blood clot, phlebitis, edema, vein obstruction, superficial thrombophlebitis, deep venous thrombosis, venous stasis, aseptic thrombophlebitis, septic thrombophlebitis, edema, lymphedema

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)

• Redness, swelling and tenderness of the skin overlying a vein

• Pus draining from the vein

• Septic clots in the blood vessels of the lungs (pulmonary emboli)

• Bloodstream infections (septicaemia)

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.

• Pain in the area of the clotted vein, this may include tenderness to the touch

• Redness of the surrounding or adjacent area

• Swelling or edema in the surrounding skin

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.

Pat

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:

• tender cordlike vein that is very sensitive to pressure

• redness and warmth in the area around the vein

• swelling in the area around the vein

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:

• Take an anti-inflammatory drug, such as aspirin or ibuprofen.

• Rest and elevate your arm or leg while you have pain and swelling, typically for 1 week.

• Put warm, moist compresses on the inflamed area (be careful to avoid burns).

• Elevate the affected arm or leg above the level of your heart when you are lying down.

With proper treatment, ST usually lasts 1 to 2 weeks.

• Follow your health care provider's instructions.

• Ask if you may exercise in bed and how soon you may start taking daily walks.

• If you have varicose veins, ask your health care provider if you should wear special support stockings.

Because ST usually results from injury, it is hard to prevent.

451 Phlebitis and thrombophlebitis

Includes:

• endophlebitis

• inflammation, vein

• periphlebitis

• suppurative phlebitis

Use additional E code to identify drug if drug-induced

Excludes:

that complicating:

• abortion (634-638 with .7, 639.8)

• ectopic or molar pregnancy (639.8)

• pregnancy, childbirth, or the puerperium (671.0-671.9)

that due to or following:

• implant or catheter device (996.61-996.62)

• infusion, perfusion, or transfusion (999.2)

• 451.0 Of superficial vessels of lower extremities

Saphenous vein (greater) (lesser)

• 451.1 Of deep vessels of lower extremities

• 451.2 Of lower extremities, unspecified

• 451.8 Of other sites

Excludes:

• intracranial venous sinus (325)

• nonpyogenic (437.6)

• portal (vein) (572.1)

• 451.9 Of unspecified site

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 )

• I80.0 Phlebitis and thrombophlebitis of superficial vessels of lower extremities

• I80.1 Phlebitis and thrombophlebitis of femoral vein

• I80.2 Phlebitis and thrombophlebitis of other deep vessels of lower extremities

Deep vein thrombosis NOS

• I80.3 Phlebitis and thrombophlebitis of lower extremities, unspecified

Embolism or thrombosis of lower extremity NOS

• I80.8 Phlebitis and thrombophlebitis of other sites

• I80.9 Phlebitis and thrombophlebitis of unspecified site

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.- )

• I82.0 Budd-Chiari syndrome

• I82.1 Thrombophlebitis migrans

• I82.2 Embolism and thrombosis of vena cava

• I82.3 Embolism and thrombosis of renal vein

• I82.8 Embolism and thrombosis of other specified veins

• I82.9 Embolism and thrombosis of unspecified vein

Embolism of vein NOS Thrombosis (vein) NOS

Medline Plus

http://www.nlm.nih.gov/medlineplus/thrombophlebitis.html

eMedicine

http://www.emedicine.com/emerg/topic582.htm

http://www.emedicine.com/emerg/topic581.htm

AllRefer Health

http://health.allrefer.com/health/thrombophlebitis-info.html

http://www.nlm.nih.gov/medlineplus/deepveinthrombosis.html

http://www.webmd.com/a-to-z-guides/understanding-thrombophlebitis-basics

DermNet

SpringerLink

PubMed

PubMed

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Informa

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

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Updated Dec. 23, 2011