DEEP VEIN THROMBO-PHLEBITIS

Deep Vein Thrombo-Phlebitis

ASSESSMENT:

• Calf or groin tenderness or pain with or without swelling.
• Positive Homans' sign may be noted; however, false-positive results are common, so this is not a reliable assessment measure.
• Warm skin that is tender to touch.

CALF:

• The fleshy hind part of the human leg below the knee.

INTERVENTION:

• Provide bed rest.
• Elevate the affected extremity above the level of the heart.
• Avoid using the knee gatch or a pillow under the knees.
• Do not massage the extremity.
• Provide thigh-high or knee-high anti embolism stockings to reduce venous stasis and assist in the venous return of blood to the heart; teach how to apply and remove stockings.
• Administer intermittent or continuous warm, moist compresses as prescribed.
• Palpate the site gently, monitoring for warmth and edema.
• Measure and record the circumferences of the thighs and calves.
• Monitor for shortness of breath and chest pain, which can indicate pulmonary emboli.
• Administer thrombolytic therapy (tissue plasminogen activator) if prescribed, which must be initiated within 5 days after the onset of symptoms.
• Administer heparin therapy as prescribed to prevent enlargement of the existing clot and prevent the formation of new clots.
• Monitor activated partial thrombo plastin time during heparin therapy.
• Administer warfarin (Coumadin) as prescribed following heparin therapy when the symptoms of deep vein thrombo phlebitis have resolved.
• Monitor prothrombin time and international normalized ratio during warfarin therapy.
• Monitor for the hazards and side effects associated with anti-coagulants therapy.
• Administer analgesics as prescribed to reduce pain.
• Administer diuretics as prescribed to reduce lower extremity edema.

CLIENT EDUCATION:

• Instruct the client concerning the hazards of anti coagulation therapy.
• Recognize the signs and symptoms of bleeding.
• Avoid prolonged sitting or standing, constrictive clothing, or crossing legs when seated.
• Elevate the legs for 10-20 minutes every few hours each day.
• Plan a progressive walking program.
• Inspect the legs for edema, and measure the circumference of the legs.
• Wear anti embolism stockings as prescribed.
• Avoid smoking.
• Avoid any medications unless prescribed by the health care provider (HCP).
• Instruct the client concerning the importance of follow-up visits and laboratory studies.
• Obtain and wear a Medic-Alert bracelet.