What is Phlebitis?

There are two main versions of phlebitis (fle-BYE-tis), superficial and deep vein thrombophlebitis (DVT). Normally, varicose vein condition is associated with superficial phlebitis. Phlebitis means inflammation of a vein. Thrombophlebitis, a condition where a blood clot in the vein causes the inflammation, usually occurs in leg veins, but it may also occur in an arm. The thrombus (clot) in the vein causes pain and irritation and may block blood flow in the veins. The less severe phlebitis condition can occur in both the surface (superficial) or deep veins.

Superficial phlebitis affects veins on the skin surface. The condition is rarely serious and, with the right treatment, it can usually be corrected quickly. Regular and proper use of a compression stocking as directed will help eliminate risk of developing superficial phlebitis as in the case of diagnosing varicose and spider veins, the proper medical evaluation is necessary to diagnose the type and severity of the phlebitis.

Possible causes of phlebitis:

  • Trauma or injury to the leg that weakens the veins
  • Long periods of inactivity like sitting or laying for long periods of time, for example long drives or flying
  • Insertion of intravenous catheters (IV) in hospitals, called IV-induced phlebitis
  • Long rest period after surgery (post-operative period), especially orthopedic procedures
  • Prolonged immobility, as in hospitalized or bed-ridden patients
  • Severe varicose veins
  • Underlying cancers or clotting disorders
  • Intravenous drug use
  • Smoking
  • Taking oral contraceptives (i.e. birth control pills)
  • Pregnancy

Phlebitis, varicose veins and spider veins share many similar possible causes.

Symptoms of phlebitis

Warmth, tenderness, redness, and swelling along the course of the vein is highly-suggestive of superficial phlebitis or thrombophlebitis.

  • Swelling of the veins
  • Swelling, redness, and/or tightness of skin around the vein
  • Fever
  • Burning or uncomfortable feeling around the vein

Other testing methods for phlebitis

D-dimer is a blood test that can indicate phlebitis by identifying the presence of a chemical that is released by blood clots when they start to degrade. While a resulting normal D-dimer result makes the diagnosis of thrombophlebitis unlikely, an abnormal result lacks specificity, meaning that an elevated D-dime level can be the result conditions other than thrombophlebitis, including recent surgery, fall, pregnancy, or an underlying cancer.

Conditions that mimic the symptoms of phlebitis include lymphangitis (swelling and inflammation of lymph nodes) or cellulitis (superficial skin infection), and even insect bites. These can be distinguished by obtaining a careful medical history and physical examination by a physician. Sometimes, a biopsy of the skin may be required to establish the definite diagnosis.

How is phlebitis treated?

Treatment of superficial phlebitis may depend on the location, extent, symptoms, and underlying medical conditions.

As with any medical condition, the key to proper diagnosis of superficial phlebitis requires a physical examination. An ultrasound scan of the area can help determine the severity of the condition.

Deep venous thrombophlebitis (DVT) is also best determined by an ultrasound scan. If deep venous thrombophlebitis is suspected or diagnosed, or if the risk of it developing is considerable, then anti-coagulation medication (blood thinners) may be necessary. Recovery from thrombophlebitis may take weeks or even months.

In general, superficial phlebitis of the upper and lower extremities can be treated by applying warm compresses, elevation of the involved extremity, encouraging walking, taking an oral anti-inflammatory medication such as ibuprofen (Motrin, Advil). Topical anti-inflammatory medications may also be helpful, such as diclofenac gel. External compression with fitted compression stockings is also a recommended for patients with superficial phlebitis of the legs.