Thrombophlebitis is an condition in which a blood clot and inflammation occurs in one or more veins close to the surface of the skin. Generally this is referred to as a superficial thrombosis versus deep venous thrombosis. It is extremely important to accurately assess this condition because an estimated 30% of patients with thrombophlebitis are subsequently diagnosed with deep venous thrombosis, which is life threatening.
The most common form of thrombophlebitis. Aseptic thrombophlebitis types include primary hypercoagulable states - disorders with measurable defects in the proteins of the coagulation and/or fibrinolytic systems and Secondary hypercoagulable states - clinical conditions with a risk of thrombosis. Risk factors for aseptic thrombophlebitis are disorders that involve increased likelihood of blood clotting, infections, varicose veins, sitting or being immobilized for an extended period of time.
Also referred to as suppurative phlebitis. It is a more serious and potentially more life threatening form of thrombophlebitis and is associated with associated with either recent IV therapy (venous cannulation) or intravenous drug abuse.
Septic thrombophlebitis is an infected blood clot in a vein, which may be life-threatening. The effects of septic thrombophlebitis may include:(1)
Infective agents includes Septic phlebitis can be caused by gram-positive or gram-negative organisms or by candidal or mycobacterial species.
Treatment is with intravenous antibiotics. These should be broad-spectrum until cultures confirm the causative organism(s). If possible, the affected vein should be tied off and removed surgically.
Conditions that cause susceptibility to thrombophlebitis include varicose veins, medical conditions that lead to sluggish blood flow, pregnancy, patients undergoing intravenous injections, infections, as well as individuals who are immobilized or bed ridden.
Other risk factors are the insertion of a vein catheter (pacemaker, chest port-a-cath), oral contraceptives and or hormone replacement medication, AIDS (lupus anticoagulant), Behcet disease, Buerger's disease, Mondor's Disease, blood type A, burns, chemotherapy, congestive heart failure, age, proteins C and S deficiency, trauma, ulcerative colitis.
Because of the fibrosis associated with lymphedema, the recurrent episodes of cellulitis and due to the compression of the vascular system, there is a higher than normal risk of developing thrombophlebitis and or deep venous thrombosis. Your physician should regularly check venous flow in the lymphedema affected limb.
The two most serious complications are pulmonary embolism and heart attack or stroke. Other complications involve damage to the veins in the leg and subsequent permanent venous pooling or swelling (edema), varicose veins, vein obstruction and permanent discoloration of the skin in the affected area.
The complications of septic thrombophlebitis include sepsis, septicemia, septic pulmonary emboli, abscess formation, pneumonia
In the absence of a triggering event, neither venous stasis nor abnormal coagulability alone causes clinically important thrombosis, but vascular endothelial injury does reliably cause thrombus formation. The initiating injury triggers an inflammatory response that results in immediate platelet adhesion at the site of injury. Further platelet aggregation is mediated by thromboxane A2 and by thrombin. Platelet aggregation due to thromboxane A2 is inhibited reversibly by nonsteroidal anti-inflammatory agents and irreversibly by aspirin, but thrombin-mediated platelet aggregation is unaffected by aspirin and nonsteroidals. This is why aspirin and nonsteroidal anti-inflammatories are somewhat effective in preventing arterial thrombosis, including stroke and myocardial infarction, but they are not very effective in preventing or treating venous thrombophlebitis. (1)
With the clinical features involved it is often easy to diagnosis thrombophlebitis from symptoms and appearance alone. However, because of the risk of deep venous thrombosis certain diagnostic tests become imperative. These tests include radiology examinations which include venous imaging, duplex ultrasound, magnetic resonance imaging, and invasive contrast venography, doppler study.
Other tests that may be used include the Perthese percussive test and the Trendelenburg test.
Cellulitis, erythema nodosa, cutaneous polyarteritis nodosa, sarcoid, Kaposi's sarcoma, hyperanalgesic psuedothrombophlebitis
Treatments include medications (anti inflammatory medicine, anticoagulants), increased ambulation, compression stockings and focusing on causative factors (antibiotics for infections). Other treatment modalities may include varicose vein stripping, insertion of a filter in the main vein in the abdomen (vena cava) and clot removal or bypass
Medications used in treatment include Heparin, Reteplase (Retavase), Penicillin G, Clindamycin (Cleocin), Metronidazole (Flagyl), Amphotericin B (AmBisome).
The edema associated with thrombophlebitis should subside upon treatment of the condition. If not, gentle decongestive therapy may be necessary.
Medications used in treatment might include IV heparin, warfarin, oxymetholone, antithrombin III, Stanozolol, ethylestrenol. Medications will be based on underling or complication medical conditions, type and severity of thrombophlebitis, whether aseptic or septic.
Taking an analgesic, such as aspirin or another nonsteroidal anti-inflammatory drug (NSAIDs) usually helps relieve the pain.
There are preventative measure that can be undertaken to lessen the likelihood of thrombophlebitis, these include
One long trips, getting up and walking around to keep circulation flowing If walking around is not possible, keep moving your legs, flexing the leg muscles Support garments that help promote fluid circulation and prevent edema Aspirin therapy may be prescribed. Aspirin affects the blood's clotting ability and can help prevent vascular coagulation
Dependant upon the severity and underlying medical cause. Usually is quite good and the patient (in uncomplicated cases) should be relieved of symptoms from two to six weeks. Death from aseptic thrombophlebitis is rare. For septic thrombophlebitis the mortality rates can be high if the condition is left untreated.
Superficial thrombophlebitis (ST, or SVT) is a condition in which inflammation causes a blood clot to form in a vein near the surface of the body. Often it develops in varicose veins, usually in the leg, pelvis, or arm. Varicose veins are enlarged veins close to the surface.
ST occurs when irritation of a vein causes blood flow to slow down or stop, and a clot then forms in the vein. ST can occur after minor injury to a vein, for example, after a bruise or after you have had an IV (medicine or fluid given through a vein). It can also occur after excessive exercise.
Symptoms of superficial thrombophlebitis may include:
Your health care provider will ask about your symptoms and examine you. He or she will be able to determine if you have ST from the physical exam. In some cases you may have special ultrasound or x-ray studies to check for clots in deeper veins.
For treatment, your health care provider may recommend that you:
With proper treatment, ST usually lasts 1 to 2 weeks.
Because ST usually results from injury, it is hard to prevent.
451 Phlebitis and thrombophlebitis
Use additional E code to identify drug if drug-induced
that due to or following:
Saphenous vein (greater) (lesser)
Phlebitis and thrombophlebitis
Includes: endophlebitis inflammation, vein periphlebitis suppurative phlebitis
Use additional external cause code (Chapter XX), if desired, to identify drug, if drug-induced.
Excludes: phlebitis and thrombophlebitis (of): · complicating: · abortion or ectopic or molar pregnancy ( O00-O07 , O08.7 ) · pregnancy, childbirth and the puerperium ( O22.- , O87.- ) · intracranial and intraspinal, septic or NOS ( G08 ) · intracranial, nonpyogenic ( I67.6 ) · intraspinal, nonpyogenic ( G95.1 ) · portal (vein) ( K75.1 ) postphlebitic syndrome ( I87.0 ) thrombophlebitis migrans ( I82.1 )
Deep vein thrombosis NOS
Embolism or thrombosis of lower extremity NOS
I82 Other venous embolism and thrombosis
Excludes: venous embolism and thrombosis (of): · cerebral ( I63.6 , I67.6 ) · complicating: · abortion or ectopic or molar pregnancy ( O00-O07 , O08.7 ) · pregnancy, childbirth and the puerperium ( O22.- , O87.- ) · coronary ( I21-I25 ) · intracranial and intraspinal, septic or NOS ( G08 ) · intracranial, nonpyogenic ( I67.6 ) · intraspinal, nonpyogenic ( G95.1 ) · lower extremities ( I80.- ) · mesenteric ( K55.0 ) · portal ( I81 ) · pulmonary ( I26.- )
Embolism of vein NOS Thrombosis (vein) NOS
Atlas of the Body
Your veins carry blood back toward the heart. Tiny vessels called capillaries in organs and tissues of the body deliver deoxygenated blood into small veins called venules, which join to form veins. Blood flows through the veins to the body's two main veins (called the vena cavae), which deliver the blood back into the heart
Source: AMA's Current Procedural Terminology, Revised 1998 Edition. CPT is a trademark of the American Medical Association. http://www.medem.com/MedLB/article_detaillb.cfm?article_ID=ZZZG57C56JC&sub_cat=510