Phlebitis

Introduction to phlebitis Thrombophlebitis, referred to as phlebitis, refers to inflammation of the venous blood vessels. According to different lesions, phlebitis can be divided into superficial phlebitis and deep phlebitis. The pathological changes of the intima of the intima, the lumen narrowed, and the blood flow was slow. The surrounding skin can present with congestive erythema, sometimes accompanied by edema. It gradually subsided, the congestion was replaced by hyperpigmentation, and the erythema turned brown. A small number of patients can cause reactions, such as chills, fever, increased white blood cells, etc., patients often complain of pain and swelling. basic knowledge The proportion of illness: the incidence rate is around 0.1%. Susceptible people: no special people Mode of infection: non-infectious Complications: thrombosis, swelling, varicose veins, pulmonary embolism, stasis dermatitis

Causes of phlebitis

There are many causes of venous thrombosis, such as trauma, surgery, pregnancy, childbirth, heart disease, malignant tumors, oral contraceptives and long-term standing, squatting, sedentary, long-term wet, etc., more common after various surgical operations Initiation, its pathological changes are characterized by damage to the vein wall, changes in blood flow status and hypercoagulable state of the blood leading to deep vein thrombosis. The pathogenesis of the motherland medicine is qi and blood stasis, block in the collaterals and qi and blood yin and yang. Disorders and hot and humid bets, both internal and external due to the combination of the disease.

Environmental factors (20%):

The cold and humid environment will make the body's warm air easy to condense in the vein. After cold, vasospasm, endovascular damage, slow blood flow, increased blood viscosity, and increased coagulation lead to venous thrombosis.

High blood concentration (25%):

Lower extremity trauma, surgery, extensive burns, pregnancy and postpartum, platelet increase, and release of coagulation factors, so that blood components change, hypercoagulable state, providing a hotbed for phlebitis formation.

Long-term infusion (20%):

Long-term catheter for continuous infusion can directly damage the vein wall, or damage the vein wall due to various mechanical shocks, and an inflammatory reaction occurs.

Long time (10%):

Can cause poor blood flow, ischemia, hypoxia, blood vessel damage, endometrial damage, increased intravenous pressure, leading to venous thrombosis.

Pathology of phlebitis:

Intravenous injection of various antibiotics or hypertonic glucose solution or mechanical damage to the vein wall, as well as blood stasis caused by long-term varicose veins, resulting in venous intimal damage, thrombosis, and rapid inflammation of the entire superficial vein wall Even involving the surrounding tissue of the vein, and there is exudate, localized pain, swelling and tenderness of the cable column, often accompanied by systemic reactions, but not much.

Risk factors for phlebitis include:

1. The material, length and diameter of the catheter needle.

2, poor operating technology.

3. Inappropriate puncture site.

4. The catheter needle is left for too long.

5. Improper fixing method.

6, the concentration of the infusion of acid, too strong, or incompatible to cause precipitation.

7. The pathophysiological condition of the patient itself, such as age or disease, causes the blood vessel wall to be weak and inflamed.

Phlebitis prevention

Wear elastic stockings to improve varicose veins in the lower extremities. For patients with hypercoagulable state, while actively correcting the underlying diseases, attention should be paid to avoid trauma to the affected parts such as limbs and trunk. In addition, during the venipuncture process, the same site is repeatedly puncture and strong irritant drugs are used. At the same time, strict aseptic operation prevents infection caused by intravenous implants.

Venous complication Complications, thrombosis, swelling, varicose veins, pulmonary embolism, stasis dermatitis

Intravenous injection of various antibiotics or hypertonic glucose solution or mechanical damage to the vein wall, as well as blood stasis caused by long-term varicose veins, resulting in venous intimal damage, thrombosis, and rapid inflammation of the entire superficial vein wall Even involving the surrounding tissue of the vein, and there is exudate, localized pain, swelling and tenderness of the cable column, often accompanied by systemic reactions, but not much.

Symptoms of venous inflammation Common symptoms are red, swimming... Local venous chord-like local venous tenderness Local swelling of the thigh Deformation of tissue surrounding the venous thrombosis

In patients with superficial phlebitis, the affected limb is red and swollen, painful, and it is aggravated when walking. It can touch painful cord-like hard strips or bead-like nodules. In patients with deep phlebitis, the onset is sudden, the affected limb is concave and swollen, and the skin is dark red. There are extensive venous varicose veins or varicose veins and telangiectasia; dystrophic changes in the later stage, accompanied by complication dermatitis, hyperpigmentation or superficial ulcers, femoral and temporal diameters are more than 1 cm thicker than healthy limbs, swollen when walking Pain increased, relieved after lying down, venography can be seen in the deep venous stenosis or occlusion of the affected limb, migratory thrombosis superficial phlebitis, refers to the location of superficial venous inflammation is uncertain, one after another, repeated episodes, is the human superficial phlebitis A special type of thrombophlebitis of the chest and abdomen refers to a common disease of venous thrombosis in the chest wall, breast, ribs and upper abdomen, and inflammatory pathological changes, also known as Monder's disease.

Classification of phlebitis

1. Mechanical phlebitis:

(1) Improper fixation method: the puncture site is not fixed firmly, causing the needle to slide.

(2) The diameter of the catheter used is too thick to stimulate the vessel wall.

(3) The puncture site is too close to the joint, and the inflammatory reaction is caused by the friction between the needle and the vessel wall due to joint movement.

2. Chemical phlebitis:

Insufficient drug dilution, infusion acid, high alkalinity, too high concentration of solute, the difference in the material of the indwelling needle is the cause of chemical phlebitis.

3, bacterial phlebitis:

Usually, the disinfection method is incorrect, the puncture technique is poor, the aseptic state of the infusion cannula is broken, and the catheter indwelling time is too long.

Inspection of phlebitis

1, laboratory testing

(1) Blood routine: It is judged whether or not a bacterial infection is combined according to the degree of increase of white blood cells and neutrophils.

(2) Coagulation: There may be thrombosis such as elevated D-Dimer.

2, imaging examination

(1) Doppler ultrasound: detecting changes in local blood flow, when there is thrombophlebitis, the local blood flow signal may disappear or partially disappear, and the lumen may not be crushed after pressurization. This examination revealed approximately 95% of proximal deep vein thrombosis.

(2) Radionuclide examination: The principle is that radiolabeled human fibrinogen can be taken up by the thrombus being formed. The formation and evolution of thrombus can be judged by observing the increase or decrease of the radiation amount in a certain part. The detection rate of thrombosis in the venous plexus of the calf is higher.

(3) Electrical impedance plethysmography: When the venous thrombosis occurs, the fluctuation of the resistance volume amplitude is small. The diagnosis of main venous obstruction is better.

(4) venography: intravenous injection of contrast agent, through the presence or absence of filling defects, to determine the presence or absence of thrombosis, at the same time can determine the location, extent, morphology and collateral circulation of the thrombus. The gold standard for diagnosis.

(5) venous pressure measurement: the venous pressure of the affected limb is elevated, suggesting that there is obstruction in the proximal cardiac vein at the pressure measurement site.

Diagnostic diagnosis of phlebitis

diagnosis:

The disease can be diagnosed based on medical history, local performance, relevant hematological positive indicators, and accurate imaging findings.

Differential diagnosis:

Need to pay attention to the identification of acute skin infections such as erysipelas, erysipelas and other similar performance, but compared with phlebitis, the former skin redness, fever and other local inflammatory reactions are more serious, but also with systemic reactions, imaging has no obvious thrombosis .

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