What Is Phlebitis?

Phlebitis occurs when a vein in your body gets inflamed or swollen. In most cases, the condition occurs because of an underlying blood clot. When a blood clot is causing vein inflammation, the medical term is known as thrombophlebitis. In other cases, phlebitis happens when you experience an injury to the vein, like when you get medication through an IV.

You can develop phlebitis in any of your veins, whether it's a superficial vein just below the surface of your skin or in the deeper muscle veins. While phlebitis is common, prompt treatment is also necessary. Without proper care, your vein can become infected. Your healthcare provider will help you develop a treatment plan for phlebitis based on which veins are affected and what caused the condition.

Types of Phlebitis

How serious phlebitis is and what problems it might cause depend on what initially caused the inflammation of the vein and which veins are affected. There are different types of phlebitis, including:

• Superficial thrombophlebitis: Occurs when you get a blood clot in a vein just beneath your skin. For people who experience blood clots more frequently, even a small injury to a vein might lead to this kind of inflammation.
• Deep vein thrombosis (DVT): Happens when a blood clot appears in a vein deep inside the body and causes inflammation. Blood clots of this type of phlebitis can often develop in the leg or thigh, and sometimes in the arms or pelvic area. While this type of inflammation can happen to anyone, they are more common among people over the age of 60.
• Septic thrombophlebitis: A type of infection that develops when a blood clot in your vein becomes infected. This infection can happen in your superficial or deep veins.

Symptoms

People with superficial thrombophlebitis usually notice that part of their skin looks red and feels warm and tender. You might feel like there's a firm rope under the area of skin that has the affected vein. Sometimes, the skin around the vein can swell up or become itchy.

When a DVT is present, you might notice the skin over the area starts to turn red or turns hot when you touch it. You might also feel pain, soreness, or swelling in the affected area.

People with septic thrombophlebitis can have symptoms ranging from slight swelling and pain in a vein close to the skin's surface to severe illness with sepsis. Sepsis (sometimes also known as septic shock) is a serious condition that causes a dangerous drop in blood pressure and affects the health of your organs. Symptoms of septic thrombophlebitis can include fever, pain, soreness along the vein, and pus that oozes out of a swollen vein.

Causes and Risk Factors

Each type of phlebitis may be caused by a variety of factors. The exact cause of your inflammation will depend on the type of phlebitis you have.

Superficial Thrombophlebitis

Superficial thrombophlebitis might show up after you've received medication intravenously (or, through an IV). You might also be at a higher risk of this type of phlebitis if you experience blood clots frequently. Other risk factors include:

• Having cancer, varicose veins, or liver problems
• History of DVT
• Underlying infections
• Being pregnant
• Sitting down or not moving around for a long time
• Using birth control pills

Deep Vein Thrombosis

Deep vein thrombosis can happen to anyone, but several factors can increase your risk. These include:

• Getting older
• A family history of blood clots
• Sitting for long periods
• Autoimmune diseases like lupus
• Heart disease
• Cancer
• History of COVID-19

People assigned female at birth are also more likely to develop blood clots during their childbearing years, especially during pregnancy and when using birth control pills or hormone therapy.

Septic Thrombophlebitis

While healthcare providers don't know exactly how septic thrombophlebitis happens, they think it starts when the lining of a vein becomes damaged. This damage can occur when an IV line is placed incorrectly or from certain medical conditions that make you more likely to get blood clots.

Once the clot forms, germs from the skin or nearby areas can get into the vein and start to grow, which may cause an infection. The germ that's most often behind this is called Staphylococcus aureus. But parasites and fungi can cause it too.

Diagnosis

If you're experiencing phlebitis or symptoms of vein inflammation, it's essential to see your healthcare provider for proper diagnosis and treatment. What methods your provider uses to diagnose the condition will also depend on the type of phlebitis they suspect you have.

Superficial Thrombophlebitis

To diagnose superficial thrombophlebitis, your provider can usually spot this condition by looking at the affected area. An ultrasound can help confirm the diagnosis. If they think an infection might be part of the problem, they might take a sample from your skin or blood to test for germs (such as viruses, bacteria, or fungi).

Deep Vein Thrombosis

To figure out if you have DVT, your healthcare provider will perform a physical exam to look for possible redness or tenderness of the affected arm or leg. They may also run tests like:

• D-dimer blood test, which can show blood clotting problems
• Doppler ultrasound, which looks at how blood flows through your veins
• Compression ultrasound, which helps find blood clots in the deep veins of your legs
• Magnetic resonance venography, which uses medical imaging to create images of your veins

Septic Thrombophlebitis​​

Your healthcare provider may order the following tests if they suspect you have septic thrombophlebitis:

• Computed tomography (CT) scan
• Magnetic resonance imaging (MRI)
• Blood count test
• Liver function tests
• Blood clotting tests

Treatment

If you receive a diagnosis for phlebitis, your treatment options will depend on the type of vein inflammation you're experiencing, alongside the severity of your symptoms and overall health status.

Superficial Thrombophlebitis

Experts are still discussing the best way to treat superficial thrombophlebitis. For mild cases, options include taking pain relievers that reduce inflammation, like Tylenol (ibuprofen), applying heat, and using compression garments.

Deep Vein Thrombosis

To treat DVT, your healthcare provider might prescribe blood thinners—a type of medication that can help prevent new clots from forming or keep existing ones from growing. You'll likely be on blood thinners for at least three months, but some people may need them longer or for life, depending on their risk of another clot.

Septic Thrombophlebitis

Treating septic thrombophlebitis depends on where the infection came from, the kind of germs causing the infection, and which veins are affected. The goal of treatment is to clear your body of the infection. To do this, your provider may prescribe antibiotics and blood thinners.

If you're experiencing pus in your vein, a surgeon may need to remove the vein with a surgical procedure. This procedure is easier for superficial veins that are located just below the skin's surface. But surgeries for deeper veins come with a higher risk of complications.

How to Prevent Phlebitis 

Fortunately, there are some strategies you can use to lower your risk of vein inflammation. These include:

• Avoiding sitting for long periods
• Moving your body when you can, especially if you're recovering from surgery or illness
• Taking blood thinner medications regularly if you have a prescription for them
• Quitting smoking if you use tobacco
• Wearing compression socks if you are prone to blood clots or leg swelling

Complications

If you don't receive treatment for phlebitis, you may be putting yourself at risk for complications. These complications may include:

• Pulmonary embolism: A blood clot in your lungs
• Embolus: A blocked vessel caused by a blood clot or air bubble
• Sepsis: A serious infection that drops your blood pressure and can cause organ damage
• Post-thrombotic syndrome: A chronic condition that can cause ongoing symptoms like swelling, pain, skin changes, and heaviness in the area of the affected vein

A Quick Review

Phlebitis is a condition that occurs when your veins become inflamed. Usually, this happens due to an underlying blood clot. There are three common types of phlebitis including superficial thrombophlebitis, deep vein thrombosis (DVT), and septic thrombophlebitis. Superficial thrombophlebitis affects veins just under the skin, while DVT is more serious, with clots in deeper veins. Septic thrombophlebitis occurs when an inflamed vein becomes infected.

If you're experiencing symptoms of phlebitis, it's essential to see your healthcare provider as soon as possible for testing and treatment. Depending on the severity of your condition, treatment may involve medications, at-home remedies, or surgery in serious cases.