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Essentials of Diagnosis
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Red, painful induration along a superficial vein, usually at the site of a recent intravenous line
Marked swelling of the extremity may not occur
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General Considerations
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May occur spontaneously, often in pregnant or postpartum women or in individuals with varicose veins
May be associated with
Trauma
Occult deep venous thrombosis (DVT) (in about 20% of cases)
Short-term venous catheterization of superficial arm veins
Longer term peripherally inserted central catheter lines
May also be a manifestation of systemic hypercoagulability secondary to abdominal cancer
Pulmonary emboli are exceedingly rare and occur from an associated DVT
Observe intravenous catheter sites daily for signs of local inflammation
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Dull pain in the region of the involved vein
Induration, redness, and tenderness along the course of a vein
Process may be localized, or it may involve most of the great saphenous vein and its tributaries
Inflammatory reaction generally subsides in 1–2 weeks; a firm cord may remain for much longer
Edema of the extremity is uncommon
Proximal extension of induration and pain with chills and high fever suggest septic phlebitis
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Differential Diagnosis
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Cellulitis
Erythema nodosum
Erythema induratum
Panniculitis
Fibrositis
Lymphangitis
Deep thrombophlebitis
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Blood culture: in septic thrombophlebitis, the causative organism is often Staphylococcus aureus; other organisms, including fungi, may also be responsible
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Nonsteroidal anti-inflammatory drugs
For septic thrombophlebitis
Antibiotics (eg, vancomycin, 15 mg/kg intravenously every 12 hours plus ceftriaxone, 1 g intravenously every 24 hours); if cultures are positive, continue for 7–10 days or for 4–6 weeks if complicating endocarditis cannot be excluded
Systemic anticoagulation with heparin or fondaparinux
Prophylactic dose low-molecular-weight heparin or fondaparinux is recommended for superficial thrombophlebitis of the lower limb veins measuring 5 cm or longer
Full anticoagulation is reserved for disease that is rapidly progressing or there is concern for extension into the deep system
Septic superficial thrombophlebitis requires
Urgent treatment with heparin (Table 14–16) to limit additional thrombus formation and antibiotics (eg, vancomycin, 15 mg/kg intravenously every 12 hours plus ceftriaxone, 1 g intravenously every 24 hours)
Removal of the offending catheter in catheter-related infections
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