Internal Medicine

0521779407-19 CUNY1086/Karliner 0 521 77940 7 June 6, 2007 17:50

1392 Superficial Thrombophlebitis

➣Spiking fevers, leukocytosis

➣Recent indwelling catheter (either peripheral IV or PICC or cen-

tral line)

Signs & Symptoms

■Swelling, tenderness and erythema over a superficial vein

■Pus or induration at the venipuncture site is suspicious for septic

thrombophlebitis

■Swelling of the whole extremity is unusual

tests

Blood

■Blood cultures and CBC for detection of septicemia in pts with fevers

differential diagnosis

n/a

management

General Measures

■In non-septic thrombophlebitis, inflammation is sterile and due to

thrombus in vein

➣no need for antibiotics

➣no need for anticoagulation

■Treat with

➣elevation

➣warm compresses

➣nonsteroidal anti-inflammatory medications

■Septic thrombophlebitis

➣prevent with aseptic technique during line placement

➣vigilant surveillance of all IV sites to prevent infection

➣surgical exploration of any suspicious prior venipuncture site

➣if pus is found in vein, complete excision of vein

➣high dose antibiotic therapy based on vein culture

➣start presumptive antibiotics for S. aureus

➣high morbidity and mortality if diagnosis is missed

specific therapy

n/a

follow-up

n/a