Phlebitis

Also called Superficial thrombophlebitis, Inflamed vein

An inflamed vein just under the skin. Usually settles, and it is not always as harmless as the reassurance suggests.

What it is

Inflammation of a vein close to the skin surface, usually with a clot in it, producing a tender red cord along the line of the vein.

The traditional reassurance is that it is harmless and self-limiting, and mostly that is right. But a proportion of people with superficial thrombophlebitis, particularly when it is long, near the groin, or in the upper thigh, have or go on to develop a deep vein thrombosis, and some go on to a pulmonary embolism. Current practice is therefore to assess rather than simply reassure, often with an ultrasound, and to consider anticoagulation for extensive or high-risk cases.

Common causes are varicose veins, intravenous cannulas and drips, injuries, immobility, pregnancy, and injecting drug use.

Recurrent phlebitis with no obvious cause deserves a look for an underlying reason, including thrombophilia and, occasionally, an undiagnosed cancer.

Cannula-related phlebitis in hospital is common, preventable, and a recognised marker of care quality: sites should be inspected daily and cannulas removed as soon as they are not needed.

Signs you might notice

A red, tender, firm cord along the line of a vein, usually in the leg or the arm.

Warmth and swelling along the vein.

Pain on touching it.

Often following a cannula, an injury, or in a varicose vein.

Urgent assessment: swelling of the whole limb rather than a line along a vein; phlebitis in the upper thigh or near the groin; a long segment; or phlebitis with breathlessness or chest pain.

999: sudden breathlessness or chest pain, which may be a pulmonary embolism.

In hospital, a red painful cannula site with fever needs the cannula out and assessment, not a dressing.

How it can affect day-to-day life

The redness settles over days but the firm cord under the skin can be felt for weeks or months, which worries people unless they are warned.

Anti-inflammatory tablets or gel, compression stockings and keeping active are the usual treatment. Rest and elevation alone are not the answer; movement helps.

Antibiotics are not usually needed. This is inflammation rather than infection, and it is frequently treated with unnecessary antibiotics.

For people with varicose veins, recurrent phlebitis is an argument for treating the veins.

For anybody with a cannula, whether in hospital or at home on intravenous antibiotics, daily inspection of the site is what prevents this.

Supporting someone well

Get it assessed rather than assuming it is harmless, particularly if it is extensive or near the groin.

Ask about ultrasound to exclude a deep vein thrombosis.

Keep moving; do not rest the limb.

Use anti-inflammatory gel or tablets if suitable, and a warm compress for comfort.

Wear compression stockings if advised, after an arterial check.

Do not expect antibiotics; this is not usually infection.

Look at cannula sites daily and ask for the cannula to be removed when it is no longer needed.

For recurrent episodes with no cause, ask about clotting tests and a general review.

Get sudden breathlessness or chest pain seen as an emergency.

Where to get help

A GP practice or urgent care for assessment and ultrasound.

999 for breathlessness or chest pain.

The ward or intravenous team for a cannula-related problem.

Thrombosis UK for information on clots and their prevention.