Medicines for Phlebitis

What it is

Phlebitis means inflammation of a vein. The term most commonly refers to superficial thrombophlebitis — inflammation of a vein just under the skin (a superficial vein), usually with a small blood clot forming in the inflamed vein. It is common and usually not serious. It most often affects the legs (particularly in association with varicose veins), but can occur elsewhere, including the arms (for example around the site of a drip/cannula, or after an injection). Phlebitis can be triggered by various things, including: varicose veins; injury or irritation to a vein (such as from a cannula, drip, or injection); prolonged inactivity; and other factors; sometimes it occurs without an obvious cause. The typical features of superficial thrombophlebitis are a red, warm, tender, and often firm or hard, cord-like area along the affected vein, just under the skin; the area may be swollen and painful. It usually affects a localised area over the vein. Superficial thrombophlebitis is generally not serious and often settles on its own over a couple of weeks or so with simple measures. However, it is important to have it assessed, for a few reasons: to confirm the diagnosis and exclude other conditions (such as a skin infection like cellulitis, which can look similar but needs different treatment); because, in some cases (particularly when it affects certain veins, is extensive, or is close to where superficial veins join the deep veins), superficial thrombophlebitis can be associated with, or extend to cause, a clot in a deep vein (deep vein thrombosis, DVT), which is more serious — so assessment considers this; and because recurrent or unexplained phlebitis can occasionally be a sign of an underlying condition. Treatment is usually simple and supportive — such as measures to relieve the symptoms (pain relief, warmth or cool compresses, and, for the legs, sometimes compression stockings and keeping active), and treating any cause or removing an offending cannula — and most cases settle. In certain situations (such as more extensive phlebitis, or where there is a risk of, or associated, DVT), additional treatment (such as anti-clotting treatment) may be used, guided by assessment. The key messages are that phlebitis is inflammation of a vein near the skin surface causing a red, tender, cord-like area, that it is usually not serious and settles with simple measures, and that it should be checked (to confirm the diagnosis and exclude a deep vein clot or infection).

How it is treated

Superficial thrombophlebitis is usually managed with simple, supportive measures, and generally settles on its own; assessment is important to confirm the diagnosis, exclude a deep vein clot or infection, and guide treatment. Because phlebitis can resemble other conditions (such as cellulitis, a skin infection) and can, in some cases, be associated with a deep vein thrombosis (DVT), it is important to have it assessed — a doctor can confirm the diagnosis, distinguish it from infection, assess whether there is any concern about a deep vein clot (particularly if the affected vein is large, the phlebitis is extensive or close to where superficial veins join deep veins, or there are other risk factors), and consider whether any underlying cause needs looking into (particularly for recurrent or unexplained phlebitis); sometimes an ultrasound scan is used to assess the veins and check for a DVT where there is concern. For typical superficial thrombophlebitis, treatment is usually simple and supportive, and most cases settle over a couple of weeks or so: measures include pain relief and anti-inflammatory measures for the discomfort (such as suitable pain relief, and applying warm or cool compresses for comfort); for phlebitis in the leg (often related to varicose veins), keeping active and, where appropriate, using compression stockings can help; and treating or addressing any cause — for example, removing an offending cannula or drip if that is the cause, and managing varicose veins if relevant. Keeping the area comfortable and continuing normal activity (rather than resting completely) generally help. In certain situations, additional treatment may be needed — for example, where the phlebitis is more extensive, affects certain veins, or where there is a risk of it extending to or being associated with a DVT, anti-clotting (anticoagulant) treatment may be used for a period, guided by the assessment; and any infection (if present, such as cellulitis) is treated with antibiotics. Recurrent phlebitis, or phlebitis without an obvious cause, may prompt further assessment for an underlying cause. It is important to seek assessment, and to seek prompt attention if there are features suggesting a DVT (such as swelling of the whole limb, significant leg swelling and pain) or infection (spreading redness, fever, feeling unwell), or if symptoms are severe or worsening. The reassuring messages are that superficial thrombophlebitis is usually not serious and settles with simple, supportive measures, that assessment is important to confirm the diagnosis and exclude a deep vein clot or infection, and that treatment is usually straightforward, with additional treatment in certain situations; so assessment, simple supportive measures, treating any cause, and being alert to features of a DVT or infection are the keys to managing phlebitis.