THE BLOG

Phlebitis - Get a Scan or Risk a DVT

15/10/2013 13:46 BST | Updated 23/01/2014 23:58 GMT

It is amazing how many people claim to have had "phlebitis". The term seems to be used by the general public and many doctors and nurses to mean any pain or inflammation in the lower legs. In fact, it is a term so commonly used that many people think they know what they mean by "phlebitis" when they clearly don't.

Is this a problem?

Well like many medical conditions, it isn't really a problem, provided you haven't got it! However, recent research into venous conditions and phlebitis has shown that in some people, phlebitis can be very serious and may require treatment with anticoagulation drugs, such as heparin or warfarin to prevent a deep vein thrombosis (DVT), or even a clot to the lung which can be life-threatening. More importantly, many doctors and nurses outside of the venous field do not understand phlebitis and mistreat patients by giving antibiotics which are useless in this condition.

So what is phlebitis?

Simply phlebitis is an inflammation in the vein ("phleb" meaning vein and "...itis" meaning inflammation). Unless you have been in hospital recently and had a drip or a drug injected into your veins or had anything weird and wonderful happen to you, virtually all phlebitis occurs in the veins of the legs. The veins become inflamed because they get clots in them - not clots in the deep veins which would be the feared deep vein thrombosis (DVT), but clots in the superficial veins just under the skin which is more properly called superficial venous thrombophlebitis (SVT).

Phlebitis almost always occurs in varicose veins, even if they cannot be seen on the surface and are "hidden varicose veins". As veins are tubular structures, phlebitis is usually felt as a lump in the leg under the skin. As the clot in the vein causes inflammation in the vein wall, the surrounding area becomes hot and red. Unfortunately anything hot and red is usually thought to indicate infection and so doctors and nurses who do not understand phlebitis and incorrectly prescribe antibiotics which have no effect.

Therefore phlebitis should only be diagnosed if there is a tender area or lump in the leg where leg veins run. Red skin or brown skin around the ankle, a swollen tender calf and redness spreading up the leg are often seen in other conditions are not phlebitis.

Until recently, if a doctor or nurse diagnosed phlebitis, the correct treatment was thought to be an anti-inflammatory painkiller such as aspirin taken regularly (which would both reduce the inflammation and reduce the pain) and support stockings to provide relief in the area and make sure blood flowed properly to any other veins reducing the risk of further clots.

However, over the last couple of years reports of patients getting DVT and clots in the lungs from superficial thrombophlebitis or clots in the superficial veins, has made two very influential committees change their guidelines as to how phlebitis should be diagnosed and treated.

Both the American College of Chest Physicians and the British Committee for Standards in Haematology have produced guidelines basically grading the risk of the phlebitis and recommending different treatments depending on the risk. This might be using oral blood thinning medications such as warfarin, heparin injections for a couple of weeks or in more minor cases non-steroidal anti-inflammatory painkillers and support stockings. The aim of these guidelines is to stop anyone progressing to a dangerous DVT or worse.

Of course, in order to be able to get the right treatment, the doctor or nurse needs to know firstly that the "phlebitis" definitely is superficial venous thrombosis, and secondly whether the clot causing the problem is isolated in a vein just under the skin or whether it has already elongated along the vein or even deep into the deep venous system within the muscle.

The only way to confirm presence of a clot in a vein and to measure the extent of it is a special venous test called a venous duplex ultrasound scan. Fortunately this test is widely available in specialist vein clinics and in hospitals and so there is no reason that patients should not be able to have a scan if the diagnosis of phlebitis is made.

It will now be a case of educating both healthcare professionals and patients to know that a diagnosis of phlebitis requires an urgent venous duplex ultrasound scan both to confirm the diagnosis and to plan the correct treatment which will reduce the risk of complications from the superficial blood clot in the leg.