thrombophlebitis

(throm″bō-flĕ-bīt′ĭs)

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[thrombo- + phlebitis]
Inflammation of a vein in conjunction with the formation of a thrombus. It usually occurs in an extremity, most frequently a leg.
SEE: deep venous thrombosis; SEE: phlebitis

TREATMENT
Drug therapies include antiplatelet and anticoagulant drugs.

PATIENT CARE
Prevention includes identifying patients at risk and encouraging leg exercises, use of antiembolic stockings, intermittent pneumatic compression devices, and early ambulation to prevent venous stasis. At-risk patients should be assessed at regular intervals for signs of inflammation, tenderness, aching, and differences in calf circumference measurements. Noninvasive venous ultrasonography provides definitive diagnosis of thrombophlebitis (DVT). It is performed in patients with risk factors for DVT who have a swollen limb and an elevated level of D-dimer in the blood. Anticoagulants are administered as prescribed, the patient is evaluated for signs of bleeding, and coagulation results are monitored to maintain an international normalized ratio (INR) of 2-3. The patient is assessed for signs of pulmonary emboli, dyspnea, tachypnea, hypotension, chest pain, changes of level of consciousness, arterial blood gas abnormalities, and electrocardiogram changes. The patient is prepared for the diagnostic procedures and medical or surgical interventions prescribed.

Patients at greatest risk for thrombophlebitis are those on prolonged bedrest; those with major trauma, congestive heart failure or respiratory failure, obesity, nephrotic syndrome, inflammatory bowel disorders, myeloproliferative disorders, cancer and cancer therapies; pregnancy, recent childbirth, and use of combination hormonal contraceptives or postmenopausal hormone therapy; smoking; varicose veins or previous DVT; central venous catheterization; and people older than 65. At highest risk are those people with multiple risk factors. Patients who are at risk should be taught preventive measures. Long-distance travelers (flying, train, or automobile) should keep well-hydrated (avoiding alcoholic beverages), avoid constrictive clothing, not cross their legs, walk about frequently, and stretch calf muscles while sitting. Properly fitted below-the-knee graduated compression stockings that provide 15 to 30 mm Hg pressure at the ankle can be worn.

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