Sections View Full Chapter Figures Tables Videos Full Chapter Figures Tables Videos Supplementary Content ++ KEY FEATURES ++ ESSENTIALS OF DIAGNOSIS ++ Redness, swelling, and pain, usually in a preexisting varicose vein Duplex ultrasound detection of thrombosis in a superficial vein ++ GENERAL CONSIDERATIONS ++ Common in the elderly and usually benign Less common in the upper extremities, where it usually occurs in association with venipuncture, catheter insertion, or chemical phlebitis ++ CLINICAL PRESENTATION ++ SYMPTOMS AND SIGNS ++ Redness and pain in an extremity superficial vein Swelling of the affected extremity suggests deep venous involvement ++ PHYSICAL EXAM FINDINGS ++ Tender, red, warm chord beneath the skin that follows the course of the vein ++ DIFFERENTIAL DIAGNOSIS ++ Cellulitis Insect bite Trauma ++ DIAGNOSTIC EVALUATION ++ IMAGING STUDIES ++ Although the diagnosis is usually based on the physical examination, confirmation can be done by venous ultrasonography ++ DIAGNOSTIC PROCEDURES ++ Contrast venography can be used if the ultrasound results are equivocal, especially in upper extremity venous thrombosis ++ TREATMENT ++ HOSPITALIZATION CRITERIA ++ Suspected deep venous thrombosis accompanying superficial thrombophlebitis: – Occurs in up to 10% of cases of lower extremity thrombophlebitis and < 5% of cases of upper extremity thrombophlebitis ++ MEDICATIONS ++ Warm compresses Nonsteroidal anti-inflammatory agents Limb elevation Subcutaneous low-molecular-weight heparin or fondaparinux can be considered in those at higher risk of deep venous thrombosis ++ THERAPEUTIC PROCEDURES ++ IV heparin for refractory cases only ++ DIET AND ACTIVITY ++ Exercise should be curtailed until the inflammation has abated ++ ONGOING MANAGEMENT ++ FOLLOW-UP ++ One visit in 2 weeks to check resolution ++ COMPLICATIONS ++ Extension to deep venous thrombosis and pulmonary embolus ++ PROGNOSIS ++ Excellent ++ PREVENTION ++ Meticulous care with IV injections and catheters ++ RESOURCES ++ PRACTICE GUIDELINES ++ Care must be taken not to miss possible underlying deep venous thrombosis, which requires anticoagulation, especially in the lower extremities; extremity swelling is a tip-off Recurrent superficial thrombophlebitis without obvious trauma should prompt a search for underlying malignancy or inherited thrombophilia ++ REFERENCES + +Di Nisio M, Middeldorp S. Treatment of lower extremity superficial thrombophlebitis. JAMA[JAMA and JAMA Network Journals Full Text]. 2014;311(7):729–730. [PubMed: 24549553] + +Samuelson B, Go AS, Sung SH, Fan D, Fang MC. Initial management and outcomes after superficial thrombophlebitis: the Cardiovascular Research Network Venous Thromboembolism study. J Hosp Med. 2016;11(6):432–434. [PubMed: 27253585] GET ACCESS TO THIS RESOURCE Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth Get Free Access Through Your Institution Contact your institution's library to ask if they subscribe to McGraw-Hill Medical Products. What is MyAccess? Create a FREE MyAccess profile to: Use this site remotely Bookmark your favorite content Track your self-assessment progress and more! GET ACCESS TO THIS RESOURCE Subscription Options Pay Per View Timed Access to all of AccessCardiology 24 Hour $34.95 (USD) Buy Now 48 Hour $54.95 (USD) Buy Now Best Value AccessCardiology Full Site: One-Year Individual Subscription $595 USD Buy Now View All Subscription Options