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PubMed1990

High G training and superficial phlebitis: a case report.

This is a report of bilateral phlebitis in an otherwise healthy 37-year-old male, occurring approximately 96 h post G-tolerance training. Of interest is an episode of significant physical activity occurring between the G-tolerance training and the onset of symptoms of phlebitis. Health care professionals seeing patients post G training need to be aware of unusual possible sequelae, especially vascular in origin. Further information is needed before a causal relationship between G-tolerance training and superficial phlebitis can be demonstrated.

Adult↗
PubMedDate not supplied

[All venous obstructions is not necessarily due to phlebitis. Case report of an ilio-femoral venous leiomyosarcoma].

Venous leiomyosarcoma are rare malignant tumours that are usually revealed by an oedema of the lower limb, a sign of deep phlebitis. As the development is not linked with radiotherapy and chemotherapy, the prognosis depends mainly on a early diagnosis, which brings the best opportunities of complete surgical exeresis before the apparition of metastasis. The case reported below as well as ten other cases taken in the literature show the necessity to mention this diagnosis when confronted to any phlebitis appeared in the absence of usual precipitating factors. It is all the more necessary when mass is found by palpation, a small tumour is revealed by echography or when phlebography shows a lateral or circumferencial stricture that is different from usual pictures of phlebitis.

Diagnosis, Differential↗
PubMed1995

Studies in phlebitis. VII: In vitro and in vivo evaluation of pH-solubilized levemopamil.

We describe a computational model and an in vitro experiment for assessing whether or not a pH-solubilized drug has the potential to precipitate upon dilution with blood. The computational model enables an efficient means of selecting buffer concentration and pH, and the in vitro test provides a simple experimental validation. Both means of screening are applied to the formulation of the weakly basic drug levemopamil-HCI. A buffered formulation of levemopamil is chosen from the computational model and shown to be free of precipitation upon dilution in vitro and to not produce phlebitis in the rabbit ear model. In comparison, an unbuffered formulation at the same pH and drug concentration precipitates in vitro and causes significant phlebitis in vivo. The results of this study reinforce the importance of buffering parenteral formulations instead of simply adjusting the pH of the formulation.

Animals↗
PubMed1977

Recurrent gouty phlebitis without articular gout.

A case of recurrent, superficial phlebitis in the lower extremities, with raised blood uric acid levels, responsive to colchicine and to urate pool depletion, but unassociated with articular complaint is reported. The possibility that such a phlebitis may represent an isolated, critical manifestation of acute gout is stressed.

Acute Disease↗
PubMed2000

Isolated granulomatous phlebitis: rare cause of ischemic necrosis of the colon: report of a case.

Isolated phlebitis of the gastrointestinal tract is rare and potentially life threatening. We report on a patient who developed peritonitis, requiring emergency laparotomy, total colectomy, and ileostomy because of colon necrosis. The specimen displayed multiple ulcerations and erosions. Histology showed a predominantly lymphocytic infiltrate of small-sized and middle-sized veins in the submucosa and subserosa, associated with granulomas and foci of vein wall necrosis. Arteries were spared. No local recurrence or systemic vasculitis developed during a follow-up period of two years. Isolated granulomatous phlebitis seems to be self-limited, and its cause is unknown. Surgical resection of the diseased intestine is usually curative.

Colectomy↗
PubMed1986

Prevention of superficial phlebitis during peripheral parenteral nutrition.

Fifty-four patients receiving peripheral parenteral nutrition consisting of 3.5 percent amino acids in a 5 percent dextrose solution were randomly assigned in a double-blind fashion to receive this solution with or without an antiphlebitic mixture (1000 IU heparin, 5 mg hydrocortisone, and 1.8 mEq sodium hydroxide as a buffer). The addition of antiphlebitic mixture resulted in a marked and highly significant reduction in the incidence of phlebitis and a prolongation of the number of phlebitis-free hours during infusion of peripheral parenteral nutrition (p less than 0.005).

Aged↗
PubMed1998

Dilution is effective in reducing infusion phlebitis in peripheral parenteral nutrition: an experimental study in rabbits.

To clarify conflicting clinical results that had been reported as to whether dilution is effective or not in reducing infusion phlebitis, this study was undertaken. We undertook two experiments with the different infusion conditions in rabbits to confirm the generality and the reproducibility of the results. To test the effect of dilution, 120 mL/kg of solution A (784 mOsm/kg) was infused into rabbit ear veins at 10 mL.kg-1.h-1 for 12 h, and 144 mL/kg of 1.2-fold-diluted solution A (648 mOsm/kg) was infused at 12 mL.kg-1.h-1 for 12 h. Similarly, 120 mL/kg of solution B (718 mOsm/kg) was infused at 5 mL.kg-1.h-1 for 24 h, and 168 mL/kg of 1.4-fold-diluted solution B (514 mOsm/kg) was infused at 7 mL.kg-1.h-1 for 24 h. The infused veins were sampled 24 h after the end of the infusion and examined histopathologically. After the 12-h infusion, phlebitic changes were observed in six of eight rabbits given solution A but in only one of eight rabbits given diluted solution A, although the same quantities of the same nutrients were infused. Also, after the 24-h infusion, phlebitic changes were observed in six of eight rabbits given solution B but in no animals given diluted solution B. The same result that dilution reduced or eliminated phlebitic changes was confirmed in the different conditions. These results suggest that osmolality of the infusion solution is an important factor in the development of phlebitis regardless of infusion volume or infusion rate and that dilution is effective in reducing the phlebitic potential of infusion solutions.

Animals↗
PubMed2003

Effect of transdermal glyceryl trinitrate and anti-inflammatory gel in infusion phlebitis.

BACKGROUND: Phlebitis is the commonest complication of intravenous infusion. It has been suggested that it is initiated by venoconstriction at the infusion site, hence treatment with a vasodilator may reduce its incidence. METHODS: A prospective controlled study was carried out on the effect of transdermal glyceryl trinitrate (GTN) and topical anti-inflammatory gel (non-steroidal anti-inflammatory drug; NSAID) on the survival of peripheral intravenous infusion in 386 patients. RESULTS: A total of 34.9% (43 out of 123) of the infusions failed in the control group compared with 14.1% (18 out of 127) in the NSAID group (P < 0.05) and 30.8% (43 out of 136) in the GTN group (P < 0.05). In the control group 31 positive cultures were obtained. Twenty-one positive cultures were obtained in the GTN group and four cases of bacterial proliferation were observed in the NSAID group. CONCLUSIONS: Infusion phlebitis is a common problem in hospitalized patients and its incidence can be effectively reduced by NSAI gel and GTN but NSAI gel is more effective than GTN.

Administration, Cutaneous↗
PubMed1992

[Ultrasonographic findings in varicose phlebitis of the great saphenous vein. Evidence of thrombus growth and detachment with asymptomatic lung embolism].

In five women (mean age 58 [31-74] years) with clinically diagnosed varicose phlebitis of the long saphenous vein appositional thrombus growth was demonstrated by serial ultrasonography (B-mode compression and colour-coded duplex sonography). In one patient the appositional thrombus was found to be free-floating as far as the common femoral vein, but this was not seen by phlebography. During therapeutic heparinization there was ultrasonographic evidence of softening and partial liquefaction of thrombus material in a cranial direction. There were no clinical signs of pulmonary embolism, but pulmonary perfusion scintigraphy demonstrated perfusion deficit characteristic of emboli. Four of the five patients had a surgical crossectomy and partial saphenous vein resection. The congruence between ultrasonographic and macro- as well as micropathological findings demonstrates the great value of B-mode and duplex ultrasound examination in the area of the epifascial veins. Ultrasonography should be performed in every case of varicose phlebitis of the large veins to exclude the presence of apposition thrombi.

Adult↗
PubMed2004

Enterocolic lymphocytic phlebitis with lymphocytic colitis, lymphocytic appendicitis, and lymphocytic enteritis.

We describe a 53-year-old man with a history of diarrhea temporally related to the use of flutamide. He developed an acute abdomen, and presented with an ileocecal intussusception due to an edematous ischemic cecum. The ischemia was due to enterocolic lymphocytic phlebitis (ELP), with numerous associated thrombi. The phlebitis involved not only the ischemic area but also the grossly unaffected areas, including the entire right colon, terminal ileum, and appendix. All layers of the bowel wall were involved. Mesenteric veins were also prominently affected, but the arteries were spared. This rare form of vasculitis was associated with a marked lymphocytic infiltrate involving the epithelium of the entire right colon, ileum, and appendix. This is the first reported case of ELP occurring in conjunction with lymphocytic colitis, lymphocytic enteritis, and lymphocytic appendicitis. The temporal association of the patient's symptoms with flutamide use suggests that this peculiar form of lymphocytic inflammation of the veins and mucosa likely represents a drug reaction. We suggest that some cases of lymphocytic colitis may also be associated with ELP but are unlikely to be recognized unless affected submucosal vessels happen to be included in the biopsy.

Appendicitis↗
PubMed2004

Chronic antral ulcer associated with gastroduodenal lymphocytic phlebitis.

Enterocolic lymphocytic phlebitis (ELP) is a rare cause of gastrointestinal ischemia. Unlike most vasculitic diseases affecting the gastrointestinal tract, ELP involves only the mural and mesenteric veins, which are surrounded by a lymphocytic and sometimes granulomatous infiltrate. The mesenteric arterial system and the systemic vasculature are characteristically spared. Most patients with ELP present with an acute abdomen that resolves following surgical resection of the involved bowel. ELP has been reported to involve the small bowel, colon, or both, but involvement of the upper gastrointestinal tract has not been previously described. Here we report a case of lymphocytic phlebitis that affected only the stomach and duodenum. The patient, a 68-year-old man, had a nonhealing gastric antral ulcer and underwent hemigastrectomy with vagotomy and Billroth II reconstruction. Both the resected stomach and duodenum showed characteristic lymphocytic and granulomatous infiltrates that involved the submucosal and mural veins, with associated obliteration of vascular lumina; the adjacent arteries were completely spared. The patient developed late postoperative complications including bile reflux gastritis and erosive esophagitis, but he had no recurrence of gastrointestinal ulceration or ischemia over a 2-year follow-up. We hypothesize that there may be more cases of upper gastrointestinal ELP than are diagnosed as such, in part because the diagnosis can be made only on surgical resections specimens.

Aged↗
PubMed1980

Suppurative Candida phlebitis of a peripheral vein.

A patient receiving total parenteral alimentation through a central catheter developed fatal candida sepsis originating from suppurative phlebitis of a peripheral vein. This case underscores the importance of aggressively pursuing all potential endovascular sources of fungemia in susceptible patients: those on antibiotics, with chemical phlebitis, and hyperglycemia.

Adult↗
PubMed1972

Relative incidence of phlebitis caused by continuous intravenous infusion of cephapirin and cephalothin.

In a single-blinded study, two groups of 10 healthy subjects were given cephapirin or cephalothin by continuous intravenous infusion for 5 days, 0.5 g every 6 hr for the first day and then 1.0 g every 6 hr for 4 days. Eight of the cephalothin subjects and two of the cephapirin subjects developed phlebitis. Phlebitis was more severe in the cephalothin group and developed more rapidly, necessitating vein changes six times more often than in the cephapirin group. The less irritating properties of cephapirin demonstrated in this study indicate it may be the more useful cephalosporin analogue for intravenous therapy.

Acetamides↗
PubMed1984

Septic pulmonary emboli secondary to internal jugular vein phlebitis (postanginal sepsis) caused by Eikenella corrodens.

Postanginal sepsis is the term used to describe the life-threatening infection caused by suppurative phlebitis of the internal jugular vein secondary to infection of the parapharyngeal spaces. This begins with a history of pharyngitis followed by infection of the parapharyngeal spaces, septic pulmonary embolism, and septicemia caused by hematogenous dissemination of the infection. The oral anaerobes are the most common pathogens associated with this syndrome. Recently, we managed 2 patients who had septic pulmonary embolism from postanginal sepsis syndrome caused by Eikenella corrodens. Previously, E. corrodens has not been described in association with this syndrome. The clinical presentation, anatomic, bacteriologic, and management aspects of postanginal sepsis syndrome are reviewed based on our experience with these 2 cases. In patients with clinical evidence of septic pulmonary embolism, particularly in the nonintravenous drug abusers, postanginal sepsis and septic jugular phlebitis have to be considered as a source of septic pulmonary embolism.

Adolescent↗
PubMed1976

Painful leg syndrome (pseudo-phlebitis).

Lower extremity venography is essential to confirm the diagnosis of phlebitis when the clinical situation is not completely typical. 8 patients are presented, 6 of whom had been given prolonged prior anticoagulant therapy for phlebitis and pulmonary embolus. Normal venograms and reassurance led to resolution of symptoms in all cases.

Adult↗
PubMedDate not supplied

Evaluation of unaccountable phlebitis with the long arm silastic catheter.

This study was initiated to identify the causal factor responsible for the development of "unaccountable phlebitis" when using the long arm silastic catheter. Use of computerized axial tomography has provided a means of analyzing veins containing indwelling silastic catheters of the upper arm. Physical data of diameters of the veins are limited to inaccuracies of the machine and must only be regarded as relative. We have been able to detect a great variability of cross-sectional vein diameter and area within any one patient. This narrowing tends to occur in the mid-upper arm region and may explain the occurrence of "unaccountable" phlebitis in this area. It appears that laminar blood flow and flotation of the catheter in the vein is inhibited in these areas of narrowing.

Arm↗
PubMed1992

Heparin and infusion phlebitis: a prospective study.

OBJECTIVE: To determine whether heparin sodium, when added to fluids infused through a peripheral catheter, reduces some local catheter-related problems (i.e., phlebitis, catheter obstruction, and extravasation of fluid) and extends the catheter's useful life. DESIGN: Prospective, double-blind, placebo-controlled. SETTING: Internal medicine ward of a general hospital with 400 beds. PATIENTS: Eighty-one consecutive acute collaborating patients who had a venous catheter in the forearm, inserted by nurses with more than one year of professional experience. INTERVENTION: Heparin sodium 1000 units/mL or NaCl 0.9% was added to compatible infusion fluids just before they were given to the patients. The final concentration of heparin was 1 unit/mL. MEASUREMENTS: Length of time until catheters were removed and reasons for their removal. RESULTS: The heparin group had a lower rate of local catheter-related problems than the placebo group (34.3 vs. 61.5 percent, respectively, p less than 0.05; 95 percent confidence interval for the difference 4.3 to 50.1 percent). The catheter's mean life in the heparin group was longer than that of placebo group (98.9 +/- 55.2 vs. 66.2 +/- 47.2 h, respectively, p less than 0.05; 95 percent confidence interval for the difference 9.15 to 56.25 h). This effect was mainly attributable to prevention of noninflammatory catheter-related problems (e.g., obstruction, extravasation) and to a delay in the appearance of phlebitis. CONCLUSIONS: Heparin sodium, when added to infusion fluids to a final concentration of 1 unit/mL, diminishes local intravenous catheter-related problems and extends the catheter's life.

Aged↗
PubMed1984

Adherence of bacteria to pediatric intravenous catheters and needles and its relation to phlebitis in animals.

The adherence of bacteria to pediatric IV catheters and needles was studied. Scanning electron micrographs showed that bacteria adhered well to the catheters and needles, mainly to non-smooth surface areas. In vitro quantitative determination, with the use of radiolabeled bacteria, revealed differences in the affinity of bacteria for the various IV cannula materials. The adherence per square area was greatest for plastic catheters, less for steel needles, and least for siliconized needles. Mean values for the adherence of Staphylococcus aureus to these cannulae were 37.9-40.3 X 10(5) bacteria/cm2 for the plastic catheters; 10.2 X 10(5) bacteria/cm2 for the steel needles, and 7.2-7.6 X 10(5)/cm2 for the siliconized needles. Removal of the glutaraldehyde-fixed bacteria adhered to the cannulae, after their placement in veins of rabbits, was lower for the plastic catheters than the IV needles. The appearance and severity of venous phlebitis produced by the various cannulae was determined in an animal model. The degree of the inflammatory response elicited correlated with the in vitro bacterial adherence, indicating that bacterial adherence plays a role in the appearance of cannula-associated phlebitis. In view of our results and other previous observations of lower rate of infections with the use of IV needles, it is suggested that needles should be preferred to plastic catheters whenever possible. The described in vitro assay for bacterial adherence can be used to determine the adherent properties of IV cannulae, which should be considered in any future cannula design.

Adhesiveness↗