiences improvement. In severe cases or when the inflammation spreads to deeper veins, however, courses over several weeks are possible.

Find out more about the Duration of a phlebitis

prophylaxis

The best prophylactic measure to prevent phlebitis is frequent To run and To go for a walk. Care should be taken not to stand still in one place for too long. While sitting and at night, it is recommended - especially with pre-existing varicose veins - the Put your legs up and by no means hit one another. Also a Compression bandage or fitted support stockings can reduce the risk of phlebitis. If these measures are not possible because a patient cannot get out of bed, for example, and there is already a suspicion of inflammation in a large vein (e.g. the great leg vein, great saphenous vein), prophylactic anticoagulation with syringes is a so-called low- Dose containing heparin is recommended until the patient is able to get out of bed or the inflammation has healed.

Since pronounced Varicose veins are among the risk factors for phlebitis, a causal treatment of this problem is also recommended in advanced stages. Various surgical methods are available for this. With regard to phlebitis in the arms, caution is the best prophylaxis. Working hygienically and being careful when administering infusions and injections should go without saying. IV catheters and other foreign material should only remain with the patient as long as they are absolutely necessary.