The treatment of phlebitis (or superficial venous thrombophlebitis) is split into two sections, the immediate and the longer term treatment/prevention.
As you will have read before in this website, the treatment of phlebitis (superficial venous thrombophlebitis) has changed completely since the guidelines of 2012 when it was found that phlebitis (superficial venous thrombophlebitis) is associated with the formation of deep vein thrombosis (DVT) and pulmonary embolism (PE). As both of these conditions can be very serious or even life-threatening, it has become necessary for doctors and nurses to take patients with phlebitis or superficial venous thrombophlebitis of the legs much more seriously and to arrange investigations and treatment urgently.
1) The immediate treatment of phlebitis (or superficial venous thrombophlebitis)
As outlined in the other sections, phlebitis (or superficial venous thrombophlebitis) is an inflammation of a vein caused by a clot within it. There is no infection involved. In the past treatments were aimed at controlling the inflammation, the pain and giving graduated pressure stockings.
However randomised controlled studies have shown that in many patients, the use of anticoagulation (blood thinning medication) can significantly reduce the risks of deep vein thrombosis (DVT) and pulmonary embolism (PE). As such, although the guidelines are more precise, the general principle is as follows:
If the duplex ultrasound scan shows:
- an underlying deep vein thrombosis (DVT), full anticoagulation is required to treat the DVT as well as the phlebitis (superficial venous thrombophlebitis)
- extensive clot in the great saphenous vein extending close to the saphenofemoral junction (SFJ) where this vein connects with the deep veins, then full anticoagulation is again required to reduce the risk of developing a deep vein thrombosis (DVT) or pulmonary embolism (PE)
- moderate clot in the main superficial veins with any other risk factors for clotting, then injections of blood thinning agents can be used to thin the blood to a lesser extent than full anticoagulation. This should be kept going for a month or so depending on the protocol used
- more minor clot in the superficial veins with no other risk factors, then non-steroidal anti-inflammatory drugs such as aspirin can be used safely.
None of the current guidelines recommend graduated pressure compression stockings, but other work has shown that this also reduces the risk of thrombosis in the leg veins. As such most vein experts would also add the use of graduated pressure compression stockings for support and comfort as well as to reduce the risk of clotting extension.
Very occasionally, the amount of thrombus (clot) is so much, and the pain is so severe, that the thrombus is removed surgically under local anaesthetic. However this is very rarely needed.
NB: Please note that in phlebitis (or superficial venous thrombophlebitis) antibiotics are not needed and should not be given
2) The longer term treatment/prevention of phlebitis (or superficial thrombophlebitis):
Once the initial treatment has been started, the patient should be in less pain progressively and the condition should start resolving. Repeated duplex ultrasound scans will be performed to check that there has been no clot extension and development of a deep vein thrombosis (DVT).
Hopefully the patient will have been under the care of a specialist vein unit from the initial duplex ultrasound scan and so the doctor in charge of the patient will have already started the search for an underlying cause.
If this has not already happened, at this stage the patient should be referred to a specialist vein unit. A duplex ultrasound scan performed by a specialist will be able to identify if there is underlying venous incompetence (“hidden varicose veins“) or the underlying cause of varicose veins are clearly present.
If the veins appear perfectly normal and there is no problem with the veins themselves, then the specialist vein unit will start looking further into the patient’s history, blood profile and medical condition to see if there are other causes for the phlebitis (or superficial venous thrombophlebitis).
What to do if you have phlebitis (or superficial venous thrombophlebitis):
If you suspect that you or someone close to you has phlebitis (or superficial venous thrombophlebitis), then the course of action is really as outlined above.
If you’re able to get to a family doctor or specialist vein unit, you should be sent for an urgent venous duplex ultrasound scan to check for a deep vein thrombosis and to assess the thrombophlebitis so that the correct treatment can be prescribed as above.
You should not accept any diagnosis or treatment from anyone without first having a venous duplex ultrasound scan. To suggest treatment without a venous duplex ultrasound scan is merely guess work. If there is some reason that a venous duplex ultrasound scan cannot be arranged urgently, then your doctor should give you some blood thinning medication, usually by injection, to prevent any clot extension whilst you are waiting to get a venous duplex ultrasound scan.
You may well find, particularly if you are attending a specialist vein unit, that you do not actually have phlebitis (or superficial venous thrombophlebitis) and you may have one of the conditions that is commonly mistaken for this. If this is the case, you will be advised of this and the correct treatment plan will be suggested to you.
If you are in a specialist vein unit, you will be given a venous duplex ultrasound scan to find out exactly which veins are affected and to check all of your other veins.
You should then be given an appointment to return when the phlebitis (or superficial venous thrombophlebitis) is settling down so that options can be discussed with you in order to to reduce the risk of ever getting phlebitis (or superficial thrombophlebitis) again. In most cases, this will mean local anaesthetic endovenous surgery to ablate or close the underlying varicose veins or hidden varicose veins.