phlebitic

Etiology

Common causes include chemical or mechanical irritation of veins by sclerosing intravenous fluids or indwelling catheters, thrombosis, or venous infections.

Symptoms

When a superficial vein is affected, the affected vein often is painful, tender, red, warm to touch, indurated along its length, or swollen. Inflammation or occlusion of large or deep veins may be asymptomatic or may produce edema distal to the lesion, as well as chills and fever and pain.

Prevention

Immobilized patients are at risk for phlebitic disorders. To prevent phlebitis, concentrated or irritating infusions should be given through central venous catheters or ports. Irritated or reddened intravenous sites should be changed, and peripheral catheters should never be left in place longer than 96 hr in adults, according to CDC guidelines. Patients with a history of deep venous thrombosis should adhere closely to anticoagulant drug regimens and avoid prolonged sitting or bedrest. They should avoid medications that increase the risk of thrombosis, such as estrogen-containing compounds.

Patient care

The Infusion Nurses Society has established the following clinical criteria to grade phlebitis:0. no symptoms; 1. erythema at access site with or without pain; 2. pain at access site with erythema or edema; 3. pain at access site with erythema, streak formation, or palpable venous cord; 4. pain at access site with erythema, streak formation, palpable venous cord longer than 1 inch (2.5 cm), or purulent drainage.

Superficial and deep vein phlebitis are treated by elevating the extremity along its length and applying warm continuous moist heat for 72 hr to reduce inflammation and relieve pain. Analgesics and anti-inflammatory drugs also are provided to manage discomfort. Any offending solution or catheter is removed from the vein. Phlebitis caused by clots may be treated with antiplatelet or anticoagulant drugs, thrombolytic agents (streptokinase), or, in rare cases, surgery. Antibiotics and/or surgery may be required for venous infections. The circumference of the affected extremity should be measured daily at the same location and compared to the unaffected one. When anticoagulant therapy is used, precautions are taken to monitor its effects and limit the risk of bleeding.