Collapsed vein

Short description: Medical injury

Collapsed veins are a common injury that results from repeated use of intravenous injections.

They can result from intravenous chemotherapy[1][2] or when injection conditions are less than ideal, such as in the context of drug abuse.

## Contents

* 1 Causes
* 2 Mechanism
* 3 Prognosis
* 4 See also
* 5 References

## Causes

Dehydration can cause temporary vein collapse.[3]

Permanent vein collapse occurs as a consequence of:

* Repeated injections, especially with blunt needles.
* Poor injection technique.[4]
* Injection of substances which irritate the veins; in particular, fluids that are hypertonic (high osmolality), vasoactive, irritants, with an extreme pH (very acidic or alkaline),[5] many chemotherapeutic drugs[4] or liquid methadone intended for oral use.

## Mechanism

Individual endothelial cells may change the structure of their cytoskeleton when a vein collapses to better deal with the increased shear stress.[6]

## Prognosis

Once endothelial swelling subsides, circulation will often become re-established. Collapsed veins may never recover. Many smaller veins are created by the body to circulate the blood, but they are not adequate for injections or IVs.

Research into solutions for patients with difficult venous access continues.[7]

## See also

* Phlebitis

## References

1. ↑ "Extravasation What is it? Patient leaflet". Milton Keynes University Hospital NHS Foundation Trust. https://www.mkuh.nhs.uk/patient-information-leaflet/extravasation-what-is-it.
2. ↑ "Guidelines for the Management of Extravasation of a Systemic Anti-Cancer Therapy including Cytotoxic Agents". West Midlands Expert Advisory Group for Systemic Anti-Cancer Therapy (SACT). https://www.england.nhs.uk/mids-east/wp-content/uploads/sites/7/2018/04/management-extravasation-of-a-systemic-anti-cancer-therapy-including-cytotoxic-agents.pdf.
3. ↑ Walsh, Gabrielle (2008-01-01). "Difficult Peripheral Venous Access: Recognizing and Managing the Patient at Risk". Journal of the Association for Vascular Access 13 (4): 198–203. doi:10.2309/java.13-4-7. ISSN 1552-8855. https://www.sciencedirect.com/science/article/abs/pii/S1552885508701089.
4. ↑ 4.0 4.1 Kreidieh, Firas Y (2016). "Overview, prevention and management of chemotherapy extravasation" (in en). World Journal of Clinical Oncology 7 (1): 87–97. doi:10.5306/wjco.v7.i1.87. ISSN 2218-4333. PMID 26862492.
5. ↑ "Extravasation injuries: prevention and management (neonatal guideline)". NHS Greater Glasgow and Clyde (NHSGGC). https://clinicalguidelines.scot.nhs.uk/nhsggc-guidelines/nhsggc-guidelines/neonatology/extravasation-injuries-prevention-and-management-neonatal-guideline/.
6. ↑ Haond, C.; Ribreau, C.; Boutherin-Falson, O.; Finet, M. (1999-10-01). "Laminar flow through a model of collapsed veins. Morphometric response of endothelial vascular cells to a longitudinal shear stress non uniform cross-wise" (in en). The European Physical Journal Applied Physics 8 (1): 87–96. doi:10.1051/epjap:1999233. ISSN 1286-0042. Bibcode: 1999EPJAP...8...87H. https://www.epjap.org/articles/epjap/abs/1999/10/ap8229/ap8229.html.
7. ↑ Little, Andrew; Jones, Drew G.; Alsbrooks, Kimberly (2022-05-04). "A narrative review of historic and current approaches for patients with difficult venous access: considerations for the emergency department". Expert Review of Medical Devices 19 (5): 441–449. doi:10.1080/17434440.2022.2095904. ISSN 1743-4440. PMID 35786122.

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