Superficial thrombophlebitis is a clot with inflammation in a vein close to the skin, most often a varicose leg vein or an arm vein after an IV. It is usually mild, but a clot near the deep veins can extend and cause a DVT or pulmonary embolism.
Key symptoms
- Painful, red, warm line along a vein
- Firm, tender cord under the skin
- Mild local swelling
- History of a recent IV, varicose veins or a long period of not moving
What you find on exam
- Palpable tender cord along a superficial vein
- Length of the cord and how close it is to the groin or knee crease
- Whole-leg swelling or calf tenderness suggesting DVT
- IV site for pus or spreading redness
Tests
- Duplex ultrasound to measure the clot and rule out DVT, especially in the thigh or if 5 cm or longer
- Blood cultures if there is fever or pus at an IV site
- Workup for cancer or clotting disorders if it recurs or moves without a clear cause
Treatment basics
- Warm compresses, leg elevation and an NSAID such as ibuprofen
- Remove the IV catheter if it is the cause
- Fondaparinux 2.5 mg daily for 45 days if 5 cm or longer or near the deep veins
- Full anticoagulation, as for DVT, if within 3 cm of the deep system
- Keep walking; compression stockings for comfort
Red flags
- Clot near the groin or extending on repeat ultrasound
- Sudden chest pain or shortness of breath
- Fever with pus or spreading redness (septic thrombophlebitis)
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Sources: NCCPA PANCE Content Blueprint; NCSBN 2026 NCLEX-RN Test Plan; NBOME COMLEX-USA clinical presentations. Written by Making Synapses. Making Synapses is not affiliated with these organizations.