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UNDERSTANDING DVT A patient and carer guide with people in mind
WHO SHOULD READ THIS BOOKLET? You may be wondering exactly why you have been given this booklet or feel that what s inside does not apply to you, but read on. Deep Vein Thrombosis (DVT) or blood clots in the leg can occur in all ages but can be prevented by simple actions that you can take yourself, or by following the preventative actions advised by the nurses and doctors. The risk of developing DVT is significantly reduced by what you can do through using the information in this booklet. Many people who become ill or require surgery may develop blood clots in their legs and there are usually very few signs of it occurring. The blood clots are often present without you or the doctors or nurses knowing, and problems may arise suddenly without warning. Unfortunately the end result of these clots may be extremely serious or make you very ill. Because of this it is better for you to be safe and prevent the problem before it arises. Not all patients will develop DVT but all patients can take some simple precautions.
WHAT IS DEEP VEIN THROMBOSIS? When you have had an operation it is normal for the blood to become thicker and stickier. This is a natural response that ensures that wounds do not bleed excessively. But this makes it easier for a clot to form in the deep veins of the leg resulting in a deep vein thrombosis. Deep Vein Thrombosis is a potentially serious complication because a fragment can break off and become lodged in the lung and affect breathing. Sometimes the fragment is large enough to cause death. In the longer term, the clot damages the vein and can lead to leg ulcers that may be difficult to treat.
WHAT CAUSES DEEP VEIN THROMBOSIS? The circumstances in which a clot is most likely to occur are when: Blood is stickier than it needs to be and clots faster to prevent the wound from bleeding. The blood is moving slowly through the veins because of inactivity and bed rest. The vein has some kind of blemish such as a varicose vein or scar from a previous injury. The risk of deep vein thrombosis can be greatly minimised by: Ensuring blood is only sticky enough to prevent wounds bleeding. Keeping the blood moving in the vein and preventing stagnation. Being aware of any damage to the vein.
WHO IS AT RISK? Anyone can develop a DVT. The time you are most at risk is after surgery or injury. Being overweight, a smoker and over 40 years of age also increases your risk. People whose veins have been damaged are more at risk. This can happen in pregnancy and at childbirth, or through injury or surgery. You should tell your nurse or doctor if any of the following applies to you: Taking the contraceptive pill or hormone replacement Pregnant Previous DVT or clotting abnormalities in your family. Certain medical conditions such as heart failure, stroke and heart attack also increase your risk and the nurse or doctor will ask you questions about these and may take blood samples. You will then be advised on what to do.
WHAT CAN I DO? KEEPING THE BLOOD MOVING The most effective way of preventing a blood clot forming is by keeping active. After your operation you will be advised to get up and about. If you are not able to walk, there are other actions you can take. For everyone it is important to follow these simple precautions. DEEP BREATHING By taking deeper breaths than usual the pressure in your chest is lowered and you help to suck the blood in your veins back up to your heart, increasing blood flow. Deep breathing also helps prevent chest infection. The physiotherapist or nurse will advise you on how much deep breathing you should do. Deep breathing should not be too energetic and make you tired or cause your fingers to tingle. If this happens, you should stop straightaway and report this immediately to the nurse or physiotherapist looking after you.
RAISING THE LEGS Raising the legs on a pillow or footstool uses gravity to help the blood to flow from the legs back to the heart more easily. People with high blood pressure or who have sustained recent injury to the head will be advised not to do this. Raising of the legs is sometimes achieved by raising the foot end of the bed or by placing the feet on a pillow or stool. EXERCISES Exercises can be done whilst you are in bed or sitting in a chair. They can be done with or without an exercise aid or cushion and will help keep the blood moving in your legs. The nurse or physiotherapist will advise you according to your operation and what you are allowed to do. These exercises should be done frequently (normally each exercise to be done 5 times, twice in each hour). Airwalker Exercise Aid System
SPECIAL STOCKINGS These provide a graduated, firm and even pressure to the legs to help the blood flow in your legs. They can be below or above knee. They are put on just before your operation or immediately after it. They must fit properly and not stop or slow the flow of blood, so leg measurements will be taken. They should: Be snug, but not tight Feel comfortable Not be rolled down If the stockings are not comfortable they should be taken off and a new size fitted. When wearing, fitting and washing the stockings you should follow the instructions given by the nurse and doctor and the written information provided by the manufacturer. INTERMITTENT COMPRESSION DEVICES Intermittent compression mimics the effect of walking, by helping to squeeze the blood back up the legs to the heart. A garment is fitted around each of your legs or feet. This is attached to a machine, which inflates a section of the garment with air.
As the garment inflates, it compresses the veins, and pushes the blood back to the heart. The garment deflates again after a few seconds. This action copies the squeezing by the calf muscle or foot, on the veins, when you walk. Intermittent compression also helps to break down some of the proteins in your blood that can cause blood clots. This means it works in two ways to prevent a DVT. This booklet discusses the way that Huntleigh Healthcare systems work. Flowtron Excel and Flowtron Universal Intermittent Pneumatic Compression Systems
CALF GARMENTS A garment, which has an inflatable section at the back, is wrapped around each calf. Your doctor or nurse connects the garments to a machine that is pre-set. The machine inflates them once a minute, on each leg. When the garments are inflated, they produce a mild squeezing sensation. They should not cause any discomfort or tingling. If they do, please speak to your nurse or doctor immediately. Garments come in various sizes and are fitted according to the size of your leg. Some garments are designed for the calf and thigh area together. Patient wearing Flowtron Excel calf garments
FOOT GARMENTS A garment is wrapped around each foot with an inflatable section that gently squeezes the sole and sides of the foot. The heel strap can be adjusted for comfort. The garments come in two sizes depending on your shoe size, and can be applied to either foot (there is no left or right). Your doctor or nurse connects the garments to a machine that is pre-set. The machine inflates each foot garment every 30 seconds, and remains inflated for 3 seconds. The garments, when inflated, gently squeeze the foot around the sides and base. This opens up the blood vessels in the foot to allow the blood to flow more freely. There should not be any discomfort, numbness or tingling. If there is, please speak to your nurse or doctor immediately. Patient wearing Flowtron Universal foot garments
Intermittent compression should be applied just before surgery and needs to be maintained until you are walking properly again, usually after about 3 days. It is essential to keep the device working at all times, including while you sleep, to keep the blood moving. An electrically powered machine runs the system. This has been pre-set and should only be adjusted by a doctor or nurse. If the digital display on the pump should say Lo, HI, F or you hear an audible alarm, inform the nurse or doctor immediately. Once the system has been set up, it should run quietly and unobtrusively. DRUG THERAPY Drugs may be given, as tablets or injections, which thin your blood and prevent it becoming too sticky and forming a clot. Because these drugs prevent your blood from clotting (coagulating) they are called anticoagulants. Anticoagulation needs to be given as near as possible to your surgery or injury. If your surgery is planned, anticoagulation is sometimes begun just before surgery. It is continued until you are fully mobile or for up to six weeks.
The most common types of anticoagulation are: HEPARIN This is given by a small injection just under the skin. The commonest are called low molecular weight heparins (LMWH). Anticoagulation is begun just before surgery and continues for up to six weeks. There are certain things you must do and must not do while having this treatment and things to look out for. As with other drugs the nurse and doctor will explain possible side effects. LOW DOSE ASPIRIN A very small amount of aspirin, taken regularly reduces the stickiness of the blood and prevents clotting. As before, the nurse and doctor will explain how it works and what to do.
If you have any concerns regarding DVT, please contact your doctor or nurse. List of contributors: Editor: Peter Davis Research Nurse, Queens Medical Centre, Nottingham, UK Ricky Autar Senior Lecturer, De Montfort University, UK Jane Wills Senior Lecturer South Bank University, UK Christine Love Senior Lecturer St. George s Hospital Medical School, Kingston University, UK Written in collaboration with the Therapy & Prevention Product Division, Huntleigh Healthcare