Phlebitis: Information & Doctors for Phlebitis

Phlebitis refers to the inflammation of a vein. Medical professionals also refer to phlebitis as inflammation of a vein.

Phlebitis can occur in both superficial veins (those located directly under the skin) and deep veins. It often occurs in conjunction with a thrombosis (blood clot). When phlebitis and a blood clot occur in a superficial vein, doctors call this thrombophlebitis. This is the most common form of phlebitis. However, it is important to note that bacterial inflammation rarely occurs in cases of thrombophlebitis. 

Thrombophlebitis most commonly affects the superficial veins of the legs, particularly the great and small saphenous veins and their side branches. The trigger is usually the formation of varicose veins; in these cases, the condition is also referred to as varicophlebitis. 

However, the veins in the arms are also a common site for venous inflammation. In these cases, however, the condition is usually preceded by blood draws or the placement of an intravenous line for infusion therapy for various reasons. Inflammation of the veins in the chest or abdomen is very rare.

Unlike purulent inflammations and wound infections, which are caused by pathogens (especially bacteria), phlebitis is usually nonbacterial. This means that germs (bacteria) cannot be detected as the cause.

Possible causes of phlebitis include:

• Varicose veins
• Lack of exercise
• Obesity
• Blood draws
• Venous access for infusion therapy
• Smoking and birth control pills
• Increased tendency toward blood clotting
• Dehydration
• Cancer

In summary, conditions that lead to

1. varicose veins
2. impaired blood flow (thrombosis), or 
3. injury to the vein (blood draw, infusion catheter) 

are associated with an increased risk of phlebitis or thrombophlebitis.

Varicose veins can contribute to the development of phlebitis © hriana | AdobeStock

The cardinal signs of inflammation (redness, swelling, warmth, pain, and functional impairment) also occur in thrombophlebitis.

External signs of thrombophlebitis typically include a painful, reddened streak along the course of the vein, and in some cases, hardening and swelling. Fever may also occur.

Venous inflammation usually lasts a few days. In severe cases, the inflammation can persist for several weeks. A milder case usually occurs when the affected vein has not been previously damaged. This is the case, for example, after infusion therapy via indwelling venous catheters. In such cases, the inflammation subsides within a few days. However, if venous surgery, thrombosis, or varicose veins cause such damage, the inflammation may well last longer.

Before a diagnosis of phlebitis can be made, the doctor conducts a thorough examination. As part of this, the doctor takes the patient’s medical history. Key points of this interview include, for example, questions about any known venous conditions such as varicose veins.

A physical examination is then performed. As mentioned above, superficial phlebitis can often be detected with the naked eye. The affected vein is thick, hardened, and causes pain when pressure is applied.

Blood tests often reveal elevated inflammatory markers, particularly white blood cell counts.

A Doppler ultrasound—which visualizes blood flow—provides clarity. If the inflammation is located in a deep blood vessel, further testing is necessary.

In more complex cases, a CT or MRI scan may also be ordered. However, this is only necessary in exceptional cases. It should be noted in this context that phlebitis with no apparent cause may also be an indication of an undiagnosed cancer. In these cases, in addition to examining and treating the phlebitis, a cancer screening must also be performed. The more extensive tests mentioned above (such as computed tomography and magnetic resonance imaging) may well be necessary.

It is important to seek treatment for phlebitis to prevent complications. Treatment for phlebitis depends on the type and severity of the condition.

In cases of superficial phlebitis, cooling and elevating the affected arm or leg can provide relief. In addition, any indwelling venous catheter should be removed. A compression bandage can aid in healing. If there is severe pain, the doctor will also recommend pain-relieving medications in the form of ointments or tablets.

In cases of phlebitis associated with a blood clot (thrombophlebitis), the doctor may remove the blood clot in some instances, particularly if there is severe pain. To do this, the doctor makes an incision in the vein. If pus is discharged during this procedure, antibiotics may be necessary in exceptional cases.

If the deep veins are also affected by the superficial vein inflammation and clots have formed there, hospitalization may be necessary. This should be arranged especially if sudden shortness of breath occurs that was not present before. The reason for this is that if the deep veins are involved, a clot (thrombus) can travel as far as the lungs and lead to what is known as a pulmonary embolism. Depending on the size of the thrombus, this then causes shortness of breath of varying severity. 

It is not possible to prevent phlebitis with 100% certainty. However, there are several things you can do to maintain the health of your veins.

You can reduce your risk of developing phlebitis by:

• treating varicose veins early
• quitting smoking (this is especially important for women who use hormonal birth control)
• Avoiding prolonged sitting and standing; if that’s not possible, doing regular exercises for your legs and feet
• avoiding clothing that is too tight; in particular, clothing should not constrict the legs
• drinking enough fluids to prevent the blood from thickening and to reduce the risk of blood clots
• Do not leave venous catheters in the vessel for too long, and 
• Be sure to inform your doctor of any changes in veins that have already undergone surgery

As a general rule, physical activity is the best prevention against phlebitis.

Exercise stimulates blood circulation and prevents many vein problems from developing in the first place.