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Superficial Thrombophlebitis

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81. Radiologic Management of Central Venous Access

, or cephalic veins when image-guidance is employed. The basilic vein is the access vein of choice as it is superficial and is usually the largest vein in the arm. Access via the cephalic vein has a higher incidence of thrombosis. This is due to its smaller size and catheter susceptibility to movement and kinking as it overlies the biceps muscle. Brachial vein access carries a greater risk of injury to the brachial artery and median nerve. Conventional Central Veins Determination of the optimal site for CV (...) thrombophlebitis, endocarditis, or osteomyelitis [7]. Additionally, catheter removal is necessary if S aureus is isolated from blood cultures of a patient with an indwelling CVC. It has been shown that attempts for catheter preservation in subjects with catheter-related infection due to S aureus have no more than a 20% chance of success. Preservation of the catheter may be attempted in clinically stable patients, in whom coagulase-negative staphylococci, Corynebacterium jeikeium, Acinetobacter baumannii

2017 American College of Radiology

82. CRACKCast E057 – Knee and Lower Leg

tendinitis Bursitis 8) Describe the sensory and motor function of nerves of the lower extremity “Foot off the brakes (dorsiflexion), to the right (eversion), and on the gas (plantar flexion)!” Peroneal nerve Anterior compartment: Sens: first toe web space Motor: long toe extension Superficial peroneal nerve Lateral compartment Sens: dorsum of foot Motor: foot pronation / Eversion Sural nerve Superficial posterior compartment Sens: lateral foot Tibial nerve Deep posterior compartment Sens: plantar aspect (...) of foot Motor: foot flexion, long toe flexion 9) Describe the 4 compartments of the lower leg and their contents Anterior Tibialis anterior Long toe extensors Anterior tibial artery Deep peroneal nerve (sensation to the first webspace of the foot) Lateral Foot everters: Peroneus longus and brevis Superficial peroneal nerve (sensation to the dorsum of the foot) Superficial posterior compartment Gastrocnemius, plantaris, soleus muscles Sural nerve (lateral side of the foot and distal calf) Deep

2017 CandiEM

83. CRACKCast E088 – Pulmonary Embolism & Deep Venous Thrombosis

as the femoral vein – and IS a DVT!!! Superficial venous system (not a true “DVT”): greater and short saphenous veins AND perforating veins DDx: (Box 88-1) Fracture (stress / occult / pathologic) Popliteal cyst / rupture of Cellulitis Superficial thrombophlebitis Vasculitis Proximal venous compression (tumour, gravid uterus) CHF related bilateral leg swelling Hypoalbuminemia Lymphedema Muscle strain / calf strain Hematoma Chronic venous insufficiency 2) Describe management of superficial thrombophlebitis (...) there) Because it can cause a PE – anyone with a u.e. DVT proximal to the elbow require definitive treatment Optimal dosing and duration is debated Usually at least 3 months of anticoagulation (do your risk analysis for everyone though!) Infusion phlebitis ) isolated brachial vein thrombosis – post recent IV infusion may be treated like a superficial thrombophlebitis of the lower leg, but good evidence is lacking. Remember, that we not only treat DVT’s to prevent PE’s, but ALSO because DVT’s damage

2017 CandiEM

84. CRACKCast E087 – Peripheral Arteriovascular Disease

intracatheter tPA (lysis) (5000 U urokinase, clamp for 30 mins, then aspirate) Management of suspected line infection: Think Local vs Systemic Local – signs of infection with no sepsis Usually no catheter removal needed; antimicrobials usually adequate Tunneled catheters may need to be removed regardless Thrombophlebitis (erythema and swelling with no purulence/fever may respond to supportive care) Systemic – look for sites of infection outside the catheter and manage appropriately UTI Anorectal SSTI’s (...) ●Hair loss over the toes and feet (thick toenails) ●Shiny/scaly skin ●Skeletonized due to atrophy of skin, fat and muscle ●Deep penetrating ulcers ●Ulcer base is gray, yellow, black, with minimal granulation tissue ● Ulcer rim is sharply demarcated , with no signs of cellular proliferation or epithelialization. ●Edema ●Prominent superficial veins ●Stasis dermatitis ●Ulcers with a weeping base and extensive granulation tissue ●Usually distal to the ankle – areas of trauma (toes, heels, metatarsal

2017 CandiEM

85. SecurAcath for securing percutaneous catheters

). Page 7 of 263 3 Clinical e Clinical evidence vidence Summary of clinical evidence 3.1 The key clinical outcomes for SecurAcath given in the decision problem were: rates of catheter migration and dislodgement rates of catheter-related infection, including catheter-related bloodstream infection, local infection or inflammation and thrombophlebitis number of unplanned catheter removals and reinsertions time taken to secure the catheter patient and clinician satisfaction scores pain while in position (...) reported pain at insertion ('if incorrectly placed and the anchor was too superficial') and pain at removal. 3.10 Hill (2014) is a Canadian-based single-centre pilot evaluation of PICCs secured with SecurAcath in 60 patients without a comparator. The author reported no malpositions but accidental dislodgement in 2 agitated patients. The author described dressing changes as being done by 'general unit staff, not IV team staff': SecurAcath gave staff increased confidence, fewer anxieties and increased

2017 National Institute for Health and Clinical Excellence - Medical technologies

86. Varicose veins: diagnosis and management

for implementation The following recommendations have been identified as priorities for implementation. Referral to a vascular service Refer people to a vascular service [1] if they have any of the following. Symptomatic [2] primary or symptomatic recurrent varicose veins. Lower-limb skin changes, such as pigmentation or eczema, thought to be caused by chronic venous insufficiency. Superficial vein thrombosis (characterised by the appearance of hard, painful veins) and suspected venous incompetence. A venous leg (...) are. Possible causes of varicose veins. The likelihood of progression and possible complications, including deep vein thrombosis, skin changes, leg ulcers, bleeding and thrombophlebitis. Address any misconceptions the person may have about the risks of developing complications. Treatment options, including symptom relief, an overview of interventional treatments and the role of compression. Advice on: weight loss (for guidance on weight management see obesity [NICE clinical guideline 43]) light to moderate

2013 National Institute for Health and Clinical Excellence - Clinical Guidelines

89. Inferior Vena Cava Filters for Prevention of Pulmonary Embolism

CODES CODES DESCRIPTION ICD-9 Diagnosis Codes 415.11 Iatrogenic pulmonary embolism and infarction 415.13 Saddle embolus of pulmonary artery 415.19 Other pulmonary embolism and infarction 451.11 Phlebitis and thrombophlebitis of femoral vein (Deep) (Superficial) 451.19 Phlebitis and thrombophlebitis of other 451.81 Phlebitis and thrombophlebitis of iliac vein 453.2 Other venous embolism and thrombosis of inferior vena cava 453.40 Acute venous embolism and thrombosis of unspecified deep vessels (...) 671.4x Deep phlebothrombosis, postpartum 671.5x Other phlebitis and thrombosis complicating pregnancy and the puerperium ICD-10 Diagnosis Codes I80.10 Phlebitis and thrombophlebitis of unspecified femoral vein I80.209 Phlebitis and thrombophlebitis of unspecified deep vessels of unspecified lower extremity I80.219 Phlebitis and thrombophlebitis of unspecified iliac vein I82.220 Acute embolism and thrombosis of inferior vena cava I82.221 Chronic embolism and thrombosis of inferior vena cava I82.3

2015 Oregon Health Evidence Review Commission

90. Vascular Access for Haemodialysis

configuration in the forearm. 2.Brachioaxillary AVG – anastomosis from brachial artery to graft and from graft to a vein in the axilla, with the graft adopting a straight configuration at in the upper arm. 3.Femoro-femoral AVG – anastomosis from the femoral artery (superficial femoral artery preferred) to graft and from graft to femoral vein with the graft adopting a looped or straight configuration in the thigh. There is an infinite variety of possible configurations using grafts as all that is needed (...) practice has shown the increased frequency of catheters in incident patients worldwide. . Several studies have reported haemodialysis catheter related rates between 0.6 and 6.5 episodes per 1000 catheter days mainly due to Gram-positive organisms and in 20- 43% of infections Staphylococcus aureus is the main culprit. Methicillin-resistant S. aureus (MRSA) accounts for 12-38% of haemodialysis catheter related bacteraemia (1). Metastatic infectious (endocarditis, osteomyelitis, thrombophlebitis, septic

2015 Renal Association

91. Varicose veins

Varicose veins Varicose veins - NICE CKS Share Varicose veins: Summary Varicose veins are dilated, tortuous, superficial veins that are most commonly found in the legs. They are often visible and palpable, and are an indication of superficial lower extremity venous insufficiency. Varicose veins are thought to be caused by incompetent valves in the affected vein, which result in reflux of blood and increased pressure in the vein distally. Unlike deep veins, which have thick walls (...) and are confined by fascia, superficial veins are unable to withstand the high pressure and eventually become dilated and tortuous. Risk factors for developing varicose veins include increasing age, family history of varicose veins, female sex, pregnancy, obesity, prolonged standing or sitting, and a history of deep vein thrombosis (DVT). For most people, varicose veins are mainly a cosmetic concern; however, in some people they can cause lower limb symptoms, typically pain, aching, discomfort, swelling

2019 NICE Clinical Knowledge Summaries

92. Opioid dependence

prevalence of tuberculosis among people who use drugs compared with the general population. Deep vein thrombosis and pulmonary emboli — these are more prevalent amongst people who use drugs. Superficial thrombophlebitis : Dependent users are susceptible to superficial thrombophlebitis because of repetitive trauma, unsterilized techniques, and irritation caused by the drug mixtures. Street drugs are often cut with substances that promote thrombosis (for example, lactose, sucrose, dextrose). Cocaine

2019 NICE Clinical Knowledge Summaries

93. Pulmonary embolism

intravenously or have infected indwelling catheters or pacemaker wires; people with peripheral septic thrombophlebitis; or recipients of transplanted organs. Foreign bodies — during intravenous drug use or from broken catheters, guide wires, vena cava filters, embolization coils, and endovascular stent components. Air — admitted during surgery or from other communication between the environment and the venous system. Risk factors What the the risk factors? About 30–50% of venous thromboembolism (VTE (...) , for example, heart disease; metabolic, endocrine, neurological disability, or respiratory pathologies; acute infectious disease; or inflammatory conditions. Long-distance sedentary travel. Varicose veins. Superficial venous thrombosis. Known thrombophilias (thrombotic disorders). Other factors, such as indwelling central vein catheter, nephrotic syndrome, chronic dialysis, myeloproliferative disorders, paroxysmal nocturnal haemoglobinuria, or Behçet's disease. [ ; ; ; ; ; ; ; ] Complications What

2019 NICE Clinical Knowledge Summaries

94. Cellulitis - acute

the CKS topic on . Septic arthritis — involvement of the joint and disproportionate pain with joint movement. Acute gout — swelling, redness, warmth, and pain on passive movement. The skin around the joint may be inflamed. For more information, see the CKS topic on . Ruptured Baker's cyst — may cause unilateral calf swelling. Thrombophlebitis — venous inflammation with thrombus formation. May cause redness, inflammation, and pain. For more information, see the CKS topic on . Cutaneous abscess — a hot (...) , red, swollen and painful swelling, which may need incision and drainage. Erysipelas — a form of cellulitis involving more superficial dermal structures distinguished clinically by raised and well demarcated borders. Chronic conditions (these are usually bilateral but if worse on one side, it may be difficult to exclude superimposed cellulitis): Varicose eczema/venous insufficiency — crusting, scaling, and itching. Contact allergic dermatitis — can present acutely as erythematous, sore and tender

2019 NICE Clinical Knowledge Summaries

96. Deep vein thrombosis

be considered if typical symptoms and signs are present, especially if the person has risk factors. Typical signs and symptoms are: Pain and swelling in one leg (occasionally both legs). Tenderness, changes to skin colour and temperature, and vein distension. Other conditions which may present with similar signs and symptoms include: Physical trauma Cardiovascular disorders such as superficial thrombophlebitis and post-thrombotic syndrome Other conditions such as ruptured Baker’s cyst, cellulitis (...) Differential diagnosis Only about a third of people with clinical suspicion of deep vein thrombosis (DVT) have the condition. Other conditions which may present with similar signs and symptoms include: Physical trauma, for example: Calf muscle tear or strain. Haematoma (collection of blood) in the muscle. Sprain or rupture of the Achilles tendon. Fracture. Cardiovascular disorders, for example: Superficial thrombophlebitis — see the CKS topic on . Post-thrombotic syndrome — see the CKS topic on . Venous

2018 NICE Clinical Knowledge Summaries

97. DVT prevention for travellers

in the control group (n = 100) developed asymptomatic DVT in the lower limbs (assessed using duplex ultrasonography within 48 hours of the return flight) and nobody in the stocking group (n = 100) developed asymptomatic DVT (relative risk 0.04, 95% CI 0 to 0.6). Four people in the stocking group developed superficial thrombophlebitis while none were found in the control group. CKS could find no studies which compared different strengths of stockings. People at high risk What advice should I give someone who (...) group (n = 100) developed asymptomatic DVT in the lower limbs (assessed using duplex ultrasonography within 48 hours of the return flight) and nobody in the stocking group (n = 100) developed asymptomatic DVT (relative risk 0.04, 95% CI 0 to 0.6). Four people in the stocking group developed superficial thrombophlebitis while none were found in the control group. CKS could find no studies which compared different strengths of stockings. Prophylaxis with low molecular weight heparin (LMWH) In people

2018 NICE Clinical Knowledge Summaries

98. Behçet’s disease in the United States: A single center descriptive and comparative study Full Text available with Trip Pro

=0.048). When comparing cohorts derived from the two different criteria, the ISG cohort had more skin manifestations (OR=3.3, p=0.0006). Acneiform lesions were associated with ~8 times higher odds of developing retinitis in our patients (p=0.0008), and superficial thrombophlebitis was associated with a trend for higher odds of developing uveitis (OR=4.1, p=0.057). Using the ICBD criteria, 38 additional patients were identified compared to only using the ISG criteria. Of these patients, 28 presented

2017 European journal of rheumatology

99. What is the best treatment for superficial vein thrombosis in the leg? Is aspirin effective in clearing the thrombus?

the chance of thrombosis extending or recurring. Advise leg elevation when resting if a leg vein is affected, as leg elevation is thought to improve venous blood flow and reduce swelling. Encourage people to keep mobile — bed rest is not advised. Anticoagulants are not usually indicated for superficial thrombophlebitis — if deep vein thrombosis is suspected, arrange for urgent referral. Antibiotics are not indicated in aseptic superficial thrombophlebitis (which accounts for most cases of superficial (...) thrombophlebitis). Consider the possibility of septic superficial thrombophlebitis if there is a break in the skin (e.g. with intravenous cannulation or drug abuse) although it can occasionally occur spontaneously. Admission is generally required for antibiotic treatment. Intravenous drug abusers may have unusual infections, including botulism, MRSA (methicillin-resistant Staphylococcus aureus) and Streptococcus Group A, and treatment of these people requires admission or specialist advice. Mild superficial

2009 TRIP Answers

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