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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