| Thrombophlebitis is an inflammation of a vein often accompanied by the formation of a blood clot. There are several types of thrombophlebitis that can be separated into two main categories depending on their tissue depth: those that occur just below the surface of the skin (superficial thrombophlebitis), and those that occur in a deep vein that usually accompanies an artery (deep venous thrombosis or DVT).
Superficial thrombophlebitis may be caused by the insertion of an IV line or as a result of trauma to the vein. Risks for superficial thrombophlebitis include an increased blood clotting tendency, infection in or near a vein, current or recent pregnancy, varicose veins, blood clots, chemical irritation, or other local irritation of the area. Prolonged sitting, standing, or immobilization may also increase the risk. Superficial thrombophlebitis may occasionally be associated with abdominal cancers (such as carcinoma of the pancreas), deep vein thrombosis, thromboangitis obliterans, and (rarely) with pulmonary embolus.
Deep vein thrombosis (DVT) mainly affects the veins in the lower leg and the thigh where a clot has formed (thrombus) in the larger veins of the lower extremities. This thrombus may interfere with circulation in the legs, and it may break off and travel through the bloodstream (embolize). The embolus thus created can lodge in the brain, lungs, heart, or other area, causing severe damage to that organ. Risks include prolonged sitting, bed rest, or immobilization; recent surgery or trauma, especially hip surgery, gynecological surgery, heart surgery, or fractures; childbirth within the last 6 months; obesity; and the use of medications such as estrogen and birth control pills. Other risks include a history of malignant tumor, polycythemia vera, changes in the levels of blood clotting factors increasing tendency to clot (hypercoagulability), disseminated intravascular coagulation (DIC), and dysfibrinogenemia. DVT may be associated with, or cause pulmonary embolus.Risk: Males are at greater risk for developing thrombophlebitis, as well as individuals over 40 years of age. Incidence and Prevalence: In hospitalized individuals, the incidence of venous thrombosis varies considerably, from 20% to 80%, and the incidence of DVT is about 80 cases per 100,000 individuals annually (Schreiber). |
Source: Medical Disability Advisor
| History: Many individuals are asymptomatic. Those with symptoms may report leg pain, leg swelling (edema), and tender, warm skin over the area of the thrombosis. Individuals may also report a history of recent surgery, prolonged periods of bedrest, inactivity, trauma, and a previous clotting disorder (hypercoagulability). Physical exam: Skin signs may be visible and noticeable to the touch (palpable). For example, in superficial vein thrombophlebitis, the area may appear red and feel warm with a hard, cord-like mass apparent beneath the skin. The area is extremely sensitive to pressure. Additionally, the individual will feel pain during palpation or compression of the affected area. Superficial vein thrombophlebitis is diagnosed solely on the basis of the physical examination. In cases of suspected DVT, there may be pain, modest swelling and rarely, a cord-like mass. Some individuals will have calf pain when the foot is passively moved upwards into dorsiflexion (Homan’s sign); however, this is an unreliable finding. Tests: No diagnostic procedures are generally needed for superficial thrombophlebitis. Frequent checks of pulse, blood pressure, temperature, skin condition, and circulation should be done. When DVT is suspected, a number of diagnostic procedures may be performed in order to rule out arterial occlusive disease, inflammation of a lymphatic channel (lymphangitis), infection of the subcutaneous tissue beneath the skin (cellulitis), and muscle inflammation (myositis). Tests may also confirm the site and extent of venous occlusion. These tests may include Doppler ultrasound (to identify areas of reduced or obstructed venous blood flow), MRI (used to evaluate DVTs), extremity venogram, blood coagulation studies, plethysmography (to identify areas of decreased circulation; it is more sensitive in detecting deep vein thrombosis), and phlebography (to confirm the diagnosis as it shows filling defects and diverted blood flow). |
Source: Medical Disability Advisor
| Most individuals are treated with medications. Anticoagulants are used to prevent new clot formation and thrombolytic therapy is infrequently used for dissolving an existing clot. Analgesics and nonsteroidal anti-inflammatory drugs (NSAIDs) may be used for inflammation and pain control. Antibiotics may be used if an infection is present.
Elastic support stockings (and wraps) are routinely recommended and may be useful in helping reduce pain in some cases. The affected limb may be elevated to reduce swelling (edema), to reduce pain by reducing pressure on it, and to reduce the risk of further damage. Moist heat may also be applied to decrease inflammation and pain. Decreased ambulation and bed rest are typically recommended.
Surgical intervention including clot removal (thrombectomy), vein stripping, or vein bypass is rarely needed, but may be considered if anticoagulant therapy is ineffective. |
Source: Medical Disability Advisor
| Generally the prognosis is favorable, as thrombophlebitis usually responds to prompt medical treatment. Complete recovery occurs within a relatively short period of time with pharmacological or surgical intervention. |
Source: Medical Disability Advisor
| Surgery, stroke, heart attack (myocardial infarction), paralysis, hypertension, and infection are possible complications. Venous ulceration and venous insufficiency of the lower leg are long-term complications of DVT. A serious, potentially fatal complication that can occur is a pulmonary embolism, wherein the blood clot dislodges from its site of origin and lodges in the blood vessels of the lung. Hemorrhagic complications are possible with patients receiving anticoagulant therapy, as are blood clotting problems if the dose is too low or if there is an allergy to the anticoagulant medications. There is also a risk of later recurrence of thrombophlebitis in the same area due to scarring of the veins. |
Source: Medical Disability Advisor
| Work accommodations may include giving the individual an opportunity to elevate the affected area, and accommodating the need for postural positional changes (e.g., no prolonged standing or sitting). Individuals should avoid sustained periods of inactivity. In more serious cases, time off for rest and recuperation will be necessary. If an individual is receiving anticoagulant therapy, working with sharp objects or any risk of trauma may need to be avoided. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Does individual have superficial thrombophlebitis or deep vein thrombosis (DVT)?
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Did individual have an IV inserted or experience trauma to the vein?
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Are any risk factors for superficial thrombophlebitis present such as an increased blood clotting tendency, infection in or near a vein, current or recent pregnancy, varicose veins, blood clots, chemical irritation, other local irritation of the area, prolonged sitting, standing, or immobilization?
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Does individual have carcinoma of the pancreas, deep vein thrombosis, thromboangiitis obliterans, or pulmonary embolus?
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Does individual have any risk factors for DVT such as prolonged sitting, bed rest, or immobilization; recent surgery or trauma especially hip, gynecological, or heart surgery or fractures; childbirth within the last 6 months; obesity; and the use of medications such as estrogen and birth control pills, a history of malignant tumor, polycythemia vera, hypercoagulability, disseminated intravascular coagulation (DIC), and dysfibrinogenemia?
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Is DVT in the lower leg or thigh?
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Does individual report leg pain, edema, and tender warm skin over the area of the thrombosis?
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On physical exam for superficial thrombophlebitis, is the area red and warm with a hard, cord-like mass apparent beneath the skin? Was palpation painful?
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On physical exam for a DVT, does individual have a Homan's sign?
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Were Doppler ultrasound, MRI, extremity arteriogram, blood coagulation studies, plethysmography, phlebography, and contrast venography done?
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Were conditions with similar symptoms ruled out?
Regarding treatment:
- Is individual being treated with analgesics, NSAIDs, anticoagulants, and thrombolytics? Is antibiotic therapy necessary?
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Does individual wear elastic support stockings or wraps? Use moist heat?
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Does individual elevate the affected limb?
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Was surgical intervention necessary?
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Was individual instructed to decrease ambulation?
Regarding prognosis:
- Can individual employer accommodate any necessary restrictions?
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Does individual have any conditions that may affect ability to recover?
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Have any complications developed such as stroke, myocardial infarction, paralysis, hypertension, infection or pulmonary embolism that may impact recovery and length of disability?
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Source: Medical Disability Advisor
| Schreiber, Donald. "Deep Venous Thrombosis and Thrombophlebitis." eMedicine. Eds. Francis Counselman, et al. 13 Oct. 2004. Medscape. 4 Jan. 2005 <http://emedicine.com/emerg/topic122.htm>. |
Source: Medical Disability Advisor
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