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PubMed1988

Are anaerobic bacteria involved in peripheral vein catheter associated thrombophlebitis?

While thrombophlebitis is a common complication of intravenous therapy, infection has been shown to be a cause of this problem in only a minority of cases. However, the methodology employed in the past would not have detected the anaerobes as a cause of this problem. As anaerobes are associated with thrombophlebitis in situations such as septic pelvic thrombophlebitis, we undertook a study to see if they might also be involved in thrombophlebitis associated with peripheral vein catheters. We prospectively studied 26 episodes of peripheral intravenous catheter associated thrombophlebitis. These catheters were all cultured under aerobic conditions by the semiquantitative technique on blood agar plates. In addition, they were promptly processed and cultured under optimal anaerobic conditions. In none of the episodes of thrombophlebitis were the catheters positive on semiquantitative culture. In addition, we did not show the presence of anaerobes on any of these catheters. We conclude that there is no evidence that anaerobes are associated with peripheral vein thrombophlebitis.

Bacteria, Anaerobic↗

PubMed1981

The surgical treatment of superficial thrombophlebitis.

Of 3,941 patients who underwent varicose vein surgery from 1968 through 1978, 163 had superficial thrombophlebitis, a common complication of varicose veins. Superficial thrombophlebitis was more frequently found in the older age groups. The incidence of occurrence (three women to one man) was identical to that of the overall group operated on for varicose veins. Twenty-two percent of the patients had thrombophlebitis that extended into the saphenous vein at or near the saphenofemoral juncture. Superficial thrombophlebitis was more frequently located in the varicosities below the knee instead of above the knee. The prolonged duration of superficial thrombophlebitis and the recurrent attacks suggest that thrombophlebitis can be chronic, recurrent, or subacute and may remain a threat as long as the varicosities are present. Review of these 163 patients, 161 of whom have been followed up from 1 to 12 years (average 5 years), who were consecutively treated by surgical excision of the thrombosed segments, with excision or stripping of the remaining varicosities, underscores the clinical impression that the surgical removal of the thrombosed vein segments and the associated varicosities shortens the convalescence and mitigates against later recurrence. This form of treatment was accomplished without death or significant morbidity, except for two patients who had clinical suspect nonfatal minor pulmonary emboli during the postoperative hospital period. Prophylactic anticoagulants were used in most patients. Surgical removal of the varicosities with excision of the thrombosed veins is currently our preferred treatment for superficial thrombophlebitis in otherwise healthy patients.

Adult↗

PubMed1997

Superficial thrombophlebitis and deep vein thrombosis. A controversial association.

BACKGROUND: Superficial thrombophlebitis is a common and benign disease. However, an association with deep vein thrombosis, a more severe condition that requires anticoagulant treatment, has been reported repeatedly with frequencies ranging from 12% to 44%. METHODS: All consecutive records of patients with lower limb superficial thrombophlebitis were retrieved from the laboratory database over a 6-year period (1989-1994), and association with deep vein thrombosis was sought. Also, to detect late events, consultations were registered over a 3-month period after the initial examination. Patients with the association of superficial thrombophlebitis and deep vein thrombosis were also compared with a randomly selected sample of subjects with superficial thrombophlebitis only. RESULTS: Objectively confirmed deep vein thrombosis was detected in 31 patients (5.6%; 95% confidence interval, 3.8%-7.9%). Additional late thromboembolic events were detected in 1.7% of the patients during the 3-month follow-up period. Previous immobilization was more common among patients with deep vein thrombosis associated with superficial phlebitis (11/31, 36%) than among a randomly selected subset of patients with superficial thrombophlebitis only (13/93, 14%), the difference being statistically significant (P < .02). CONCLUSIONS: When large populations of patients with superficial thrombophlebitis are studied, the association with deep vein thrombosis appears rather small. Thus, systematic screening for deep vein thrombosis may not be warranted in the presence of superficial thrombophlebitis unless additional risk factors (eg, immobilization) are present.

Adult↗

PubMed1999

Puerperal septic pelvic thrombophlebitis: incidence and response to heparin therapy.

OBJECTIVE: Before the availability of modern imaging studies the diagnosis of septic pelvic thrombophlebitis causing prolonged puerperal fever was difficult to confirm without surgical exploration. With the use of computed tomography infection-related pelvic phlebitis can now be confirmed, and this study was designed to determine its incidence after delivery. We also designed a randomized clinical trial to evaluate the efficacy of heparin added to antimicrobial therapy for treatment of women with septic phlebitis. STUDY DESIGN: We studied women who had pelvic infection and fever that persisted after 5 days despite adequate antimicrobial therapy with clindamycin, gentamicin, and ampicillin. After giving consent study participants underwent abdominopelvic computed tomographic imaging. Women with pelvic thrombophlebitis were randomly assigned to 1 of 2 management schemes that included continuation of antimicrobial therapy, either alone or with the addition of heparin, until the temperature was </=37.5 degrees C for 48 hours. RESULTS: During the 3-year study period 44,922 women were delivered at Parkland Hospital; among these 8535 (19%) were delivered by the cesarean route. There were 69 women who met criteria for prolonged infection, and 15 (22%) of these were found to have septic pelvic thrombophlebitis. Four had infection after vaginal delivery and 11 had been delivered by the cesarean route. Of 14 women randomly assigned to therapy, 8 were assigned to receive continued antimicrobial therapy without the addition of heparin and the other 6 were assigned to receive heparin therapy in addition to the antimicrobial agents. According to an intent-to-treat analysis there was no significant difference between the responses of women with pelvic infection who were and were not given heparin therapy. Specifically, women not given heparin were febrile for 140 +/- 39 hours compared with 134 +/- 65 hours for women who received heparin (P =.83). Duration of hospitalization was also similar between the 2 groups at 10.6 +/- 1.9 days for those with thrombosis who were given antimicrobial agents alone and 11.3 +/- 1.2 days for women who also received heparin (P >.5). The 54 women with persistent fever but without computed tomographic evidence of septic pelvic thrombophlebitis were hospitalized for a mean of 12.0 +/- 4.1 days, compared with 10.9 +/- 2.9 days for women in whom thrombosis was diagnosed (P =.14). These women were followed up for >/=3 months post partum and none showed evidence of reinfection, embolic episodes, or postphlebitic syndrome. CONCLUSIONS: The overall incidence of septic pelvic thrombophlebitis was 1:3000 deliveries. The incidence was about 1:9000 after vaginal delivery and 1:800 after cesarean section. Women given heparin in addition to antimicrobial therapy for septic thrombophlebitis did not have better outcomes than did those for whom antimicrobial therapy alone was continued. These results also do not support the common empiric practice of heparin treatment for women with persistent postpartum infection.

Adult↗

PubMedDate not supplied

Bilateral suppurative thrombophlebitis due to Staphylococcus aureus.

Suppurative thrombophlebitis is an infection of the wall of a superficial vein, usually is associated with intravenous catheter placement, and accounts for about 10% of all nosocomial infections. Suppurative thrombophlebitis occurs most commonly in patients with burns, patients with cancer, and persons receiving steroids. Skin flora organisms (e.g., Staphylococcus aureus and to a lesser extent Enterobacteriaceae) are the most common pathogens. Suppurative thrombophlebitis should be suspected when a patient having phlebitis presents with a temperature of 102 degrees F or higher. The diagnosis of suppurative thrombophlebitis is usually straightforward and made by demonstration of pus coming from the wound of the removed intravenous device or by aspiration of pus percutaneously from the involved vein. Treatment of superficial suppurative thrombophlebitis consists of venotomy of the affected vessel and systemic antimicrobial therapy. We present a case of S. aureus bilateral suppurative thrombophlebitis, which is most unusual.

Arm↗

PubMed1991

[Deep-vein thrombophlebitis and pulmonary embolism as a sign of malignant disease].

In five meticulously controlled investigations, the question of whether deep thrombophlebitis and pulmonary embolism may be signs of occult cancer was raised. One investigation was considered to be of doubtful value on account of selection. In two other investigations, an increased risk for cases of cancer was found among patients under the age of 50 years in whom suspicion of thrombophlebitis was confirmed and among patients with verified suspicion of pulmonary embolism. Two investigations reveal that the risk of cancer is particularly great if no risk factor for deep thrombophlebitis (so-called idiopathic deep thrombophlebitis) was found. In one of these investigations, problems concerning blinding were, however, present and the possible solution is not commented upon. On the present basis, arguments exist for a paraclinical investigation of patients with idiopathic deep thrombophlebitis or with pulmonary embolism. Investigation is probably only necessary in other patients with deep thrombophlebitis if symptoms suggestive of cancer are present and patients under the age of 50 years should be offered outpatient control in view of the possibility of cancer.

Age Factors↗

PubMed1989

[Pathogenesis, diagnosis and therapy of thrombophlebitis and varicophlebitis].

Thrombophlebitis is defined as thrombotic inflammation of a previously healthy superficial vein, varicophlebitis as that occurring in varicosities. The latter appears responsible for the majority of thrombotic venous occlusions. In contrast to venous thrombosis, the thrombotic involvement of deep veins, thrombophlebitis usually resolves without sequel and, in general, thrombophlebitis nor varicophlebitis are associated with the risk of pulmonary embolism. The clinical presentation of thrombophlebitis is that of a tender, hardened superficial vein which, in the presence of inflammation, may be very painful. The lower extremities are most frequently involved. Differential diagnostic considerations include bacterial cellulitis and lymphangitis. The cause of thrombophlebitis, which is rare without precipitating factors, may be a mechanical lesion such as kinking of the vein or trauma to the wall of the vein as well as other primary disease such as auto-immune afflictions, endangiitis obliterans or malignancy; in particular, with localization in the area of the rump, with concomitant occurrence in various regions or extending phlebitis, paraneoplastic syndromes and hemoblastoses should be ruled out. Rarely, phlebitis may be associated with tuberculosis and syphilis. Thrombophlebitis may be caused iatrogenically by improper application of chemical substances which cause damage to the venous walls as well as by indwelling catheters or cannulas. This form can progress to sepsis and pulmonary embolism may be incurred. Varicophlebitis, in contrast, accounts for about 90% of all cases of phlebitis and can be regarded as a typical late complication of varicosities in the superficial venous system.(ABSTRACT TRUNCATED AT 250 WORDS)

Bandages↗

PubMed1991

A randomised study of the effects of osmolality and heparin with hydrocortisone on thrombophlebitis in peripheral intravenous nutrition.

Intravenous nutrition administered via the central route incurs both the risks of catheter insertion and catheter related sepsis. Peripheral intravenous nutrition avoids these risks but is associated with a high risk of thrombophlebitis. We undertook a study to look at the incidence of thrombophlebitis caused by the infusion of a) a 'ready to use' mixture (Vitrimix KV) with an osmolality of 1130 mOsmol/kg, b) Vitrimix KV plus heparin and hydrocortisone, and c) a feed, with an osmolality of 700 mOsmol/kg, with heparin and hydrocortisone, to investigate the effects of the addition of heparin and hydrocortisone and the effect of osmolality on the incidence of thrombophlebitis. The addition of heparin (500 u/l) and hydrocortisone (5 mg/l) to Feed A significantly reduced the daily risk of thrombophlebitis from 0.43 to 0.11 episodes per patient, p < 0.01. A reduction in the osmolality resulted in a further fall in the incidence of thrombophlebitis to 0.04 episodes per patient with a significant increase in the median life span of the cannula from 26 h to 86 h, p < 0.02. Our data show that a low incidence of thrombophlebitis can be achieved by the use of a low osmolality feed with heparin and hydrocortisone. It is recommended that peripheral intravenous nutrition be used in patients who require nutritional support for less than 10 days.

Journal Article↗

PubMed1993

[Cerebral thrombophlebitis disclosing Behçet disease. Value of high resolution MRI].

A 21-year-old male of Moroccan descent was admitted for inflammatory polyarthralgia and monoarthritis of the left knee. The patient reported a history of recurrent isolated aphthous ulcerations of the oral cavity. He was found to be positive for the HLA B5 antigen. The other investigations for Behçet's disease were negative. During hospitalization, headache responsible for insomnia developed. Neurologic evaluation was normal, as well as funduscopy and spinal tap findings. CT scan images were suggestive of cerebral thrombophlebitis. Magnetic resonance imaging (MRI) disclosed an old thrombosis of the right transverse sinus. Time-of-flight MRI (MRI with sequences adapted to the study of vessels) evidenced recent thrombophlebitis of the left transverse sinus. Cerebral angiography fully confirmed MRI findings. Treatment with a corticosteroid and an anticoagulant was successful. Final diagnosis was Behçet's disease. Subsequently, the patient developed additional features of the disease, including hypersensitivity to pinprick, retinal vasculitis, and erythema nodosum. This case is interesting for two reasons: cerebral thrombophlebitis in Behçet's disease can manifest as localized headache. It occurs in 6 to 13% of patients. Early diagnosis and treatment are essential; MRI features of cerebral thrombophlebitis were confirmed by the cerebral angiogram. MRI established that the thrombophlebitis was of recent onset. MRI may be appropriate as the initial investigation in patients with suspected cerebral thrombophlebitis.

Adult↗

PubMed1983

A trial of povidone-iodine ointment for the prevention of cannula thrombophlebitis.

The efficacy of povidone-iodine ointment in the prevention of cannula thrombophlebitis was assessed in a prospective controlled study of 100 consecutive patients. Thrombophlebitis was evaluated clinically, and in addition all cannulae were cultured, semi-quantitatively and by the conventional broth technique, to detect any bacterial colonization. The incidence of thrombophlebitis was slightly higher in the test than in the control group. It is concluded that the use of povidone-iodine ointment for prophylaxis does not reduce the incidence of cannula thrombophlebitis. There was no significant association between the incidence of thrombophlebitis and cannula colonization as measured by either the semi-quantitative technique or the conventional broth technique.

Adult↗

PubMed1989

The use of intravenous cannulae and the occurrence of thrombophlebitis.

The occurrence of thrombophlebitis in a coronary care unit was studied in relation to the use of short plastic intravenous cannulae. The incidence of thrombophlebitis was 51% in cases where cannulae were used for continuous infusion of glucose 5% and 13% for cannulae which were locked after the injection of heparin. Only one case of infectious thrombophlebitis was seen. The other cases of thrombophlebitis had a chemical or mechanical aetiology. Replacement of glucose 5% by a NaCl 0.9% solution for continuous infusion reduced the incidence of thrombophlebitis to 33%. Heparin-locked cannulae, to provide rapid access to the patient's circulation, proved to be a safe alternative to continuous infusion.

Catheterization↗

PubMed1975

Infusion thrombophlebitis and infection with various cannulas.

A prospective study was carried out of the frequency of thrombophlebitis and bacterial contamination of cannulas associated with four commonly used intravenous cannulas of differing length and chemical composition. For all cannulas the frequency of thrombophlebitis increased significantly with time. Long 'Teflon' cannulas were significantly more likely to be contaminated with bacteria and associated with thrombophlebitis than all other cannulas, while the low frequency of thrombophlebitis with butterfly stainless steel cannulas was shown to be due to their short duration of use. It is suggested that long teflon cannulas should be avoided and that infusion thrombophlebitis could be eliminated as a clinical problem by the use of intermittent short duration intravenous infusions.

Bacteriological Techniques↗

PubMed1985

Diagnosis of septic pelvic thrombophlebitis by measurement of fibrinopeptide A.

Septic pelvic thrombophlebitis is an uncommon but potentially life-threatening complication of puerperal endometritis. The lack of specific physical findings necessitates a diagnosis based by exclusion on the patient's response to anticoagulation. Fibrinopeptide A (FPA) is the first peptide cleaved from fibrinogen during thrombin-mediated fibrin generation. Because of its short half-life, FPA accurately reflects the level of ongoing fibrin generation. In a preliminary study of 40 puerperal patients, FPA successfully differentiated puerperal fever secondary to endometritis or abscess from fever responsive to a heparin trial. The mean FPA level in patients presumed to have septic pelvic thrombophlebitis was 23.8 ng/ml as opposed to 7 ng/ml in patients with endometritis. No patient with septic pelvic thrombophlebitis as diagnosed by her response to a heparin trial had a level of FPA less than 14 ng/ml. There was no overlap of FPA levels between patients with endometritis or abscess and septic pelvic thrombophlebitis. The data suggest further prospective evaluation of FPA for the diagnosis of septic pelvic thrombophlebitis is warranted.

Anti-Bacterial Agents↗

PubMed2004

Septic pelvic thrombophlebitis and preeclampsia are related disorders.

OBJECTIVE: To elicit factors associated with the postpartum development of septic pelvic thrombophlebitis in a single large referral tertiary patient population. METHODS: A nine-year single institution retrospective case review of all patients with enigmatic fever and septic pelvic thrombophlebitis was analyzed. RESULTS: A total of 55 patients with septic pelvic thrombophlebitis were provided care during the study interval. The average gestational age at delivery was 36.8 +/- 4.3 weeks. The most prevalent concurrent medical complication of pregnancy was preeclampsia (45%) while chorioamnionitis affected only 13%. The average length of ruptured membranes was 22.8 +/- 56.8 hours (median 10.5, 95% confidence interval [CI] 7.0-38.7 hours), with 22% of patients undergoing amnion rupture at the time of cesarean delivery. Prolonged (>24 hours) amnion rupture occurred in only 9% of patients. Most affected patients were delivered abdominally (91%) but a minority delivered vaginally (9%). Antibiotic therapy for presumed infection was initiated at 27.4 +/- 24.6 hours postpartum. Subsequently intravenous heparin therapy was initiated 128.9 +/- 54.2 hours thereafter enigmatic fever defervesed 37.2 +/- 36.8 hours later (median 34.0, 95% CI 27.2-47.3 hours). Patients received 6.3 +/- 1.8 days of heparin therapy. CONCLUSION: In this series, septic pelvic thrombophlebitis was frequently preceded by cesarean delivery and commonly associated with preeclampsia. Unexpectedly, a small number of patients suffered prolonged rupture of membranes or chorioamnionitis. We speculate that the cesarean delivery of a population of at-risk patients with preeclampsia may predispose them to develop septic pelvic thrombophlebitis.

Anti-Bacterial Agents↗

PubMed2006

Evidence for elective replacement of peripheral intravenous catheter to prevent thrombophlebitis: a systematic review.

AIM: This paper reports a review of the scientific evidence for elective replacement of peripheral intravenous catheters in adults in the absence of any clinical complications, with the aim being to reduce the incidence and severity of thrombophlebitis. BACKGROUND: The incidence of thrombophlebitis associated with peripheral intravenous catheters has been reported to range from 5.3% to 77.5%. Many factors that increase the risk for thrombophlebitis have been reported, of which time in situ is one. In Sweden, the recommended guideline is elective replacement of peripheral intravenous catheters every 12-24 hours. METHOD: A systematic literature review was carried out in 2005 using the Cochrane Library, OvidMedline and CINAHL databases and hand searching of reference lists and with keywords catheterization, peripheral, thrombophlebitis and parenteral nutrition. The review included randomized controlled trials of elective replacement of peripheral intravenous catheters in adults. Three reviewers assessed the data found according to predetermined criteria. FINDING: Three randomized control trials met the inclusion criteria and were retrieved for critical appraisal. The samples in two of the trials included patients requiring total parenteral nutrition. Patients in the third trial were receiving crystalloid and drugs. Time intervals for elective replacement varied. Study quality and relevance were rated as 'medium' in two of the trials and as 'low' in the third trial. CONCLUSION: Limited scientific evidence suggests that elective replacement of peripheral intravenous catheters reduces the incidence and severity of thrombophlebitis.

Catheterization, Peripheral↗

PubMed2005

The epidemiology of peripheral vein complications: evaluation of the efficiency of differing methods for the maintenance of catheter patency and thrombophlebitis prevention.

BACKGROUND AND AIMS: Peripheral vein catheter patency and infusion thrombophlebitis remains a significant problem in everyday clinical practice. The aim of the study was to investigate the epidemiology of peripheral vein complications and to evaluate three different methods for the maintenance of peripheral vein catheter patency and the prevention of vein thrombophlebitis. METHODS: A total of 300 post-operative patients undergoing elective orthopaedic surgery were prospectively studied. Patients were divided into three groups: controls--catheters not flushed following drug administration; saline group--the catheters flushed with 3 mL of normal saline 0.9% after each catheter use; heparin group--the catheters flushed with 3 mL of 100-U/mL heparin in normal saline 0.9% after each catheter use. RESULTS: Complications occurred in 36% of the patients and the incidence of thrombophlebitis was 8% and only 4% in the control group. In the normal saline group there was a significant increase in total complications and obstruction together with thrombophlebitis as compared with the control group. Kaplan-Meier curves demonstrate that the control group had a significantly higher proportion of catheters without complications. CONCLUSIONS: The use of normal saline solutions in post-operative patients thus should be avoided for catheter maintenance. In patients receiving low molecular weight heparin, no intravenous flushing should be used for preventing catheter obstruction or thrombophlebitis in order to reduce costs and nursing workload.

Catheterization, Peripheral↗

PubMed1981

Thrombophlebitis in cancer patients.

Five cancer patients (three with lesions in the lung and one each with breast and head and neck cancer) with multiple metastases developed "migratory thrombophlebitis." These patients were not ambulatory. None of the patients showed a picture of "consumptive coagulopathy," although a "hypercoagulable state" was observed. Fibrinogen levels were normal or increased, FDP were slightly increased, and AT-III was decreased. Prior to heparin therapy, values for PT and PTT were within normal range. Sodium heparin, 30,000 to 36,000 units per day, was administered by continuous intravenous infusion. Despite prolongation of the PTT to twice the baseline levels, signs and symptoms of thrombophlebitis persisted for several days. When thrombophlebitis was controlled with heparin, Coumadin therapy was instituted, but thrombophlebitis recurred at the original site and at new sites, even though the prothrombin time was in the therapeutic range (2 to 2 1/2 times the normal value). The antithrombotic action of heparin depends on a normal quantity of plasma AT-III. Long-term use of heparin is feasible, but the optimal time for discontinuation of heparin treatment has not been established. Heparin is superior to oral anticoagulation therapy to control thrombophlebitis associated with advanced cancer.

Adult↗

PubMed2006

[Treatment of thrombophlebitis by the method of the transplantation of the endothelial cells].

The end XX of century was marked by introduction into the clinical practice of the methods of cellular therapy. Intensive studies on its application for treating the whole series of diseases are conducted. Thrombophlebitis is not an exception in spite of the already existing effective surgical and conservative methods of its treatment. On the rabbits we produced experiments on the treatment of thrombophlebitis of "aseptic" and infectious etiology. The results of complex treatment with the use of autologous vascular endothelial cells were studied. The damaged wall of vein under the conditions of the "aseptic" model of thrombophlebitis, with conducting active complex therapy with the start of antibiotics and trombolitic means is completely covered with endothelium, and only to the place where the dust devils were attached to the walls of vein, defects remain. In these places the wall of vein gradually is extended and undergoes scarring, and the intact sections of vein around the defect are hypertrophied and then they undergo dilatation, being adapted thus to the new conditions of functioning. The transplanted endothelial vascular cells not only modify the process of remodulation of the damaged vein and thus they contribute to averting the dilation of its wall and expansion of scar, but also contribute to the retention of the thickness of the wall of vein. Calculations showed that in the case of "aseptic" etiology the processes of thrombogenesis and treating thrombophlebitis continue more rapidly than in the case of the infectious etiology. The comparison of traditional method of the treatment of thrombophlebitis with the complex (with the application of auto of endothelial cells) showed that the latter is more effective.

Animals↗