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PubMed1990

Study of iatrogenic thrombophlebitis.

This is an analysis of 42 adult patients with 97 episodes of thrombophlebitis following 167 venepunctures. Almost all commonly used fluids had contributed to the development of thrombophlebitis. The observations showed significantly higher chances of development of thrombophlebitis with the quantity of fluids more than 2500 ml. (chi 2 = 15.50, P less than 0.001), autoclaved containers (chi 2 = 5.5, P less than 0.05) use of rubber tubing for infusion set (chi 2 = 4.7, P less than 0.05) and infusion rate more than 20 drops per minute (chi 2 = 15.25. P less than 0.001). Average time interval between beginning of IV infusion and development of thrombophlebitis was found to be 18 hours and average extent of thrombophlebitis was 7 cm. The commonest micro-organism isolated from needles was Pseudomonas aeruginosa.

Adult↗
PubMed1987

Obesity: is it really a risk factor in thrombophlebitis?

Obesity is assumed to be a risk factor in the occurrence of thrombophlebitis. We studied 168 consecutive patients retrospectively; 33 were men and 135 women, with an average age of 34 (range 27 to 41) years. All patients had a gastric bypass because of obesity, with a minimum of 100 lb over normal weight. The mean weight was 279.2 lb (range 191 to 500). Only three patients had a history of deep vein thrombophlebitis, with no thromboembolism. Eighty-four of the patients were studied preoperatively by noninvasive means (Doppler, impedance plethysmography [IPG], phleborheography [PRG]); 12 had evidence of old disease, and two had a history of treated deep vein thrombophlebitis. No patient had prophylactic therapy. The incidence of clinical deep vein thrombophlebitis was zero; noninvasive evaluation in 64 patients demonstrated no abnormality. Postoperative thromboembolism, which occurred in three of 168 (1.8%) patients, was confirmed by ventilation-perfusion scan and pulmonary angiogram. The mortality from thromboembolism was less than 1% (1/168 patients). Extreme obesity may not necessarily constitute a major risk factor in the occurrence of postoperative deep vein thrombophlebitis and thromboembolism. Prophylactic medications and therapy may add inappropriate risk, undue cost, and unnecessary discomfort, and must be weighed against a mortality of less than 1%.

Adult↗
PubMed1984

Dynamics of thrombophlebitis in central venous catheterization via basilic and cephalic veins.

The incidence distribution of thrombophlebitis after central catheterization via basilic and cephalic veins was investigated, using 227 catheters made of various plain or heparin-coated materials and with differing stiffness and surface structures. The platelet-adhesion stimulating properties were measured in vitro. Thrombophlebitis showed similar incidence patterns with all catheter types. The maximum incidence of venous reaction was found one to ten days after catheter insertion (central tendency 3-8 days with a peak at 5 days). After ten days the risk of thrombophlebitis fell significantly. The results supported the view that central venous catheters inserted via basilic or cephalic veins should not be withdrawn or exchanged as prophylaxis against thrombophlebitis, at any rate when long-term catheterization is intended. For conclusive comparisons between catheter materials regarding induction of clinically apparent thrombophlebitis, all the patients in the trial should be catheterized for ten days or more, unless symptoms of venous reaction arise earlier.

Adolescent↗
PubMed1997

Influence of fine-bore catheter length on infusion thrombophlebitis in peripheral intravenous nutrition: a randomised controlled trial.

Previous studies indicated that the risk of thrombophlebitis associated with continuous infusion of intravenous nutrition (IVN) via peripheral veins was reduced when fine-bore catheters, inserted to 15 cm, were used in place of standard intravenous cannulas. An explanation has not been identified, but may be owing to the greater length of the catheters. A randomised controlled study was performed in which a standard nutritional solution was infused via 22G polyurethane catheters inserted to a length of either 5 cm or 15 cm. Catheters were reviewed twice each day and removed when complications occurred, or when IVN was no longer required. There was no significant difference in median time to thrombophlebitis or extravasation, or in daily risk of thrombophlebitis, between insertion lengths. Survival proportions were similar for each length at all times. Catheters inserted into cephalic veins were more prone to thrombophlebitis or extravasation (nine episodes, 14 catheters) than catheters inserted into basilic veins (five episodes, 24 catheters, P = 0.009). The survival proportion was at all times greater when catheter tips lay in basilic veins. Thus, the risk of thrombophlebitis or extravasation was not influenced by the length of catheter within the vein. However, the vein in which the catheter tip lay appeared to influence the development of morbidity.

Adult↗
PubMed1996

Cavernous sinus thrombophlebitis: case report.

OBJECTIVE AND IMPORTANCE: Cavernous sinus thrombophlebitis is a rare, dangerous, and historically difficult condition to diagnose and treat. Knowledge of the imaging findings and the importance of early diagnosis and treatment are emphasized. CLINICAL PRESENTATION: We present a case of cavernous sinus thrombo-phlebitis caused by sphenoid sinusitis. Previously undescribed magnetic resonance imaging findings of cavernous sinus thrombophlebitis include enlargement of the cavernous sinus, abnormal enhancement and increased T2 signal of the petrous apex and clivus, and marked narrowing of the cavernous portion of the internal carotid artery. Resolution of cavernous sinus thrombophlebitis is also documented by magnetic resonance imaging. INTERVENTION: The anatomy of the cavernous sinus dictates the natural history and diagnosis of cavernous sinus thrombophlebitis. We review the literature regarding the clinical diagnosis, differential diagnosis, and treatment of cavernous sinus thrombophlebitis. CONCLUSION: We emphasize the importance of a high index of suspicion, the potentially rapid and fatal course of the disease process, and the subsequent need for antibiotic therapy and selective surgery.

Cavernous Sinus↗
PubMed1986

Puerperal pelvic thrombophlebitis: impact on diagnosis and treatment using x-ray computed tomography and magnetic resonance imaging.

The clinical diagnosis of puerperal pelvic thrombophlebitis was confirmed by x-ray computed tomography in 11 women, and further documented in six by magnetic resonance imaging. Venous thrombi were demonstrated in ovarian, iliofemoral, and inferior vena caval vessels. In six women with ovarian vein involvement and no evidence of iliofemoral thrombophlebitis, resolution followed intravenous antimicrobial therapy alone, and in three of these, resolution was confirmed by x-ray tomography. In contrast, three of five women with symptomatic iliofemoral thrombophlebitis had a prolonged febrile course despite antimicrobial and heparin therapy. The clinical courses of these 11 women were consistent with the observation that pelvic thrombophlebitis is associated with pelvic infection. Disease manifested within a few days after parturition was more likely due to ovarian vein involvement, whereas disease with later onset of symptoms was more likely due to iliofemoral thrombosis, with or without vena caval extension. Through the use of x-ray computed tomography and magnetic resonance imaging, the natural course of pelvic thrombophlebitis can be better elucidated and therapeutic regimens more clearly evaluated.

Female↗
PubMed2006

Pregnancy, thrombophlebitis and thromboembolism: what every obstetrician should know.

Thrombophlebitis is caused by superficial venous thrombosis and vascular inflammatory changes affecting the lower limbs. The condition is often encountered in pregnancy and symptomatic treatment including compression and analgesia are commonly employed. The obstetrician may become involved in the management of thrombophlebitis; however the potential for embolic complications, and need for adequate assessment remain widely unrecognised. This case report highlights pitfalls in the management of thrombophlebitis, in particular the dangers of clinical assessment without the use of Doppler ultrasound and the potential for deep venous extension and embolic complications. The case also documents the use of low molecular-weight heparin in pregnancy to prevent such complications and promote thrombus resolution; a review of the available treatment options, including surgery, is included. Whilst thromboembolism remains a leading cause of maternal death, the potential dangers of symptomatic thrombophlebitis should not be overlooked.

Adult↗
PubMed1992

Influence of catheter type on occurrence of thrombophlebitis during peripheral intravenous nutrition.

To reduce the likelihood of thrombophlebitis during intravenous feeding through a peripheral vein, the osmolality of the solution is usually reduced by disproportionately raising the lipid content and lowering the carbohydrate, electrolyte, and aminoacid concentrations. The possibility that delivery system rather than feed is the main influence on the development of thrombophlebitis was examined in a randomised comparison of a fine-bore silicone catheter against a short 'Teflon' cannula. The nutrient solution given through a peripheral vein was a standard feed used for infusion into a central vein (osmolality 1250 mOsmol/kg, 13 g nitrogen, 200 g glucose [800 kcal], and lipid emulsion [1000 kcal]). 27 patients received the infusion through a fine-bore silicone rubber catheter (diameter 23 G, length 15 cm) and 23 through a teflon catheter (diameter 20 G, length 3.2 cm). The median duration of feeding was 5 days in each of the two groups. Thrombophlebitis developed in all patients in the teflon group but in only 2 (7%) of the silicone group. The first silicone catheter for a patient lasted a median of 128.5 h, compared with 40 h for the first teflon cannula (p less than 0.001). The results show that when a nutrient solution of osmolality 1250 mOsmol/kg is delivered through a peripheral vein with an ultrafine-bore silicone catheter, the risk of thrombophlebitis is low. For many patients intravenous feeding may thus be given through a peripheral instead of a central vein without compromising the nutritional adequacy of the feed.

Adolescent↗
PubMed2002

The epidemiology of peripheral vein infusion thrombophlebitis: a critical review.

We critically assessed studies on the clinical importance, diagnosis, incidence, and pathogenesis of peripheral vein infusion thrombophlebitis, including catheter-related and patient-related risk factors. We reviewed the evidence linking thrombosis, particularly prothrombotic states such as the inherited thrombophilic disorders, with peripheral vein infusion thrombophlebitis. Peripheral vein infusion thrombophlebitis occurs in 25% to 35% of hospitalized patients with peripheral intravenous catheters and has both patient-related implications (e.g., sepsis) and economic consequences (e.g., extra nursing time). Although duration of catheterization, catheter-related infection, and catheter material are important risk factors for peripheral vein infusion thrombophlebitis, patient-related risk factors are not well elucidated.

Catheterization, Peripheral↗
PubMed1988

Thrombophlebitis and disturbed hemostasis following administration of intravenous hematin in normal volunteers.

PURPOSE: Acute porphyria episodes are routinely treated with hematin, but side effects, including disturbances of hemostasis and peripheral thrombophlebitis, are associated with the compound's use. Thrombophlebitis is particularly troublesome in patients who require repeated administration of hematin, and may eventually lead to the placement of central venous lines or implantation of indwelling venous access ports. We undertook this study to determine whether only patients with porphyria experienced peripheral thrombophlebitis and disturbed hemostasis following administration of hematin, or if this was a general phenomenon that could also be observed in normal volunteers. SUBJECTS AND METHODS: Hematin was administered intravenously in the doses customarily used in therapy of acute porphyria crises (4 mg/kg body weight) to nine normal male volunteers, who were screened by history, physical examination, routine blood cell counts, urinalysis, biochemical screening profile, and coagulation tests. Hemostasis tests were performed in each subject, and hematin concentrations were determined. RESULTS: Within the first 24 hours, the activated partial thromboplastin time was prolonged in all subjects (mean of 25 percent), the prothrombin time was increased in eight subjects (mean of 20 percent), and the thrombin time in five subjects rose (mean of 15 percent), whereas the concentration of circulating platelets decreased in three subjects (mean of 20 percent). In four subjects (45 percent), thrombophlebitis developed following hematin infusion. CONCLUSION: Although hematin is frequently effective in the treatment of acute porphyria crises, it is often associated with abnormalities in coagulation and these effects also occur in normal volunteers.

Adult↗
PubMed2003

Morbidity in superficial thrombophlebitis and its potential surgical prevention.

Thrombophlebitis is a common condition which can lead to deep venous thrombosis (DVT) and subsequent pulmonary embolism (PE). Thrombophlebitis can reach the deep venous system via the long or short saphenous vein or via perforating veins. Between the 1st of January 1999 and the 31st of December 2000 a total of 17 cases of superficial (or ascending) thrombophlebitis closer than 5 cm to the deep venous system were surgically treated in our clinic. 14 times the long saphenous vein was affected and 3 times the short-saphenous vein. The age of the nine females and seven males ranged from 31 to 77 (mean of 54.6) years. Duplex ultrasound was performed in all patients. In the case of a deep venous thrombosis (four cases) a computer tomography scan (CT) of the pelvis and abdomen was performed to define the extension of DVT. In all 17 (100%) cases a high ligation (crossectomy) and in four (23.5%) cases a venous thrombectomy was performed. In all of these four cases the DVT was limited to the common femoral vein. In all seventeen procedures including venous thrombectomy there was no mortality and no relevant morbidity. Mean hospitalization time was 3.1 days for crossectomy with thrombectomy, and 1.8 days for crossectomy alone. Follow-up has been so far uneventful (mean follow-up time being 12 months in the case of a DVT). In the literature there is no clear concept of how to treat, conservatively or operatively, ascending thrombophlebitis. The surgical procedure can be performed under local anesthesia, and it is safe and efficient.

Adult↗
PubMed1993

The incidence of deep venous thrombosis in patients with superficial thrombophlebitis of the lower limbs.

PURPOSE: The purpose of this study was, first, to determine the incidence of underlying occult deep venous thrombosis (DVT) in patients with superficial thrombophlebitis and, second, to see if any risk factors are helpful in identifying these patients. METHODS: Forty-four consecutive patients with a clinical and duplex ultrasound-confirmed diagnosis of superficial thrombophlebitis were assessed for DVT. All patients had a duplex ultrasound study of the deep venous system. Standard thrombosis risk factors were assessed for each patient. RESULTS: Ten patients (23%) had DVT. All cases were clinically occult. One patient had propagated thrombus in the common femoral vein. Three patients had popliteal vein thrombi. The remaining patients had calf vein thrombus only. Four of these were not in continuity with the superficial thrombus. The site of the superficial thrombophlebitis was not predictive of DVT. None of the known venous thrombotic risk factors were helpful in identifying patients at risk for DVT. CONCLUSION: Noninvasive deep venous studies are recommended in all patients with lower limb superficial thrombophlebitis because of the high incidence of occult DVT. Patients with DVT can then be treated appropriately.

Female↗
PubMedDate not supplied

Do heparin, hydrocortisone, and glyceryl trinitrate influence thrombophlebitis during full intravenous nutrition via a peripheral vein?

The aim of this prospective, randomized study was to determine if the addition of heparin and hydrocortisone, and the application of a topical glyceryl trinitrate patch over the catheter site (triple therapy) would results in a reduced incidence of thrombophlebitis during i.v. nutrition through a peripheral vein. Forty-six patients were randomized to receive either standard i.v. nutrition (i.v.N)(1200 mosm/kg) (control group, n = 23), or i.v.N plus triple therapy (study group, n = 23). The patient's arm was examined daily, and the catheter was removed if signs of thrombophlebitis were evident. The two groups were well matched in terms of age and gender, as well as indication for feeding and total days of i.v.N supplied. The catheters in the study group survived longer (p < .0001), and resulted in a lower incidence of thrombophlebitis (p < .05). The time of onset of thrombophlebitis was delayed in the study group (p < .0001). It is recommended that heparin, hydrocortisone, and a glyceryl trinitrate patch should be administered to all patients receiving i.v. nutrition via a fine-bore peripheral catheter.

Administration, Cutaneous↗
PubMed1988

Infusion thrombophlebitis: a prospective comparison of 645 Vialon and Teflon cannulae in anaesthetic and postoperative use.

A prospective study of the incidence and severity of infusion thrombophlebitis in peripheral intravenous infusions used for anaesthetic and postoperative purposes in 645 patients was conducted over a four-month period. Conditions of insertion were carefully controlled while ward management was according to standard practice. A total of 330 polyurethane Vialon and 315 FEP-A Teflon cannulae were used. The results show that the nature of the cannula was the single most important factor in the incidence and severity of infusion thrombophlebitis, Vialon cannulae being associated with a 46% lower incidence than the Teflon type. Less important but significant factors included intravenous antibiotics, duration of infusion, cannula tip damage and caesarean section. Factors not associated with infusion thrombophlebitis included potassium therapy, blood transfusion or site of insertion in the upper limb. Heparinisation increased duration of infusion without affecting the incidence of infusion thrombophlebitis.

Adult↗
PubMed1980

Diazepam-associated thrombophlebitis: a review and discussion of possible prevention.

Intravenous diazepam is an excellent anxiolytic drug for dental patients. Thrombophlebitis associated with its use has prompted this review. Recognition and management of thrombophlebitis are discussed along with the causes of vascular injury after intravenous diazepam. In two histologic studies, Graham and others thought it unlikely that precipitated crystals of diluted diazepam caused postinjection vasculopathology. It seems to be an inherent property of the vehicle or the drug itself. The reviewed methods of minimizing thrombophlebitis after intravenous diazepam are with hepari flush or saline solution flush, steroids, vein size and venipuncture site, the use of a different vehicle, dilutions, and the use of other benzodiazepines. Lorazepam, midazolam, and flunitrazepam are relatively new benzodiazepines that produce less thrombophlebitis than diazepam after injection. These newer benzodiazepines are still being investigated and more clinical trials must be done to recommend any of them as alternatives to intravenous diazepam in dentistry.

Benzodiazepines↗
PubMed1999

Surgical management of ascending saphenous thrombophlebitis.

BACKGROUND: Acute saphenous vein ascending thrombophlebitis is recognised to be a dangerous condition due to the reported high incidence of deep vein thrombus involvement and possibly fatal pulmonary embolism. We assessed the accuracy of duplex scanning in determining the extent of thrombosis as well as the effectiveness of surgical treatment. METHODS: We retrospectively reviewed 146 patients referred to our Vascular Laboratory for acute superficial thrombophlebitis from 1987 to 1997. Duplex scanning identified 85 cases of superficial thrombophlebitis involving at least a segment of the saphenous vein localised below the knee (58.2%); 37 of thrombophlebitis extending into both the superficial and deep venous systems (25.3%), and 24 of saphenous thrombosis extending to within 5 cm of the saphenofemoral junction (16.4%). The latter group underwent saphenofemoral disconnection. We compared the preoperative duplex with the surgical reports and evaluated the surgical results. RESULTS: We did not observe any complication. Return to work and normal activity occurred within 3-5 days. When varicose vein thrombectomy was performed concurrently, the patients had better postoperative pain control. CONCLUSIONS: Duplex scanning showed 100% accuracy both in determining the presence of thrombosis and its extent. Saphenofemoral disconnection for thrombosis involving the saphenofemoral junction is a safe procedure and can be performed on an outpatient basis.

Anticoagulants↗
PubMed2002

High versus low doses of unfractionated heparin for the treatment of superficial thrombophlebitis of the leg. A prospective, controlled, randomized study.

BACKGROUND AND OBJECTIVES: The optimal treatment of superficial thrombophlebitis of the leg is undefined. The main study objective was to assess the efficacy and safety of unmonitored high doses as compared to low doses of unfractionated heparin (UFH) for prevention of venous thromboembolic complications in patients with superficial thrombophlebitis of the thigh. DESIGN AND METHODS: Sixty consecutive patients with acute thrombophlebitis of the great saphenous vein, as assessed by ultrasonography, were randomized to subcutaneous injection twice daily of UFH in high unmonitored doses (12,500 IU for one week followed by 10,000 IU) or prophylactic doses (5,000 IU) for four weeks. The rate of asymptomatic involvement of the deep venous system and/or symptomatic thromboembolic events during a six-month follow-up period was assessed and compared between the two study groups. RESULTS: Six of the 30 patients (20.0 %; 95% CI, 7.7 to 38.6) randomized to low-dose UFH developed symptomatic or asymptomatic events as compared to 1 of the 30 patients (3.3%; 95% CI, 0.07 to 17.2) who received high-dose UFH (p=0.05 by one-sided Fisher's exact test). No patient experienced major bleeding complications in either group. INTERPRETATION AND CONCLUSIONS: The results of this study suggest that in patients with acute thrombophlebitis of the thigh unmonitored high doses of UFH are more effective than prophylactic doses of UFH for prevention of venous thromboembolic complications and do not enhance the risk of bleeding complications.

Dose-Response Relationship, Drug↗
PubMed1990

Treatment of superficial thrombophlebitis. A comparative trial between placebo, Hirudoid cream and piroxicam gel.

A prospective randomized trial on the treatment of superficial thrombophlebitis has been performed in 68 patients randomized to either Hirudoid cream, piroxicam gel or placebo. Both spontaneous and infusion thrombophlebitis were included. Treatment effect was evaluated using the status of thrombophlebitis, the thrombophlebitic area, pain intensity with a visual analogue scale, and side effects were registered. Both in the treatment groups and the placebo group there was a significant decrease of signs and symptoms during the treatment period. There was no statistical difference between the treatment groups and no difference between spontaneous and infusion thrombophlebitis.

Administration, Topical↗