How to recognize phlebitis

Inflammation of the veins (phlebitis) manifests itself as pain, reddening and warming of the skin. More about causes, symptoms and treatment

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Phlebitis - briefly explained

An inflammation of the veins (phlebitis) is a localized inflammation of a superficial vein (thrombophlebitis superficialis). It can be associated with or caused by clot formation. Phlebitis is differentiated from phlebothrombosis, a thrombosis of the deep venous system.

Most of the time, superficial phlebitis is caused by varicose veins. If this is the case, it is called varicophlebitis.

Causes: what causes phlebitis?

The main causes of phlebitis are slower blood flow in the case of varicose veins, heart failure or being bedridden. An increased willingness of the blood to clot, for example in the puerperium and after operations, increases the risk additionally. Basic inflammatory diseases, tumor diseases or an injury to the vein wall can also be the reason for superficial phlebitis. One of the most common causes is an intravenous indwelling catheter (usually left in the vein for too long). If bacteria enter a vein through small skin injuries, this can also be the trigger. This can be particularly dangerous in the face area (upper lip, corner of the eye and nose), as the veins are directly connected to those in the brain.

A recurrent phlebitis (recurrent) with changing localization can also be an expression or harbinger of a so-called thrombangitis obliterans. Strictly speaking, this disease is an inflammatory change in the small and medium-sized arteries and veins (thrombangitis). The cause of this condition is unknown and mostly occurs in male smokers under the age of 45.

Symptoms: how do you recognize phlebitis?

Typical symptoms of a phlebitis are reddening of the skin, overheating and sometimes considerable pain (especially when muscles are tensed, for example when walking) in the affected area. The inflamed vein can be felt as a painful reddened hard cord. Fever occurs mainly when there is bacterial inflammation. In contrast to a deep vein thrombosis, there is no swelling of the extremity, as most of the blood can continue to drain through the deep venous system.

Phlebitis usually lasts a few days, but in more severe cases it can last for several weeks. Lighter cases occur in otherwise healthy, undamaged veins. More severe phlebitis usually occurs in connection with varicose veins, after a vein thrombosis or after a vein operation.

How do you treat phlebitis?

The doctor will definitely use ultrasound to check whether the deep veins are involved or not. Therapy is based on this. Phlebitis of superficial veins is treated with topical remedies such as anti-inflammatory ointments and cooling. Basic therapy is a correctly fitted compression bandage.

How to use compression stockings correctly:

If the doctor gives the green light, the blood circulation should be stimulated by movement and no bed rest should be observed. In addition, anti-inflammatory, pain reliever pills and anticoagulant medication can be used. If the inflammation is widespread, heparin may be injected to prevent thrombosis and the progression of superficial phlebitis.

The doctor can remove painful clots in the superficial veins at an early stage using small stab incisions by massaging them out. If there is bacterial inflammation, he can give an antibiotic.

If varicose veins repeatedly lead to phlebitis, surgery should be considered. Which type of therapy seems suitable should be discussed individually with the doctor.

Swell:

German Society for Angiology - Society for Vascular Medicine e. V .: S2k guidelines for diagnosis and therapy of venous thrombosis and pulmonary embolism - Pocket version 2017. Online: https://www.awmf.org/uploads/tx_szleitlinien/065-002k_S2k_VTE_Venenthrombose-Lungenembolie_2017-04.pdf (accessed 01 / 2021)

Olin JW: Thromboangiitis obliterans (Buerger's disease) 12/2020. Online: https://www.uptodate.com/contents/search (accessed 01/2021)

Scovell S: Phlebitis and thrombosis of the superficial lower extremity veins 12/2020. Online: https://www.uptodate.com/contents/search (accessed 01/2021)

Herold: Internal Medicine, 2017

Important NOTE:
This article contains general information only and should not be used for self-diagnosis or self-treatment. He can not substitute a visit at the doctor. Unfortunately, our experts cannot answer individual questions.