What is Phlebitis?

Phlebitis (thrombotic phlebitis) refers to the acute aseptic inflammation of venous blood vessels. Phlebitis can be divided into superficial phlebitis and deep phlebitis according to different lesions. Few patients may have fever, an increase in the number of white blood cells, etc. Patients often report pain and swelling. There are many causes of venous thrombosis, such as trauma, surgery, pregnancy, childbirth, heart disease, malignant tumors, oral contraceptives, and long standing, squatting, sedentary, long lying, etc., which are more commonly caused by surgery. .

Basic Information

nickname

Thrombophlebitis

English name

phlebitis

Visiting department

Vascular surgery

Common causes

Intravenous injection of strong, high-concentration drugs, or long-term use; superficial varicose veins, obesity, smoking, trauma; bacterial infections

Common symptoms

Painful, swollen and tender cords or beads

Causes of phlebitis

Intravenous injection of strong irritating, high-concentration drugs or prolonged use damages venous endothelial cells; superficial varicose veins, blood stagnation; venous endothelial damage caused by obesity, smoking, and trauma; bacterial infections. After venous intimal injury, a thrombus is formed, which quickly leads to an inflammatory reaction of the entire superficial vein wall, even involving the surrounding tissues of the vein, and exudate, showing localized pain, swelling and tenderness of the cord-like hard strips or beaded induration , Systemic response is not obvious.

Clinical manifestations of phlebitis

1. thrombophlebitis of the extremities

Thrombogenic phlebitis of the extremities is characterized by local swelling and pain in the affected limb, which can touch painful cord-like hard strips or bead-like nodules. Deep veins are involved, swollen swelling of the affected limb, swelling and pain aggravated during walking, relieved after resting, dark red skin, extensive varicose veins and telangiectasias; local malnutrition changes with stasis dermatitis in later stages , Hyperpigmentation or superficial ulcers.

2. Wandering thrombophlebitis

Superficial venous inflammation occurs at an uncertain location, and is characterized by intermittent, migratory, and alternating attacks throughout the body. It is a special type of superficial phlebitis in humans, which is often combined with female reproductive organs and pancreatic tumors.

3. Thoracic and abdominal wall thrombophlebitis

Superficial venous thrombosis of the chest wall, breast, two costal margins, and upper abdominal wall, with inflammatory pathological changes at the same time, also known as Mondor disease.

Phlebitis

Laboratory inspection

(1) Blood routine Judging by the increase of white blood cells and neutrophils, it is judged whether there is a bacterial infection.

(2) Coagulation There may be thrombotic manifestations such as elevated D-Dimer.

2. Imaging examination

(1) Doppler ultrasound detects changes in local blood flow. When thrombophlebitis occurs, the local blood flow signal disappears or is partially missing, and the lumen cannot be compressed after compression. Such an examination will reveal about 95% of proximal deep vein thrombosis.

(2) Radionuclide inspection The principle is that the radiolabeled human fibrinogen can be taken up by the forming thrombus. You can judge the formation and evolution of thrombus by observing the increase and decrease of radiation in a certain part. The detection rate of thrombosis in the venous plexus of the calf is high.

(3) Impedance plethysmography When venous thrombosis is formed, the fluctuation of the impedance volume is small. The diagnosis of main vein occlusion is better.

(4) Intravenous angiography Intravenous injection of contrast agent, through the presence or absence of filling defects, to determine the presence or absence of thrombosis, at the same time the position, scope, shape and collateral circulation of the thrombus can be clarified. The gold standard for diagnosis.

(5) Determination of venous pressure The venous pressure of the affected limb is elevated, which indicates that the proximal cardiac vein is blocked at the pressure measurement point.

Phlebitis diagnosis

The disease can be diagnosed based on medical history, local manifestations, relevant hematologically positive indicators, and accurate imaging results. It should be noted that acute skin infections such as erysipelas can also have similar manifestations, but compared with phlebitis, the former has more severe local inflammation such as redness, swelling, and fever, and is often accompanied by systemic reactions, and there is no obvious thrombosis on imaging.

Phlebitis treatment

General treatment

Remove the cause of phlebitis, such as venous catheters. If combined with bacterial infection, antibiotics can be given as appropriate. Lower extremity lesions need to raise the affected limb in the acute phase to avoid standing, sitting, etc. At the same time, medical stretch socks can be added to promote venous blood return. Locally, hot compresses and physical therapy can be used to promote the absorption of inflammation and relieve pain.

2. Drug treatment

Heparin ointment for external use, anti-inflammatory drug ointment, orally promoting blood circulation and other stasis drugs such as venous reflux. For lesions at the base of the thigh and around the knee joint, low molecular heparin or unfractionated heparin is required. For patients with combined bacterial infection, antibiotics should be used according to the type of infected bacteria.

3. Surgical treatment

Local thrombophlebitis can resolve after the inflammatory phase. If there is still a cord-like hard object with pain, surgical resection can be considered. The varicose veins of the lower limbs combined with superficial phlebitis can be treated after the inflammation subsides.

Phlebitis prevention

Wear elastic socks to improve varicose veins of the lower limbs. For patients with hypercoagulable blood, while actively correcting the underlying disease, care should be taken to avoid trauma to extremities, trunks and other prone areas. In addition, avoid repeated puncture of the same site and use of strong irritating drugs during venipuncture. At the same time strict aseptic operation to prevent infection caused by intravenous implants.