Infectious Disease Compendium

Septic Thrombophlebitis

Diagnosis

Infected veins, they often present with sustained fevers and persistent bacteremia.

Epidemiologic Risks

Cannulating the vein, either for medical reason or the use of drugs. As if the two are different.

Microbiology

S. aureus tends to predominate (it ain't called coagulase positive staph for nuthin'; it sure likes to clot) but any organism that can cause a catheter infection can lead to infected clot. Clot of the internal jugular is Lemmiers and often due to F. necrophorum. Clot in the hepatic vein is pylephlebitis, often due to E. coli.

Empiric Therapy

For peripheral thrombophlebitis, the vein needs to be resected. Usually. In the IVDA, 7 days of IV antibiotics followed by po will often work (PubMed).

For septic thrombophlebitis of the great vessels, anticoagulation. Antibiotics depends on what grows in the blood.

Pearls

Rants

ICD9 Codes (Soon to be supplanted by ICD10)

Thrombophlebitis 451.9; Thrombosis, thrombotic (marantic) (multiple) (progressive) (septic) (vein) (vessel) 453.9. Thrombophlebitis 451.9;

antecubital vein 451.82; arm 451.89;

breast, superficial 451.89; cephalic vein 451.82;

deep (vessels) 451.19; deep 451.83; during or resulting from a procedure NEC 997.2;

femoral vein 451.11; femoropopliteal 451.19; following infusion, perfusion, or transfusion 999.2; hepatic (vein) 451.89;

idiopathic, recurrent 453.1; iliac vein 451.81; iliofemoral 451.11;

jugular vein 451.89; ; leg 451.2;

lower extremity 451.2;

migrans, migrating 453.1;

nonpyogenic 437.6;

popliteal vein 451.19; portal (vein) 572.1; postoperative 997.2;

radial vein 451.82;

saphenous (greater) (lesser) 451.0;

superficial (vessels) 451.0; superficial 451.82;

tibial vein 451.19.

Thrombosis, thrombotic (marantic) (multiple) (progressive) (septic) (vein) (vessel) 453.9;

aorta abdominal 444.0; aorta bifurcation 444.0; aorta saddle 444.0; aorta terminal 444.0; aorta thoracic 444.1; aorta, aortic 444.1;

brain (artery) (stem) 434.0; brain iatrogenic 997.02; brain postoperative 997.02; brain sinus 325;

calf 453.42;

distal (lower leg) 453.42; due to (presence of) any device, implant, or graft classifiable to 996.0-996.5 - see Complications, due to (presence of) any device, implant, or graft classified to 996.0-996.5 NEC; syphilis 094.89; effort 453.8; endocardial - see Infarct, myocardium; eye (see also Occlusion, re

362.30; femoral (vein) 453.8; femoral 453.41; femoral artery 444.22; femoral deep 453.41; femoral with inflammation or phlebitis 451.11;

hepatic (vein) 453.0;

iliac 453.41;

jugular (bulb) 453.8;

leg deep (vessels) 453.40; leg lower (distal) 453.42; leg superficial (vessels) 453.8; leg upper (proximal) 453.41; liver (venous) 453.0; liver artery 444.89; liver infectional or septic 572.1; liver portal vein 452; lower extremity 453.8; lower leg 453.42;

mesenteric vein (inferior) (superior) 557.0; mesenteric (artery) (with gangrene) 557.0;

peroneal 453.42; popliteal 453.41; portal 452; portal due to syphilis 093.89; portal infectional or septic 572.1; proximal (upper leg) 453.41; puerperal, postpartum, childbirth 674.0; pulmonary (artery) (vein) 415.19; pulmonary iatrogenic 415.11; pulmonary postoperative 415.11;

renal (artery) 593.81; renal vein 453.3;

seminal vesicle 608.83; silent NEC 453.9; sinus, intracranial (venous) (any) 325; spinal cord 336.1; spinal cord due to syphilis 094.89; spinal cord pyogenic origin 324.1; spleen artery 444.89; spleen, splenic 289.59;

thigh 453.41; tibial 453.42;

vena cava (inferior) (superior) 453.2.