What is the sign and symptoms of phlebitis? Is phlebitis dangerous?

Phlebitis

Phlebitis is an inflammation of a vein; the term is used almost synonymously with thrombophlebitis. This process occurs most commonly in the large veins of the legs, although the disease can involve veins in the upper extremities and abdomen. Phlebitis can be the result of an injury, slowing of the circulation, or can occur in association with an infection, tumors, or cancers anywhere in the body.

A vein functions as the route for the return of blood from a part to the heart. When a vein becomes inflamed,its inner channel is closed off by a clot. The drainage of the body part is impeded and it becomes swollen. A major danger is that the clot can break off and go through to the lung. These emboli can be fatal if a large blood vessel is blocked off by the traveling clot. If the clot is infected, it may introduce abscesses into the lung and other organs. About one in ten individuals with phlebitis can develop complications in the lung.

What are the symptoms of leg phlebitis? 

The part becomes painful and swollen. The small veins just beneath the skin become prominent and distended. Sometimes the tissues of the leg become hot and red. The arterial pulses in the leg are normal, indicating that this is a venous process, not an arterial block.

Is it necessary to take an X ray for diagnosis? 

Usually not. The diagnosis is ordinarily made on examination alone. X rays are required only for certain types of treatment.

How can phlebitis be avoided? 

There is no special consideration except in certain high risk groups. The man whose work is sedentary and who sits for a long period of time (analagous to long auto rides or plane flights) should get up and frequently walk around and flex his leg muscles. People with circulatory problems may be benefited by supportive bandages. One can't alter one's life pattern to avoid this problem. Certain constricting types of garters, girdles and undergarments should be avoided by the patient who has a propensity for disease of the veins.

How can this disease be avoided in the surgical patient? 

We encounter phlebitis about once in every hundred surgical patients, although it appears more frequently (in about 3 to 4 percent) in individuals after major intestinal surgery. Doctors try to avoid it by giving plenty of fluids to avoid drying out. The patient is also encouraged to take deep breaths to improve the circulation, and to exercise his legs to avoid pooling blood in that area. Sometimes supportive bandages are applied for the same purpose.

How can the dangerous emboli be avoided? 

This is an exceedingly important problem because about 10 percent of patients with phlebitis get this complication. It can be fatal in up to 20 percent of the individuals who get it. Therefore, preventive measures are always indicated. The major approach is to treat the phlebitis locally with wet dressings, supportive bandages, elevation and antibiotics. But, most importantly, the blood is thinned down by drugs called anticoagulants. These serve to decrease the likelihood of clotting. The same type of medication and approach is applied to certain patients who have had heart attacks.

How is the effect of these drugs controlled? 

Obviously they have to be controlled because if the effective clotting time is exceeded, the patient will start to bleed, and if too little is administered, the drug will be ineffective. Therefore, the level has to be checked daily at first and at least once a week after it has stabilized. This testing of the clotting propensity is a routine procedure.

Is this drug treatment always successful? 

It is in most cases but not invariably. If the individual continues to get clots passing to the lung despite effective anticoagulant levels of blood thinning, then the drugs have failed.

When is surgery done to prevent emboli? What is done? 

If an individual has had a clot go to the lung while on anticoagulants or if he has had two emboli, surgery should be done. The operation entails occluding the main vein in the abdomen (inferior vena cava) so that clots cannot pass from the legssup or pelvic organs to the lungs.

Phlebitis (Superficial Thrombophlebitis) Explained



Is the operation dangerous? 

The operation has no special danger. The risk is that of the disease which is being treated. Emboli to the lung can be immediately fatal. Decisions about treatment should be made before the situation becomes hopeless. Caval ligation is not used as the first therapy because it is not always required and because it can be followed by swelling of the legs.

What about chronic recurrent phlebitis with ulcers near the ankle? 

This should be treated to clear up the local infection and to resolve the inflammation. The varicose veins should be removed. The raw area can be covered with a skin graft taken from elsewhere in the body. A supportive bandage will help. There is no simple effective operation. This condition tends to be chronic and the patient must make an adjustment. He can function normally in virtually all respects, and it imposes nothing beyond caution about further injuring of the leg and ankle area.

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