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PubMed1991

Single versus double occlusive dressing technique to minimize infusion thrombophlebitis: Vialon and Teflon cannulae reassessed.

Infusion thrombophlebitis is the commonest complication of intravenous cannulation. This study was undertaken to prospectively evaluate a double-occlusive dressing technique and a new cannula, bismuth oxide-Teflon (Critikon Inc., Aust.), comparing it to Vialon (Deseret Medical Inc., Utah, USA). The study group of two hundred patients had a 16 gauge intravenous cannula inserted in theatre using a standard technique. The incidence of thrombophlebitis was determined on a daily basis. Cannula tips were sent for culture on removal. Vialon was found to be superior to Teflon after day 1. Although a double-occlusive dressing technique increased the duration of cannulation (50.9 vs. 41.9 hours, P less than 0.05), there was no difference in the incidence of thrombophlebitis. Neither cannula material nor dressing technique had an influence on the results of cannula tip culture (6% incidence). There was no evidence of bacteraemia in any case.

Bacteria↗

PubMed2003

Protein S deficiency in repetitive superficial thrombophlebitis.

Protein S deficiency is one of the principal congenital thrombophilias reported. The objective of this study was to assess the prevalence of protein S deficiency in patients with repetitive superficial thrombophlebitis. Thirty-six consecutive patients, 28 female and eight male, who presented with repetitive superficial thrombophlebitis (two or more cases); age range, 17 to 58 years, mean, 38.2 years; were evaluated. Coagulometry was used to determine the biologic activity of protein S. In 5.5% of the patients with repetitive superficial thrombophlebitis, protein S deficiency was detected.

Adolescent↗

PubMedDate not supplied

Lesser saphenous vein thrombophlebitis: its natural history and implications for management.

Little attention has been given to superficial thrombophlebitis and particularly to lesser saphenous vein thrombophlebitis (LSVT) by vascular surgeons. A prospective nonrandomized study was conducted to assess LSVT's potential association with deep venous thrombosis (DVT) as well as its natural history. Between January 1994 and December 1995, the authors reviewed 33 cases of LSVT detected by duplex scanning in 32 patients at their institution's vascular laboratory. Combined LSVT/DVT was treated with heparin and warfarin. LSVT alone or LSVT plus greater saphenous vein thrombophlebitis (GSVT) were treated with local warm compresses and nonsteroidal antiinflammatory drugs. Follow-up scans were obtained in 23 of the 32 patients and ranged from 2 weeks to 18 months after diagnosis of LSVT. Thirty-one patients had unilateral LSVT and 1 patient had bilateral LSVT. Isolated LSVT was found in 9 patients (28%), LSVT combined with DVT occurred in 21 patients (65.6%), and 2 patients had LSVT/GSVT. LSVT was contiguous with DVT in 15 patients, and in 5 patients it was noncontiguous. Within 3 months, 9 of 16 patients (56%) with LSVT/DVT had complete or partial resolution of their LSVT, and 1 (14%) of the 7 patients with LSVT and LSVT/GSVT had improved. Within 18 months, 13 of 16 patients (81%) with LSVT/DVT had complete resolution of their thrombus while only 3 of 7 patients (43%) with LSVT and LSVT/GSVT had resolved. These data show that LSVT is more often associated with DVT (65.6%) than previously believed. While most LSVT will improve in 18 months, those associated with DVT will resolve sooner. Whether anticoagulation accounted for this difference remains to be proven.

Adult↗

PubMed1984

Contrast agent induced thrombophlebitis following leg phlebography: iopamidol versus meglumine iothalamate.

A comparison was made of the incidence of venous thrombophlebitis resulting from the use of a high-osmolality contrast medium (Conray 60%, meglumine iothalamate), and a low-osmolality contrast medium (Niopam 61%, iopamidol). In 20 patients Conray was injected into one leg and Niopam into the other. The incidence of thrombophlebitis was then determined using the iodine-125 fibrinogen uptake test in a prospective, randomised, double-blind study. There was significantly less thrombophlebitis with Niopam than with Conray and it is concluded that Niopam is a safer contrast medium for phlebography.

Adult↗

PubMed2004

Thrombophlebitis diagnosed on indium-111 labelled white cell scan.

A 64-year-old lady with type 2 diabetes and a non-resolving right foot ulcer, had an indium-111 labelled white cell scan (indium-111 WCS) to investigate the possibility of underlying osteitis. The scan suggested the possibility of infective thrombophlebitis. Unknown to the clinical team who requested the scan and the radiologist who performed it, the lady was admitted to hospital 2 days following the procedure with cellulitis and septic thrombophlebitis in the right leg. There is only one previous report in the literature of septic thrombophlebitis being diagnosed in this way. Perhaps indium-111 WCS has something to offer in the diagnosis of this condition and in determining those who require antibiotic treatment.

Female↗

PubMed1988

Are patients with multiple sclerosis protected from thrombophlebitis and pulmonary embolism?

To study the incidence of deep venous thrombophlebitis (DVT) and pulmonary embolism (PE) in patients with multiple sclerosis (MS), charts of 228 subjects with multiple sclerosis who constituted 1986 hospital admissions to the Milwaukee Regional Medical Center were reviewed, covering a 3 1/2-year period. The records were investigated for any other hospitalization for deep venous thrombophlebitis and pulmonary embolism. No case of pulmonary embolism or deep venous thrombophlebitis was found. There were over 57,416 non-MS-related admissions during the same interval. Among these patients there were 175 with PE and 258 with DVT. The presence of lower extremity spastic disease may have prevented clotting. This statistically low incidence of thromboembolic events in MS is less than expected, and further studies are warranted.

Adult↗

PubMed1985

Detection of thrombophlebitis in the lower extremities: a regional comparison of 123I fibrinogen scintigraphy and contrast venography.

123I fibrinogen scintigraphy and contrast venography were compared in 43 patients suspected of having thrombophlebitis. A total of 69 legs and 268 regions were available for comparison. Of 43 patients, 31 had venographic signs of thrombophlebitis. When venography was used as a standard, scintigraphy had a sensitivity and accuracy equal to or greater than 90%, regardless of whether the comparison was made for patients, legs, or regions. There was complete agreement in the iliac region between venography and scintigraphy. Beyond inherent differences between the procedures, the few discrepancies between venography and scintigraphy could be explained by circumstances, such as interval between procedures, heparin treatment, limited disease, and procedural deficiencies. The accuracy of 123I fibrinogen scintigraphy, its simplicity, and absence of morbidity make it an attractive diagnostic procedure in patients suspected of having thrombophlebitis. A major limitation of 123I fibrinogen scintigraphy is the lack of general availability of a suitable, commercial radiopharmaceutical at present.

Diagnostic Errors↗

PubMed2006

[Group B streptococcal vertebral osteomyelitis following superficial suppurative thrombophlebitis].

An 80-year-old woman with type II diabetes mellitus was admitted to hospital with high-grade fever and leg pain for the previous three days. Physical examination revealed marked distention of the peripheral veins in both lower legs and she complained of pain. Spontaneous superficial suppurative thrombophlebitis was diagnosed and transfusion of cefazolin every 8 hours was started immediately after blood cultures. After 48 hours, the distention of the peripheral veins was improved; however, she suffered from a severe back pain thereafter. Two sets of blood culture yielded Group B streptococcus. Therefore the antibiotic was changed to ampicillin every 6 hours. To investigate the cause of back pain, MRI of the lumbar vertebral body was taken. Saggital gadolinium T1-weighted MRI demonstrated a high signal intensity lesion from Th7 to Th11, suggesting vertebral osteomyelitis following Group B streptococcal bacteremia from superficial suppurative thrombophlebitis. One week later, the clinical symptoms mostly disappeared. After six weeks of treatment, she was discharged. Suppurative thrombophlebitis is an inflammation of the vein wall by microorganisms and sometimes causes secondary metastatic abscess. Aging and diabetes are also risk factors for group B streptococcal invasive infection. This case suggests vertebral osteomyelitis should be taken into consideration during the course of group B streptococcal bacteremia in an elderly patient complaining back pain.

Aged↗

PubMed1976

Importance of calf vein thrombophlebitis.

Fifty-four patients with phlebogram-proven deep vein thrombophlebitis limited to the tibial and popliteal veins were studied for evidence of pulmonary embolism, both symptomatic and silent. All but two patients were symptomatic of either phlebitis or embolism. Pulmonary embolism, as judged by lung scan defects with V-Q imbalance, changing serial scans, or positive pulmonary angiograms were found in 50%. Popliteal thrombi had an embolism incidence of 66%, whereas tibial thrombi had a 33% incidence. Emboli from the popliteal veins were more extensive than were tibial emboli. Forty-five percent of all emboli were silent. Bilateral phlebitis was accompanied by a 75% incidence of pulmonary embolism. Emboli from tibial veins were minor in five of nine instances, but three instances involved 20% or more of total lung volume and one involved over 40% of total lung volume. These results support the belief that popliteal thrombophlebitis merits anticoagulant therapy. They also suggest caution in the management of tibial vein phlebitis. Objective tests are recommended to monitor for pulmonary embolism and for propagation of the thrombus before deciding to withhold anticoagulants in tibial thrombophlebitis.

Humans↗

PubMed2000

[Superficial thrombophlebitis].

Thrombophlebitis of the superficial veins (SVT) of the leg is usually regarded as a mild and uncomplicated disease. Although this is generally true for acute thrombosis of the branches of the saphenous vein, the natural history of SVT involving the main trunk may not be as benign. The association of SVT with deep venous thrombosis (DVT) has been reported to range from 17 to 40%; the progression of the thrombotic process from the greater saphenous vein into the deep venous system has been reported in 8.6% of the cases. For this reason, even if symptoms of DVT are lacking, it is necessary to use duplex ultrasonography to be certain that DVT does not exist concurrently with SVT. In a recent study we found that saphenous-vein thrombi embolize even when no femoral-vein involvement is evident. Of 21 patients included in the study, findings compatible with a high probability of pulmonary embolism were detected in 7 (33.3%, 95% CI, 14.6 to 57.0), although clinical symptoms were present only in 1. The risk of pulmonary embolism is similarly high in patients with and without thrombosis at the sapheno-femoral junction. These patients presumably would benefit from anticoagulation, but such a benefit remains to be proven. Superficial thrombophlebitis, in the absence of DVT proven by duplex ultrasonography, is generally treated with nonsteroidal anti-inflammatory agents. A prospective randomized study is being carried out at our Institution evaluating therapeutic doses of anticoagulant drugs in SVT. Interim report suggests that, in thrombophlebitis of the thigh, high fixed doses of unfractioned heparin are more effective than low doses for the prevention of early and late venous thromboembolic complications and are not associated with an appreciable bleeding risk.

Acute Disease↗

PubMed2003

[Superficial thrombophlebitis].

Superficial thrombophlebitis is a frequent complication of varicose veins that occurs rarely on normal veins. In the latter case, it may be associated with thrombophilia, cancer or inflammatory disease. Superficial thrombophlebitis is rarely complicated by deep vein thrombosis through extension in the deep vein system. Therefore, depending of its localisation, a venous ultrasound is indicated to evaluate its extension. Treatment is based on elastic compression, non steroid anti-inflammatory drugs and mobilisation. If thrombophlebitis approaches the saphenous junction with the deep vein systems or involves perforans veins anticoagulant treatment is indicated.

Humans↗

PubMed2004

Laparoscopic procedures as a risk factor of deep venous thrombosis, superficial ascending thrombophlebitis and pulmonary embolism--case report and review of the literature.

UNLABELLED: Since its introduction laparoscopic surgery has been used for many indications, e.g., cholecystolithiasis, hernia, appendicitis, fundoplication, benign large bowel disease and gynaecological disorders. It has been considered as safe and efficient procedure for most patients with only few contraindications, mostly heart-lung disease. When the initial enthusiasm has been replaced by a more critical observation, more complications of laparoscopy or laparoscopic surgery were not only discovered but also reported. In laparoscopic hernia repair there is a tendency for severe complications when compared to open surgery. There is a controversy on possible side-effects of laparoscopic surgery, e.g., thrombosis, and the increased necessity of prophylaxis for thromboembolic events. Recently a growing number of reports on thromboembolic complications in association with laparoscopic surgery were published. Thrombosis may be caused by detrimental effects of pneumoperitoneum on venous flow (increased abdominal pressure and negative Trendelenburg position) and activation of the haemostatic system. Further risk factors may contribute to the risk to develop venous thrombosis. It is well accepted that varicose veins are associated with an increased risk for the thrombosis. However, the association of varicose veins with complications of laparoscopic surgery is unclear. The possible impact of thrombotic complications makes an analysis of the association of varicose veins or a history of deep vein thrombosis on the development of thrombosis after laparoscopic surgery mandatory. Although this is the first report on ascending thrombophlebitis and thrombosis of the sapheno-femoral junction after laparoscopic surgery, the incidence of deep vein thrombosis or superficial thrombophlebitis after laparoscopic surgery or laparoscopy may be much higher according to the pathophysiological changes during and after these procedures. In many patients venous thrombosis may not be recognized or it appears when the patient is already discharged. CONCLUSION: Laparoscopy and laparoscopic procedures may have an increased risk for the development of thrombosis due to increased abdominal pressure and negative Trendelenburg position. Patients with varicose veins and a history of thromboembolism may aggravate laparoscopy associated risks for the development of thromboembolic complications. Superficial thrombophlebitis in the thigh is not a benign disease entity and may lead to deep vein thrombosis (DVT) and pulmonary embolism (PE). Urgent surgical treatment (high ligation) may be warranted together with low-molecular weight heparin (LMWH) and compressions therapy. Patients with varicose veins and a history of venous thrombosis may not be suitable candidates for laparoscopic surgery. Family practitioners may be confronted with this complication more often since patients are discharged earlier from hospital after laparoscopic interventions due to legislative regulations.

Diverticulitis, Colonic↗

PubMed1989

[Use of defibrotide in the treatment of acute superficial thrombophlebitis of the legs].

The efficacy of defibrotide in the treatment of acute thrombophlebitis of the legs has been investigated in 140 patients, randomized into two groups. All patients received defibrotide either alone or as an addition to conventional therapies. Two different schemes of administration were selected and carried out in each group, according to the time of onset of thrombophlebitis. Defibrotide demonstrated a good clinical efficacy in both groups, with a highly significant reduction in those patients receiving defibrotide and conventional therapies. The clinical result were outstanding in two subgroups: extensive thrombophlebitis and brachioaxillary phlebitis.

Acute Disease↗

PubMed1989

Surgical management of fungal peripheral thrombophlebitis.

Fungal infection of central venous catheters is well described. Peripheral fungal thrombophlebitis, however, has only been recognized recently, is thought rare, and is poorly characterized as to clinical presentation and treatment. We report the cases of eight patients with peripheral Candida thrombophlebitis. Patients were elderly and critically ill. All had received broad-spectrum antibiotics. Skin colonization appeared the source of contamination. Sepsis, shock, and organ failure were frequent. Physical findings of fungal phlebitis may be subtle, and diagnosis is often delayed. Multiple sites are frequently involved. Treatment necessitates radical excision of suspected veins and systemic antifungal chemotherapy. Persistent fungemia suggests inadequate phlebectomy or the existence of further affected veins. Peripheral thrombophlebitis is probably a common source of fungal sepsis and should be considered in all patients with fungemia. Without aggressive surgical intervention, survival is unlikely.

Aged↗

PubMed1979

[Treatment of acute thrombophlebitis of the lower limbs with long-term intraosseous drug infusions].

Under analysis are the results obtained in 62 patients with acute thrombophlebitis of lower extremities treated by prolonged intraosseous heparin-penicillin blockade. The acute inflammatory phenomena along the veins subsided within 2-6 days. The complete cure was observed 1,5-6,5 days earlier in cases with superficial thrombophlebitis and 4-15 days earlier in profound thrombophlebitis as compared with control.

Adolescent↗

PubMed1981

Surgical approach to extensive suppurative thrombophlebitis of the central veins of the chest.

Suppurative thrombophlebitis is a potentially lethal intravascular infection associated with the usage of intravenous catheters. Conventional approaches to management include ligation and excision of involved venous structures. These measures may not be feasible in all situations. This paper describes the successful medical/surgical management of a patient with suppurative thrombophlebitis of the major vessels of the chest. When suppurative thrombophlebitis extends into the large central veins and antibiotic therapy fails, surgical intervention may be necessary.

Adolescent↗

PubMed1981

Suppurative thrombophlebitis in childhood.

Thrombophlebitis in children is almost always related to intravenous therapy. In most cases the inflammatory reaction is self-limited and resolves when the intravenous catheter or needle is removed. In some cases contamination may result in suppurative thrombophlebitis, a potentially life-threatening complication of intravenous therapy. This report describes two-6-year-old children with suppurative thrombophlebitis that was successfully treated by drainage of periphlebitic abscess and excision of the infected vein. Early recognition and prompt surgical management should reduce morbidity and prevent mortality in these cases.

Arm↗

PubMed1980

Thrombophlebitis in the elderly.

Treatment of the elderly patient can be significantly compromised by complications which are less troublesome in younger individuals. In the authors' experience this has been the case with septic thrombophlebitis secondary to intravenous infusion. Thirteen patients over 65 years of age presented with septic thrombophlebitis during the course of hospitalization for a variety of diseases. All infections occurred in an upper extremity site of polyethylene catheter insertion. Twenty-five per cent of patients had proven bacteremia and clinically recorded septicemia, with Staphylococcus aureus as the most common organism. Treatment consisted of either a full course of intravenous antibiotics or more commonly surgical therapy (either incision and drainage or resection of the involved vein). Three patients required extensive procedures including muscle debridement and fasciotomy. The mean hospital stay of 19 days was largely related to thrombophlebitis and not primary disease. There was one mortality. Prevention of this condition by meticulous attention to sites of intravenous infusion and frequent changing of these sites rather than treatment after the fact provides the safest mode of patient care.

Aged↗