Veins Thrombophlebitis

Dunnihoo DR, Gallaspy JW, Wise RB et al (1991) Postpartum ovarian vein thrombophlebitis a review. Obstet Gynecol Surv 46 415-427... 

Thrombophlebitis. Inflammation of the veins involving the formation of blood clots. 

When the drug is given IV, the nurse inspects the needle insertion site for signs of extravasation or infiltration (see Chap. 2). In addition, it is important to inspect the needle insertion site and the area above the site several times a day for signs of redness, which may indicate thrombophlebitis (inflammation of a vein with formation of a clot within the vein) or phlebitis (inflammation of a vein), if either problem occurs, the nurse contacts the primary health care provider and the IV must be discontinued and restarted in another vein, preferably in another extremity. 

MONITORING DRUGS GIVEN INTRAVENOUSLY. For optimal results, die nurse inspects the needle site and die area around die needle every hour for signs of extravasation of die IV fluid. The nurse performs diese assessments more frequently if the patient is restiess or uncooperative It is important to check the rate of infusion every 15 minutes and adjust it as needed. The nurse should inspect die vein used for die IV infusion every 4 hours for signs of tenderness, pain, and redness (which may indicate phlebitis or thrombophlebitis). If tiiese are apparent, die nurse must restart the IV in another vein and bring the problem to the attention of the primary health care provider. 

The most common adverse reaction associated with the administration of fat emulsion is sepsis caused by administration equipment and thrombophlebitis caused by vein irritations from concurrently administering hypertonic solutions. Less frequently occurring adverse reactions include dyspnea, cyanosis, hyperlipidemia, hypercoagulability, nausea, vomiting, headache flushing, increase in temperature sweating, sleepiness, chest and back pain, slight pressure over the eyes, and dizziness. 

PN can be administered via a smaller peripheral vein (e.g., cephalic or basilic vein) or via a larger central vein (e.g., superior vena cava). Peripheral PN (PPN) is infused via a peripheral vein and generally is reserved for short-term administration (up to 7 days) when central venous access is not available. PN formulations are hypertonic, and infusion via a peripheral vein can cause thrombophlebitis. Factors that increase the risk of phlebitis include high solution osmolarity, extreme pH, rapid infusion rate, vein properties, catheter material, and infusion time via the same vein.20 The osmolarity of PPN admixtures should be limited to 900 mOsm/L or less to minimize the risk of phlebitis. The approximate osmolarity of a PN admixture can be calculated from the osmolarities of individual components ... 

Thrombophlebitis Inflammation of a blood vessel (e.g., vein) associated with the stimulation of clotting and formation of a thrombus (or blood clot). 

The most common drug-related adverse experiences in patients treated with ertapenem, including those who were switched to therapy with an oral antimicrobial, were diarrhea, infused vein complication, nausea, headache, vaginitis, phlebitis/thrombophlebitis, and vomiting. 

Normochromic normocytic anemia is the most common hematological side effect of amphotericin B administration thrombocytopenia and leukopenia are much less common. Infusion of the drug into a peripheral vein usually causes phlebitis or thrombophlebitis. Nausea, vomiting, and anorexia are a persistent problem for some patients. 

Aside from its use as an antimalarial compound, quinine is used for the prevention and treatment of nocturnal leg muscle cramps, especially those resulting from arthritis, diabetes, thrombophlebitis, arteriosclerosis, and varicose veins. 

It is indicated in acute myocardial infarction, pulmonary embolism, deep vein thrombosis, arterial thrombosis, acute thrombosis of central retinal vessels, extensive coronary emboli and severe iliofemoral thrombophlebitis. 

Adverse effects include diarrhoea, rash, pain at site of injection and thrombophlebitis of injected vein. 

In hormone replacement therapy, the risk of deep vein thrombosis is increased by a factor of 2-4 (35-37). The absolute increase in the treated population as a whole is low, with about one case of venous thromboembolism in 5000 women-years of use of hormone replacement therapy. However, in the subgroup with pre-existing risk factors, such as obesity, varicose veins, smoking, and a prior history of venous thromboembolism or superficial thrombophlebitis, the increase in risk from hormone replacement therapy can be substantial among these women are those with a genetic predisposition to thrombosis, generally due to some form of thrombophilia, such as deficiency of the coagulation inhibitors protein S, protein C, or anti thrombin III. In any of these subjects thrombosis can occur early in hormone replacement therapy. However, this tendency to early occurrence of deep vein thrombosis also seems to be present in all those who take hormone replacement therapy. 

In 40 patients with atrial fibrillation, some with severe heart disease (including cardiogenic shock in eight and pulmonary edema in 12), amiodarone 450 mg was given through a peripheral vein within 1 minute, followed by 10 ml of saline 21 patients converted to sinus rhythm, 13 within 30 minutes and another 8 within 24 hours (21). There were two cases of hypotension, but in those that converted to sinus rhythm there was a slight increase in systolic blood pressure. There were no cases of thrombophlebitis. Efficacy is hard to judge from this study, because it was not placebo-controlled. 

After rapid intravenous administration hypotension, shock, and atrioventricular block can occur and can be fatal (2). The rate of infusion should not exceed 5 mg/minute. Qther adverse effects reported during intravenous infusion include sinus bradycardia (236), facial flushing, and thrombophlebitis (236-239). The risk of this last complication can be reduced by infusing the drug into as large a vein as possible and preferably via a central venous catheter, or perhaps by using a very dilute solution of the drug (240). 

A major complication of intravenous infusion is thrombophlebitis, which is a principle limitation of peripheral parenteral nutrition. Its precise pathogenesis is unclear, but venospasm has been proposed as the most likely cause. However, in a study with ultrasound techniques to monitor vein caliber, there was no evidence to support this hypothesis, although thrombophlebitis was observed (10). The author suggested that the initiating event may be venous endothelial trauma, caused by the venepuncture itself, abrasion at the catheter tip, or the delivery of the feeding solution. 

Thrombophlebitis is a common reaction to the administration of cephalosporins into peripheral veins. The use of buffered solutions mitigated the reaction with cefalotin (192). Published trials have mainly compared older cephalosporins, but the overall results are still contradictory (193,194). Pain and inflammatory reactions after intramuscular injection are also common. Ceftriaxone is probably given more often intramuscularly now than any other cephalosporin. Its local tolerability does not differ from that of other compounds (195). 

Intravenous administration of erythromycin into peripheral veins relatively commonly causes thrombophlebitis, although the lactobionate form of erythromycin may be less irritating to veins than other parenteral forms (11,12). In a prospective study of 550 patients with 1386 peripheral venous catheters, the incidence of phlebitis was 19% with antibiotics and 8.8% without erythromycin was associated with an increased risk (13). 

Infusion phlebitis presents a problem in parenteral nutrition. Various alternative techniques of administration have been compared in order to identify means of countering this problem (9). Mechanical trauma appears to be a causative factor it can be reduced by hmiting the time of exposure of the vein wall to nutrient infusion and by minimizing the amount of prosthetic material within the vein (10). This is hkely to be even more important in small veins. In one study the addition of heparin (500 U/1) and hydrocortisone (5 micrograms/ml) significantly reduced the risk of thrombophlebitis from 0.43 to 0.11... 

Thiopental is used for i.v. anesthetic induction in the horse, usually to precede intubation and maintenance with inhalation anesthetics. It is used at 5-10% in the horse, with the higher concentration allowing for a significant reduction of the volume of injection. Thiopental at these concentrations should only be injected i.v. via a preplaced i.v. catheter, preferably placed in a large vein, such as the jugular vein. Even with these precautions, evidence of jugular thrombophlebitis can be seen at 48 h after the routine administration of guaifenesin and 10% thiopental to horses (Dickson et al 1990). 

Thrombophlebitis can be identified by heat, swelling or the presence of any exudate around the catheter insertion site or a palpable thrombus ("corded" feel) in the catheterized vein. Catheter-ized veins should be examined at least daily. 

Ultrasonography of a catheterized vein can help to identify thrombus formation. It is prudent to continue to check the vein for 2-3 days after catheter removal because thrombophlebitis may develop or become apparent in this period. 

Gardner S Y, Reef V B, Spencer P A 1991 Ultrasonographic evaluation of horses with thrombophlebitis of the jugular vein 46 cases (1985-1988). Journal of the American Veterinary Medical Association 199 370-373 Gennari F J 1998 Hypokalemia. New England Journal of Medicine 339 451-458 Glazier D B, LIttledike E T, Evans R D 1979... 

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