Introduction

Celina had been hospitalised for about a week due to digestive problems. She had been receiving her prescribed medications through the vein. One evening, she noticed swelling around the arm used for the medications. This swelling was accompanied by pain, colour change, and hardening of the skin around that area. She was concerned and immediately called the attention of her healthcare provider. She was duly assessed, made to have some scans and blood tests. Before the end of that day, there was a conclusion and a medical name for what had happened to Celina. She has thrombophlebitis. 

Thrombophlebitis is when blood clots cause inflammation (pain and swelling) of the vein. Although any vein in your body can develop thrombophlebitis, it occurs mostly on the legs. It is usually not fatal, but can be a pointer to more serious health problems. Thrombophlebitis usually occurs in a particular part of your body, but it can sometimes spread.

Types of thrombophlebitis

Thrombophlebitis can be classified as those affecting deep veins or superficial veins

1. Blood clots in deep veins: This is called deep venous thrombosis (DVT). This occurs when blood clots occur in a large vein. DVT can also cause blood clots in the lungs and other body parts. To avoid this fatal occurrence, DVT should be treated without delay
2. Superficial thrombophlebitis is the presence of blood clots in surface veins. Blood clots can form in little veins or extensions of a large vein. Although it is not a serious condition like DVT, it can be a pointer to the development of DVT or other severe conditions
3. Infected blood clots in veins: Infection can cause thrombophlebitis. When this happens, it is known as septic thrombophlebitis. Infection can spread through your body if this happens 
4. Migrating blood clots: This occurs when a blood clot formed in a vein moves from that vein to a different vein in a different part of your body

Causes of thrombophlebitis

The following can cause you to develop thrombophlebitis:

• Hereditary changes in your DNA: the DNA passed down to you from your parents can cause blood clots to form in your veins
• Pregnancy: expecting a child increases your risk of having blood clots in your veins. You may continue to have this risk even after delivery
• Immobility or inactivity: sitting or not being active for extended hours can affect the flow of blood in your veins. When this happens, it increases your risk of developing thrombophlebitis
• Treatments: some treatments require the insertion of tubes into your veins to administer medications. These tubes are known as catheters and IV (intravenous) lines. Your risk of developing thrombophlebitis increases because of this
• Use of leisure drugs through the vein: injecting drugs into your vein is a risk factor for developing infection and thrombophlebitis
• Abnormal veins: some veins can become abnormal and have a spider-like appearance, become blue and bulging. This is known as varicose veins and increases your risk of having thrombophlebitis
• Injury to the veins: this can cause inflammation, which in turn can cause blood clots to form

Signs and symptoms of thrombophlebitis

The following indicates the presence of thrombophlebitis:

• Feeling pain 
• Swelling around the area
• Redness (erythema) 
• Hardened skin (induration)
• Increased body temperature
• Discharge, mostly pus
• Inflammation that spreads up the limb (ascending lymphangitis) 
• Fluctuance (a soft, squishy swelling filled with fluid) 
• A vein that is painful to the touch and has a cord-like texture 

How is thrombophlebitis diagnosed?

Scans and blood tests are used to diagnose thrombophlebitis. 

• An ultrasound scan helps your doctor know if it is deep vein thrombosis or superficial vein thrombosis
• Blood test shows the level of a substance in the body known to dissolve blood clots. This substance is called D-dimer and is high in the presence of thrombophlebitis
• A health assessment performed by your healthcare provider will usually reveal signs and symptoms that can help diagnose the condition

Treatment goals for thrombophlebitis

• To prevent the formation of blood clots in the lungs. This is a life-threatening complication known as pulmonary embolism
• To reduce pain and swelling, and reduce the risk of tissue death
• To prevent long-term complications known as post-thrombotic syndrome (PTS) through
  • Removal of the blood clot early enough
  • Avoiding obstruction in the veins
  • Maintaining the normal function of blood vessel valves
  • Preventing backflow of blood (reflux) 

PTS is a condition that can cause chronic pain, swelling, and disability in the affected leg.

Non-surgical (conservative) management of thrombophlebitis

Non-surgical care of thrombophlebitis includes:

• Immediate removal of tubes in the veins used for medication purposes when there is any sign of thrombophlebitis
• Use of special stockings, wraps, or bandages that provide compression. The pressure these compression items provide stops new clots from forming and relieves your symptoms
• Prop up the affected area, especially your leg. This can relieve pain and reduce swelling
• Use warm compression on the affected part to relieve pain
• Use of medications: The various medications used in the treatment of thrombophlebitis are:
  • Painkillers to relieve pain, such as acetaminophen or ibuprofen
  • Antibiotics are for the treatment of infection and to also stop it from spreading
  • Clot-dissolving medicines to break down blood clots already formed (thrombolytic drugs) 
  • Medicines that prevent blood clots from forming are called blood thinners or anticoagulants

What are the indications for surgical management of thrombophlebitis? 

Your healthcare provider will suggest surgery to manage your thrombophlebitis if the following are present:

• Presence of infected thrombophlebitis
• Failure to resolve symptoms despite the use of antibiotics and other non-surgical treatment options for up to two days
• Presence of other conditions such as kidney disease, diabetes, or if you are undergoing cancer treatment

Surgical management of thrombophlebitis

Thrombophlebitis can become difficult to manage even when being treated with antibiotics. When this happens, surgery becomes necessary. Either your surgeon ties off the affected vein or removes it completely. Sometimes, they are done separately or in combination. 

Vein removal (vein stripping) 

The affected vein is stripped off or removed by your surgeon. This is possible through small cuts around the affected area after you have been given anaesthesia. Anaesthesia is necessary so you don't feel pain during the procedure. The cuts provide access for the surgeon to get to the vein. The affected vein is then disconnected from your body's large vein network and finally removed. 

Vein ligation (vein tying) 

The affected vein is ligated or tied off to disconnect the flow of blood through it. This procedure is usually followed by vein removal. This surgical procedure is especially important in the treatment of varicose veins. 

Other surgical procedures for the treatment of thrombophlebitis are;

• Surgical removal of blood clots known as thrombectomy: your surgeon may make cuts into the veins to remove clots or insert special tubes to suck it out
• Surgical bypass: thrombophlebitis causes damage to blood vessels, affecting the flow of blood through them. Your surgeon makes a new bypass vein using another vein from a different part of your body. This acts as a new channel around the bad vein, making the flow of blood better
• Sealing shut the affected veins through the injection of specific substances. This procedure is called Sclerotherapy. 

Surgical complications 

• Infection
• Scar tissue formation
• Numbness
• Pain
• Negative reaction to anaesthesia
• Recurrence of blood clots
• Blood loss

Postoperative care

The following are recommended as care after surgery:

• Avoid strenuous physical activity
• Prevent the formation of new blood clots by walking around
• Monitor signs of complications
• Continue to take your prescribed medications
• Continue the use of compression socks unless advised not to

FAQs

How common is thrombophlebitis?

The incidence of thrombophlebitis varies according to its type. Deep vein thrombosis (DVT) is quite common, with around nine hundred thousand (900,000) people affected yearly in the United States. Of this number, about sixty thousand to hundred thousand (60,000-100,000) die each year. 

Can thrombophlebitis be contagious?

No. Thrombophlebitis is not contagious, although the presence of infection increases your risk of developing it. 

How long does it take to recover after treatment of thrombophlebitis? 

The time needed for recovery depends on how severe your condition is. The treatment option being used (surgical or non-surgical) can also affect recovery time. You should feel better after a few days of treatment, although weeks may be needed for full recovery

What lifestyle modifications can help reduce my risks? 

To reduce your risk of developing thrombophlebitis,

• Do not sit for extended hours. Movement  promotes the circulation of blood in the veins
• Maintain proper nutrition
• Drink enough water to stay hydrated
• Stop smoking
• Regular wellness checks with your healthcare provider
• Exercise regularly
• Do not inject yourself with drugs through the veins

Summary

Thrombophlebitis is a treatable condition. It is mostly accompanied by swelling and pain, which can be relieved with medications, compression, or elevating the affected area. When conservative management is not successful, surgery is required to treat thrombophlebitis. See your healthcare provider immediately if you suspect thrombophlebitis to avoid further damage to your health.