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1-35. THROMBOPHLEBITIS
Thrombophlebitis is inflammation of a vein with blood clot formation. Venous stasis (slowing of venous blood circulation) and pressure or other injury to vein walls predisposes its development. The most common sites for development of thrombophlebitis are in the veins of the pelvis and legs. A postoperative patient or any other individual who has remained still for hours at a time with relaxed muscles and a resultant slowing of venous circulation in the legs is particularly liable to develop thrombophlebitis. When inactivity is combined with pressure on the popliteal space and the calf of the leg, the possibility of developing thrombophlebitis increases.
a. Signs and Symptoms of Thrombophlebitis.
(1) Cramping pain in the calf.
(2) Possible redness, warmth, and swelling along the course of the involved vein.
(3) Pain that may appear only on dorsiflexion of the foot.
b. Nursing Implications.
(1) Do not, under any circumstance, rub or massage the affected limb.
(2) Place the patient on immediate bed rest and notify the RN.
(3) Keep the affected limb horizontal and at rest until the physician has examined the patient and ordered specific treatment. Support the entire limb from the thigh to the ankle on pillows, keeping the limb level unless otherwise ordered. Orders for treatment may include elevation and application of continuous massive warm, moist packs to the entire limb.
(4) Use a bed cradle to prevent any pressure from the bed linen.
(5) Be alert to any complaint or other evidence of respiratory difficulty or chest pain. A clot which is adherent to the vein wall, or a portion of a clot, can become dislodged and be carried in the circulation as an embolus to distant and smaller arterial blood vessels in the lungs. Sudden dyspnea, violent coughing, or severe chest pain may be the first sign of embolism.
(6) Discontinue routine postoperative exercise, ambulation, deep breathing, and coughing measures until the physician has indicated which measures are to be resumed and which precautions are to be taken.
(7) Carry out all subsequent treatment and nursing care measures in a manner that will avoid abrupt movements and any strain on the part of the patient.
(8) When ordered, apply anti-embolism hose or intermittent external pneumatic compression system to give support and aid venous circulation.
(9) When the patient is allowed out of bed, remind him to alternate walking and resting with feet propped on a stool to avoid pressure in the popliteal space. Prolonged standing or sitting with no movement must be avoided. Check to see that the edge of the chair seat does not press the popliteal space and that the patient does not sit with crossed legs.
