Table of ContentsView AllTable of ContentsSymptomsCausesDiagnosisTreatment
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View All
Table of Contents
Symptoms
Causes
Diagnosis
Treatment
Other triggers of phlebitis includeautoimmune diseases(in which the immune system mistakenly attacks the body’s own tissues), blood clotting disorders, and cancer.
This article describes the signs and symptoms of phlebitis and the possible causes and triggers. It also explains how phlebitis is diagnosed and treated based on the underlying cause.
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What Are the Warning Signs of Phlebitis?
Phlebitis affects superficial veins, meaning those situated near the surface of the skin that are often visible and wispy. This differs from a more serious condition known asdeep vein thrombosis (DVT)which affects deeper veins of the leg.
With phlebitis, the vein becomes inflamed either because the walls of the vein are damaged, a blood clot develops within the vein, or both.People withvaricose veinsare at greater risk than those without.
Symptoms of phlebitis tend to develop progressively, causing:
The pain will often get worse when lowering the leg or getting out of bed in the morning. There may also be fever and a pus-like discharge if an infection is involved.
Where Phlebitis Commonly OccursBetween 60% and 80% of cases of phlebitis occur along the great saphenous vein (GSV), which runs from the inner thigh to the inner foot. Between 10% and 20% of cases occur along the short saphenous vein (SSV), which runs along the back of the leg from just above the knee to the outside of the foot.
Where Phlebitis Commonly Occurs
Between 60% and 80% of cases of phlebitis occur along the great saphenous vein (GSV), which runs from the inner thigh to the inner foot. Between 10% and 20% of cases occur along the short saphenous vein (SSV), which runs along the back of the leg from just above the knee to the outside of the foot.
Depending on the cause of phlebitis, it can take anywhere from weeks to months for the symptoms to fully subside.
Complications
Different studies have found between 3.1% and 65.6% of people with SVT also had deep venous thrombosis at the same time.
Risk factors include:
Female gender was associated with a lower risk for SVT developing into DVT.
Note that Verywell Health prefers to use inclusive terms. But when citing a health authority or study, the terms for gender or sex from that source will be used.
Why DVT Is So Dangerous
Causes and Risk Factors
With that said, phlebitis can affect people without varicose veins.One of the most common triggers of phlebitis is the placement of a peripheral intravenous catheter (PIVC). Other possible causes includethrombophilia(a blood clotting disorder), autoimmuneconnective tissue diseases, and cancer.
SVT is seen more often in these groups:
Peripheral Intravenous Catheter (PIVC)
A PIVC is a type of tubing placed in the vein of an arm or leg that is used to deliver fluids, drugs, or blood transfusions. The placement of a PIVC damages the walls of the vein and triggers an inflammatory response in which blood cells calledplateletsare activated.
Platelets, also known asthrombocytes, are responsible for blood clotting. During a venous injury, the activation of these cells can cause the formation of clots that can block superficial veins, leading to SVT.
Risk of Phlebitis From IV CathetersRoughly one in eight people who receive a PIVC will develop phlebitis, according to a 2021 study in theJournal of Intensive Care.
Risk of Phlebitis From IV Catheters
Roughly one in eight people who receive a PIVC will develop phlebitis, according to a 2021 study in theJournal of Intensive Care.
While PIVCs are most commonly used in people in the hospital, SVT tends to be more common in people given a PIVC in an emergency or outpatient setting.
How to Manage Post-Thrombotic Syndrome
Thrombophilia
Thrombophilia, also known as hypercoagulation, is another possible cause of SVT. The condition is either due to the lack of proteins that regulate blood clotting or to the overproduction of clotting factors that promote clotting.
Causes of thrombophilia include:
Causes and Risk Factors of Blood Clots
Autoimmune Diseases
Autoimmune diseases are those in which the body’simmune systemmistakenly attacks its own cells and tissues. In cases of SVT, connective tissues that make up blood vessels are the target of the assault.
The autoimmune diseases commonly linked to SVT include:
Cancer
Active cancer increases the risk of phlebitis, which in some cases may be an early warning sign of malignancy. Phlebitis can occur with any number of cancers, the most common of which include:
The higher your cancer stage (a measure of how far it has spread, from 0 to 4), the greater your risk of phlebitis.
In severe cases, an active malignancy can trigger the onset of DVT and a potentially life-threatening condition calledpulmonary embolism(in which a fragment of a blood clot breaks off and gets lodged in the lungs).
Chemotherapy-Induced PhlebitisCertain chemotherapy drugs like anthracyclinesandNavelbine (vinorelbine)are also associated with an increased risk of SVT (referred to as chemotherapy-induced phlebitis).
Chemotherapy-Induced Phlebitis
Certain chemotherapy drugs like anthracyclinesandNavelbine (vinorelbine)are also associated with an increased risk of SVT (referred to as chemotherapy-induced phlebitis).
How Cancer Causes Blood Clots
How Phlebitis Is Diagnosed
Phlebitis can often be diagnosed with a physical exam and a medical history review. This is especially true in people with varicose veins or those who have undergone a recent PIVC insertion.
Given the increased risk of DVT, your healthcare provider will likely order anultrasound. In an ultrasound, a handheld device uses sound waves to create detailed images of blood vessels and other soft tissues. This imaging study can help rule out DVT or diagnose borderline cases in which a blood clot is situated closer to a larger vein.
If phlebitis occurs with respiratory symptoms (such as shortness of breath, chest pain, and fainting), a radioactive imaging test calledlung scintigraphymay be used to check for a pulmonary embolism.
Other tests may be ordered if SVT is unexplained, recurrent, and/or develops in the absence of varicose veins. These may include blood tests to detect thrombophilia, autoimmune diseases like lupus, or antiphospholipid syndrome. Cancer screening may also be advised based on your family history and individual risk factors.
Cancer screening and blood testing are generally considered unnecessary when SVT develops in the presence of varicose veins.
How Pulmonary Embolism Is Diagnosed
Treatment of Phlebitis
As painful and distressing as phlebitis can sometimes be, most cases are not serious and will resolve on their own over time.
Uncomplicated cases will typically respond to the following treatments aimed at easing pain and reducing local inflammation:
Additional treatments may be prescribed based on the severity of your symptoms and/or the location of the venous blockage, including:
Summary
A peripheral intravenous catheter (PIVC) is the most common cause of phlebitis, although phlebitis can also result from an autoimmune disease, thrombophilia, or cancer.
Phlebitis is commonly diagnosed with a physical exam, a medical history review, an ultrasound, and possibly blood tests. The first-line treatment choices are heating pads, compression socks, and OTC anti-inflammatory drugs.
Although many cases of phlebitis are not serious and will resolve on their own without treatment, you shouldn’t ignore the symptoms. This is especially true if you’ve had phlebitis in the past.
By getting a proper diagnosis and treatment, you can take steps to further reduce your risk of DVT, including losing weight, exercising regularly, and quitting cigarettes.
How to Prevent Deep Vein Thrombosis
16 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.De Almeida MJ, Guillaumon AT, Miguelin D, et al.Guidelines for superficial venous thrombosis.J Vasc Bras.2019;18:e20180105. doi:10.1590/1677-5449.180105Decousus H, Bertoloetti L, Frappe P.Spontaneous acute superficial vein thrombosis of the legs: do we really need to treat?J Thromb Haemost.2015;13 Suppl 1:S230-S237. doi:10.1111/jth.12925National Health Service (UK).Phlebitis (superficial thrombophlebitis).Mihala G, Ray-Barruel G, Chopra V, et al.Phlebitis signs and symptoms with peripheral intravenous catheters: incidence and correlation study.J Infus Nurs. 2018;41(4):260-263. doi:10.1097/NAN.0000000000000288Di Minno MND, Ambrosino P, Ambrosino F, Tremoli E, Di Minno G, Dentali F.Prevalence of deep vein thrombosis and pulmonary embolism in patients with superficial vein thrombosis: a systematic review and meta-analysis.J Thromb Haemost. 2016;14(5):964-972. doi:10.1111/jth.13279Yasuda H, Yamamoto R, Hayashi Y, et al.Occurrence and incidence rate of peripheral intravascular catheter-related phlebitis and complications in critically ill patients: a prospective cohort study (AMOR-VENUS study).J Intensive Care.2012;9:3. doi:10.1186/s40560-020-00518-4Siniscalchi C, Rocci An.Isolated superficial vein thrombosis in multiple thrombotic defects.Acta Biomed.2019;90(4):606–10. doi:10.23750/abm.v90i4.7981Sobreira ML, Rogatto SR, Dos Santos RM, Santos IT, Ferrari IC, Yoshida WB.An unexpectedly high rate of thrombophilia disorders in patients with superficial vein thrombosis of the lower extremities.Ann Vasc Surg. 2017;43:272-7. doi:10.1016/j.avsg.2017.02.022Streiff MB, Agnelli G, Connors JM, et al.Guidance for the treatment of deep vein thrombosis and pulmonary embolism.J Thromb Thrombolysis.2016;41:32–67. doi:10.1007/s11239-015-1317-0Zoller B, Li X, Sundquist J, Sundquist K.Autoimmune diseases and venous thromboembolism: a review of the literature.Am J Cardiovasc Dis.2012;2(3):171–183.Koningsbrugge O. Lotsch F, Reitter EM, et al.Presence of varicose veins in cancer patients increases the risk for occurrence of venous thromboembolism.J Thromb Haemost. 2013;11(11):1993-2000. doi:10.1111/jth.12408Cancer Research UK.Cancer and the risk of blood clots.Centers for Disease Control and Prevention.Understanding your risk for blood clots with cancer.Harris V, Hughes M, Roberts R, Dolan G, Williams EM.The development and testing of a chemotherapy-induced phlebitis severity (CIPS) scale for patients receiving anthracycline chemotherapy for breast cancer.J Clin Med.2020;9(3):701. doi:10.3390/jcm9030701Shum E, Halmos B, Cheng H, et al.Vinorelbine-induced phlebitis is common in patients receiving adjuvant chemotherapy for non-small cell lung cancer (NSCLC).J Clin Oncol.2016 34:15_suppl:e20016-e20016. doi:10.1200/JCO.2016.34.15_suppl.e20016Cannegieter SC, Horvath-Puho E, Schmidt M, et al.Risk of venous and arterial thrombotic events in patients diagnosed with superficial vein thrombosis: a nationwide cohort study.Blood.2015;125(2):229–235. doi:10.1182/blood-2014-06-577783
16 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.De Almeida MJ, Guillaumon AT, Miguelin D, et al.Guidelines for superficial venous thrombosis.J Vasc Bras.2019;18:e20180105. doi:10.1590/1677-5449.180105Decousus H, Bertoloetti L, Frappe P.Spontaneous acute superficial vein thrombosis of the legs: do we really need to treat?J Thromb Haemost.2015;13 Suppl 1:S230-S237. doi:10.1111/jth.12925National Health Service (UK).Phlebitis (superficial thrombophlebitis).Mihala G, Ray-Barruel G, Chopra V, et al.Phlebitis signs and symptoms with peripheral intravenous catheters: incidence and correlation study.J Infus Nurs. 2018;41(4):260-263. doi:10.1097/NAN.0000000000000288Di Minno MND, Ambrosino P, Ambrosino F, Tremoli E, Di Minno G, Dentali F.Prevalence of deep vein thrombosis and pulmonary embolism in patients with superficial vein thrombosis: a systematic review and meta-analysis.J Thromb Haemost. 2016;14(5):964-972. doi:10.1111/jth.13279Yasuda H, Yamamoto R, Hayashi Y, et al.Occurrence and incidence rate of peripheral intravascular catheter-related phlebitis and complications in critically ill patients: a prospective cohort study (AMOR-VENUS study).J Intensive Care.2012;9:3. doi:10.1186/s40560-020-00518-4Siniscalchi C, Rocci An.Isolated superficial vein thrombosis in multiple thrombotic defects.Acta Biomed.2019;90(4):606–10. doi:10.23750/abm.v90i4.7981Sobreira ML, Rogatto SR, Dos Santos RM, Santos IT, Ferrari IC, Yoshida WB.An unexpectedly high rate of thrombophilia disorders in patients with superficial vein thrombosis of the lower extremities.Ann Vasc Surg. 2017;43:272-7. doi:10.1016/j.avsg.2017.02.022Streiff MB, Agnelli G, Connors JM, et al.Guidance for the treatment of deep vein thrombosis and pulmonary embolism.J Thromb Thrombolysis.2016;41:32–67. doi:10.1007/s11239-015-1317-0Zoller B, Li X, Sundquist J, Sundquist K.Autoimmune diseases and venous thromboembolism: a review of the literature.Am J Cardiovasc Dis.2012;2(3):171–183.Koningsbrugge O. Lotsch F, Reitter EM, et al.Presence of varicose veins in cancer patients increases the risk for occurrence of venous thromboembolism.J Thromb Haemost. 2013;11(11):1993-2000. doi:10.1111/jth.12408Cancer Research UK.Cancer and the risk of blood clots.Centers for Disease Control and Prevention.Understanding your risk for blood clots with cancer.Harris V, Hughes M, Roberts R, Dolan G, Williams EM.The development and testing of a chemotherapy-induced phlebitis severity (CIPS) scale for patients receiving anthracycline chemotherapy for breast cancer.J Clin Med.2020;9(3):701. doi:10.3390/jcm9030701Shum E, Halmos B, Cheng H, et al.Vinorelbine-induced phlebitis is common in patients receiving adjuvant chemotherapy for non-small cell lung cancer (NSCLC).J Clin Oncol.2016 34:15_suppl:e20016-e20016. doi:10.1200/JCO.2016.34.15_suppl.e20016Cannegieter SC, Horvath-Puho E, Schmidt M, et al.Risk of venous and arterial thrombotic events in patients diagnosed with superficial vein thrombosis: a nationwide cohort study.Blood.2015;125(2):229–235. doi:10.1182/blood-2014-06-577783
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
De Almeida MJ, Guillaumon AT, Miguelin D, et al.Guidelines for superficial venous thrombosis.J Vasc Bras.2019;18:e20180105. doi:10.1590/1677-5449.180105Decousus H, Bertoloetti L, Frappe P.Spontaneous acute superficial vein thrombosis of the legs: do we really need to treat?J Thromb Haemost.2015;13 Suppl 1:S230-S237. doi:10.1111/jth.12925National Health Service (UK).Phlebitis (superficial thrombophlebitis).Mihala G, Ray-Barruel G, Chopra V, et al.Phlebitis signs and symptoms with peripheral intravenous catheters: incidence and correlation study.J Infus Nurs. 2018;41(4):260-263. doi:10.1097/NAN.0000000000000288Di Minno MND, Ambrosino P, Ambrosino F, Tremoli E, Di Minno G, Dentali F.Prevalence of deep vein thrombosis and pulmonary embolism in patients with superficial vein thrombosis: a systematic review and meta-analysis.J Thromb Haemost. 2016;14(5):964-972. doi:10.1111/jth.13279Yasuda H, Yamamoto R, Hayashi Y, et al.Occurrence and incidence rate of peripheral intravascular catheter-related phlebitis and complications in critically ill patients: a prospective cohort study (AMOR-VENUS study).J Intensive Care.2012;9:3. doi:10.1186/s40560-020-00518-4Siniscalchi C, Rocci An.Isolated superficial vein thrombosis in multiple thrombotic defects.Acta Biomed.2019;90(4):606–10. doi:10.23750/abm.v90i4.7981Sobreira ML, Rogatto SR, Dos Santos RM, Santos IT, Ferrari IC, Yoshida WB.An unexpectedly high rate of thrombophilia disorders in patients with superficial vein thrombosis of the lower extremities.Ann Vasc Surg. 2017;43:272-7. doi:10.1016/j.avsg.2017.02.022Streiff MB, Agnelli G, Connors JM, et al.Guidance for the treatment of deep vein thrombosis and pulmonary embolism.J Thromb Thrombolysis.2016;41:32–67. doi:10.1007/s11239-015-1317-0Zoller B, Li X, Sundquist J, Sundquist K.Autoimmune diseases and venous thromboembolism: a review of the literature.Am J Cardiovasc Dis.2012;2(3):171–183.Koningsbrugge O. Lotsch F, Reitter EM, et al.Presence of varicose veins in cancer patients increases the risk for occurrence of venous thromboembolism.J Thromb Haemost. 2013;11(11):1993-2000. doi:10.1111/jth.12408Cancer Research UK.Cancer and the risk of blood clots.Centers for Disease Control and Prevention.Understanding your risk for blood clots with cancer.Harris V, Hughes M, Roberts R, Dolan G, Williams EM.The development and testing of a chemotherapy-induced phlebitis severity (CIPS) scale for patients receiving anthracycline chemotherapy for breast cancer.J Clin Med.2020;9(3):701. doi:10.3390/jcm9030701Shum E, Halmos B, Cheng H, et al.Vinorelbine-induced phlebitis is common in patients receiving adjuvant chemotherapy for non-small cell lung cancer (NSCLC).J Clin Oncol.2016 34:15_suppl:e20016-e20016. doi:10.1200/JCO.2016.34.15_suppl.e20016Cannegieter SC, Horvath-Puho E, Schmidt M, et al.Risk of venous and arterial thrombotic events in patients diagnosed with superficial vein thrombosis: a nationwide cohort study.Blood.2015;125(2):229–235. doi:10.1182/blood-2014-06-577783
De Almeida MJ, Guillaumon AT, Miguelin D, et al.Guidelines for superficial venous thrombosis.J Vasc Bras.2019;18:e20180105. doi:10.1590/1677-5449.180105
Decousus H, Bertoloetti L, Frappe P.Spontaneous acute superficial vein thrombosis of the legs: do we really need to treat?J Thromb Haemost.2015;13 Suppl 1:S230-S237. doi:10.1111/jth.12925
National Health Service (UK).Phlebitis (superficial thrombophlebitis).
Mihala G, Ray-Barruel G, Chopra V, et al.Phlebitis signs and symptoms with peripheral intravenous catheters: incidence and correlation study.J Infus Nurs. 2018;41(4):260-263. doi:10.1097/NAN.0000000000000288
Di Minno MND, Ambrosino P, Ambrosino F, Tremoli E, Di Minno G, Dentali F.Prevalence of deep vein thrombosis and pulmonary embolism in patients with superficial vein thrombosis: a systematic review and meta-analysis.J Thromb Haemost. 2016;14(5):964-972. doi:10.1111/jth.13279
Yasuda H, Yamamoto R, Hayashi Y, et al.Occurrence and incidence rate of peripheral intravascular catheter-related phlebitis and complications in critically ill patients: a prospective cohort study (AMOR-VENUS study).J Intensive Care.2012;9:3. doi:10.1186/s40560-020-00518-4
Siniscalchi C, Rocci An.Isolated superficial vein thrombosis in multiple thrombotic defects.Acta Biomed.2019;90(4):606–10. doi:10.23750/abm.v90i4.7981
Sobreira ML, Rogatto SR, Dos Santos RM, Santos IT, Ferrari IC, Yoshida WB.An unexpectedly high rate of thrombophilia disorders in patients with superficial vein thrombosis of the lower extremities.Ann Vasc Surg. 2017;43:272-7. doi:10.1016/j.avsg.2017.02.022
Streiff MB, Agnelli G, Connors JM, et al.Guidance for the treatment of deep vein thrombosis and pulmonary embolism.J Thromb Thrombolysis.2016;41:32–67. doi:10.1007/s11239-015-1317-0
Zoller B, Li X, Sundquist J, Sundquist K.Autoimmune diseases and venous thromboembolism: a review of the literature.Am J Cardiovasc Dis.2012;2(3):171–183.
Koningsbrugge O. Lotsch F, Reitter EM, et al.Presence of varicose veins in cancer patients increases the risk for occurrence of venous thromboembolism.J Thromb Haemost. 2013;11(11):1993-2000. doi:10.1111/jth.12408
Cancer Research UK.Cancer and the risk of blood clots.
Centers for Disease Control and Prevention.Understanding your risk for blood clots with cancer.
Harris V, Hughes M, Roberts R, Dolan G, Williams EM.The development and testing of a chemotherapy-induced phlebitis severity (CIPS) scale for patients receiving anthracycline chemotherapy for breast cancer.J Clin Med.2020;9(3):701. doi:10.3390/jcm9030701
Shum E, Halmos B, Cheng H, et al.Vinorelbine-induced phlebitis is common in patients receiving adjuvant chemotherapy for non-small cell lung cancer (NSCLC).J Clin Oncol.2016 34:15_suppl:e20016-e20016. doi:10.1200/JCO.2016.34.15_suppl.e20016
Cannegieter SC, Horvath-Puho E, Schmidt M, et al.Risk of venous and arterial thrombotic events in patients diagnosed with superficial vein thrombosis: a nationwide cohort study.Blood.2015;125(2):229–235. doi:10.1182/blood-2014-06-577783
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