Major complication seen in peripheral venous access
a. Characteristic clinical manifestations of superficial thrombophlebitis include pain and slight swelling of the extremity, with most of the edema over the course of the involved vein.
b. Unless the patient is obese, a palpable, tender subcutaneous cord is usually found (a pathognomonic finding). Erythema may be present in the overlying skin.
c. The differential diagnosis includes cellulitis and streptococcal lymphangitis.
d. If there are systemic manifestations of severe infection, septic thrombophlebitis is likely. In addition, the induration, tenderness, and redness over and along the course of the vein are usually more extensive than with sterile thrombophlebitis.
e. Septic thrombophlebitis associated with an I.V. catheter can be detected by removing the device and culturing the tip. Antibiotics should be administered.
f. If the patient is in a toxic state from presumed septic thrombophlebitis in a subcutaneous vein or is not responding to treatment, it may be appropriate to ligate the vein, to drain it by cutting down on the phlebitic process with the patient under local or general anesthesia and laying the vein open, or to combine ligation with drainage.