RISK FACTORS: Immobilization, Obesity, Advanced age, Postoperative states, Intravenous catheter, Duration of intravenous catheterization, Cutdowns, Cancer, debilitating diseases, Steroid, Incidence is 40 times higher with plastic cannula (8%)
GENERAL MEASURES :
. Heat application
. Extremity elevation
SURGICAL MEASURES :
. Septic
. Excision of the involved vein segment and all involved tributaries
. Excision from ankle to groin may be required in some burn patients
. If systemic symptoms persist after vein excision, reexploration is necessary with removal of all involved veins
. Drainage of contiguous abscesses
. Remove all cannulae
. Aseptic
. Mondor disease, consider surgical transection of the phlebitic cord
. Management of underlying conditions
PATIENT EDUCATION :
β’ Avoid trauma
β’ Be alert to change in skin color
β’ Be alert to tenderness over extremities
DRUG(S) OF CHOICE :
. Septic
. Initially: semisynthetic penicillin (e.g., nafcillin 2 g IV q6h) plus an aminoglycoside (e.g., gentamicin, 1.0-1.7 mg/kg IV)
. Duration of therapy is empiric
. If due to Candida albicans, consider a short course of amphotericin B, approximately 200 mg cumulative
dose
. If osteomyelitis documented, antibiotic therapy for at least 6 weeks
. Aseptic general
. Non-steroidal anti-infl ammatories
. Oral anticoagulant warfarin
. Systemic anticoagulant heparin
. Low molecular weight heparin
. Antithrombin III and heparin cofactor II defi ciency
. IV heparin
. Antithrombin III concentrate
. Prophylaxis: warfarin, oxymetholone
. Proteins C and S
. Long-term warfarin, lower dose, no loading
. Disorder of tissue plasminogen activator
. Phenformin and ethylestrenol
. Stanozolol and phenformin
. Stanozolol alone
. Ethylestrenol alone
. Dysfibrinogenemia
. Acute attack - anticoagulation
. Prophylaxis - stanozolol
. Abnormal plasminogen and plasminogenemia
. Acute attack - anticoagulation
. Prophylaxis - warfarin
. Factor XII deficiency
. Standard therapy
. Lupus anticardiolipin
. Prophylaxis - warfarin
. Trousseau syndrome
. Heparin
. For pregnancy
. Heparin
. Behcet disease
. Phenformin
. Ethylestrenol
. Stanozolol
. Thromboangiitis obliterans
. Stop smoking
. Pentoxifylline
ALTERNATIVE DRUGS :
β’ Factor XII deficiency - streptokinase or alteplase [tissue plasminogen activator (tPA)]
⒠Behçet - oral anticoagulants plus cyclosporine
β’ Thromboangiitis obliterans - corticosteroid, antiplatelets and vasodilating drugs
PATIENT MONITORING :
. Septic
. Routine WBC and differential and culture
. Repeat culture from the phlebitic vein
. Aseptic
. Clinical followup to rule out secondary complications
. Repeat of blood studies for fi brinolytic system, platelets and factors
PREVENTION/AVOIDANCE :
. Use of scalp vein cannulae
. Avoidance of lower extremity cannulations
. Insertion under aseptic conditions
. Secure anchoring of the cannulae
. Replacement of cannulae, connecting tubing, and IV fluid every 48-72 hrs
. Neomycin-polymyxin B-bacitracin ointment in cutdown
POSSIBLE COMPLICATIONS :
. Septic: Systemic sepsis, bacteremia (84%); septic pulmonary emboli (44%); metastatic abscess formation;
pneumonia (44%); subperiosteal abscess of adjacent long bones in children
. Aseptic: Deep vein thrombosis; thromboembolic phenomena
EXPECTED COURSE/PROGNOSIS :
. Septic high mortality (50%), if untreated
. Aseptic
. Usually benign course; recovery 7-10 days
. Antithrombin III and heparin cofactor defi ciency; recurrence rate is 60%
. Proteins C and S, recurrence rate 70%
. Prognosis depends on development of DVT and early detections of complications
. Aseptic thrombophlebitis can be isolated, recurrent or migratory