Earlier this month I saw a patient who was referred to me by his General Practitioner with phlebitis. His GP had been treating him with antibiotics and if anything, his leg was getting worse.
Now treating phlebitis with antibiotics is simply wrong and I am going to tell you the truth about phlebitis.
Phlebitis is simply a medical term indicating that there is inflammation in the vein. Most commonly it affects the superficial leg veins and it is associated with localised swelling — a lump- which is red, tender and warm and sometimes the lump actually feels hot and painful. Usually phlebitis comes on out of the blue for no apparent reason but very occasionally I see phlebitis as complication of some cancers, intravenous arm catheters used in hospital — drips – or sometimes as a reaction to some very irritant intravenous injections such as chemotherapy. I haven’t seen a case of phlebitis due to bacteria for years and that happened in a drug addict who was injecting into a leg vein with dirty needles. The standard usual case of superficial leg vein phlebitis seen by a GP does not need antibiotics. Antibiotics may do more harm than good.
Now until recently, phlebitis in superficial leg veins was thought to be a rather trivial condition and many doctors dismissed phlebitis as being of no real significance. Even the term phlebitis is often misunderstood and misused. Many people including doctors describe any discomfort in their veins as being phlebitis. To absolutely sure that the problem is phlebitis, a duplex ultrasound scan is needed — the ultrasound appearance of phlebitis is characteristic and diagnostic. The vein wall is thickened and there is a variable amount of clot inside the vein. A scan is the only way of checking the vein directly and confirming that the vein is inflamed. Ultrasound has also revealed that a very important group of people with phlebitis either already have a DVT or they are at risk of developing a deep vein thrombosis. The inflammation in the wall of the veins affected by phlebitis activates clotting of the blood inside these veins. This clot can extend or spread from the superficial vein into the deep vein.
So this is another very important reason why everyone with phlebitis should have a duplex ultrasound scan. A duplex scan is the only way to correctly identify people who already have a DVT and who need treatment to prevent that clot leaving the leg, travelling around the body and lodging in the lung — a serious sometimes fatal condition called pulmonary embolism. A duplex scan will also determine whether these people with phlebitis are at risk of a DVT and who need preventative treatment. So the first important message is that everyone with phlebitis should have a duplex ultrasound scan.So how should superficial leg vein phlebitis be treated? Well we can only offer the correct treatment for phlebitis if we know the results of the duplex scan. The scan my show that the phlebitis is only in a small area and that only a limited number of superficial veins are affected. If there is very little associated clot in these superficial veins and if this clot is well away from the deep veins, then treatment with aspirin or aspirin-like medication called non –steroidal inflammatory drugs and compression stockings may be sufficient. A good medical sock will support the vein while it is recovering and the anti-inflammatory tablets or cream will ease the swelling and pain. If the phlebitis is extensive or if the clot in the superficial veins is already close to the deep veins, a course of blood thinning injections — anticoagulant heparin medication- is needed to reduce the significant risk of developing a DVT. Of course if the scan shows that a DVT has already formed, full anticoagulant treatment for several months is needed. So the correct treatment of phlebitis requires a scan. So in summary, phlebitis is not an infection and antibiotics are not the correct treatment. Phlebitis is not a trivial condition, it can be serious and may cause a Deep Vein Thrombosis. Everyone with phlebitis should have a duplex ultrasound scan to confirm the correct diagnosis, to check for DVT and to guide the correct treatment.
ReferencesCHEST February 2012;
British Journal of Haematology, 2012, 159, 28–38
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If you’re worried about your veins and would like a confidential chat please do get in touch. I am happy to offer simple advice by telephone or email for free and without obligation.
The VeinCare Centre also offers a screening assessment with our vascular technologist. For £25 you can have a scan with Wendy Parsons. She is not a doctor and so she could not give you medical advice but she can check your deep veins and your varicose veins and give you an idea of how bad they are and what treatment options might be available. If you would like to have an appointment with Wendy please call 0800 698 3467.