What is a GIPSA PPN hospital

A thrombosis leads to a blood vessel blockage caused by a blood clot. Thrombosis often occurs in the leg veins.

Thrombus: what are the symptoms?

1. Thrombus (blood clot) in the leg (vein thrombosis)

  • The patient has a rapid pulse.
  • The ankle or calf of the affected leg is swollen.
  • The patient shows an increased body temperature up to and including a slight fever.
  • The person affected perceives a feeling of tension or heaviness in the lower leg.
  • The main veins are more visible through the skin in leg vein thrombosis.
  • The patient reports sore muscles in the groin, thighs, foot and / or lower leg.
  • The patient's lower leg feels extremely warm.
  • The skin on the affected limbs is very stretched and shiny. Sometimes it is bluish in color.

2. Thrombus in the arm

  • The affected arm hurts when moving and / or when it is touched with greater pressure.
  • If there is a thrombosis in the arm, it is very swollen and feels very hot.
  • The hand is swollen.
  • The veins in the arm and hand are clearly visible through the skin.
  • The arm and / or the hand sometimes show a reddish to purple color.

3. Thrombus in the anal vein

If an anal thrombosis occurs, the affected person's anus is significantly swollen. This swelling is extremely painful for him. Mainly because the thrombosis is usually close to or directly at the opening.

What promotes the development of a thrombosis?

  • Sitting for long and cramped periods (tourist class syndrome)
  • Prolonged lying down (for this reason, people who have had an operation or who are bedridden are injected with blood thinners.)
  • Tumors
  • Operations
  • Lack of fluids / not drinking enough, sweating too much: a combination that causes the blood to become thick and the risk of thrombosis increased.
  • cancer
  • Hormonal changes (birth control pills, pregnancy)
  • Varicose veins
  • Cigarettes
  • Scarring of the blood vessels
  • arteriosclerosis
  • Increased tendency to clot
  • Autoimmune disease

How is thrombosis treated?

Thrombosis can be treated in three different ways:

  • Medicinal
  • Operational
  • Compression therapy

Worth knowing

The methods used to treat thrombosis will depend on where the clot is located. Sometimes different treatment methods are combined.

What is the goal of thrombosis treatment?

When treating a thrombosis, the aim is always to prevent the thrombus from detaching from the inner vein wall. Why? The loosened blood clot can cause an embolism or clog the blood supply to important organs, which can be life-threatening. In addition, a blood clot can cause irreparable and long-term damage to organs, extremities and blood vessels.

Attention "Thrombosis": What are the correct first aid measures?

If a thrombosis occurs, the right immediate measures are crucial to prevent more serious consequential damage. The following is a series of measures that should be observed or adhered to in the event of a thrombosis.

  • As soon as a thrombosis occurs, the affected limbs (such as the legs in a leg vein thrombosis) should be raised as high as possible.
  • If the doctor has already prescribed thrombosis injections for the patient, these should be administered to the affected person according to the instructions for use.
  • Exertion should be avoided for the thrombosis patient.
  • A compression bandage should be applied to the affected limb to prevent the limbs from swelling any further and preventing even more blood from building up.

Applying a compression bandage in the event of a thrombosis: this must be taken into account

If a compression bandage is to be applied, make sure that it is applied tightly and that it encloses the affected area over a large area. Under no circumstances should the compression bandage be too tight so as not to constrict the limbs.

tip

If thrombosis stockings of compression class II are at hand, they can also be of use in an emergency.

Thrombosis: the diagnosis

If there is a suspicion that a patient is affected by a thrombosis, the emergency doctor or the affected person must be taken to hospital immediately. Once there, the first step is to carry out a physical examination of the patient by the specialist. The doctor will pay attention to the typical signs of thrombosis (Payr, Meyer or Homans signs). An ultrasound examination can then be carried out to check the condition of the veins and to find the exact position of the occlusion.

Alternatively, the blood vessels can be shown on an X-ray using venography.

Worth knowing

A venography always occurs when it comes to examining a deeper leg thrombosis.

What happens with venography?

In venography, a contrast agent is injected into a superficial vein on the back of the foot. A tight bandage is now placed around the affected leg to ensure that the contrast agent is well distributed. With the X-ray, the doctor can now see where the thrombus is because the flow of contrast medium is interrupted at this point.

Computed tomography is another option for diagnosing thrombosis.

Worth knowing

If there is a thrombus in the eye, the ophthalmologist will take a retinal image to determine exactly where the blood clot is.

The blood test is part of the diagnosis

Even in the case of a thrombosis, the doctor will have a blood test carried out on the person concerned. A so-called D-dimer thrombosis test is carried out here. This means that the laboratory looks for D-dimers, a breakdown product that can only be found in the blood when there is / has actually been a blood clot.

How does the thrombosis treatment work?

The drug-based thrombosis treatment

Drug treatment is designed to prevent the blood clot from growing or peeling off. Depending on which drug is used,

  • the body's own enzymes are activated to shrink or dissolve the thrombus.
  • the body's own blood clotting is disabled to such an extent that no new thrombus can develop.

Some of these drugs must be used for life after a thrombosis.

What drugs are used to treat thrombosis?

  • Heparin: This drug inhibits blood clotting. In the case of a thrombus, a high dose of heparin is administered subcutaneously intravenously or by infusion.
  • Fondaparinux is always used when heparin has no effect.
  • DOACs (e.g. apixaban, rivaroxaban)

What happens after thrombosis treatment?

Follow-up treatment is carried out between 5-10 days after thrombosis treatment. He is given anti-coagulants in tablet form. This medication must be taken between three and six months after the thrombosis. Some doctors also prescribe so-called vitamin K antagonists.

Worth knowing

In addition to heparin, thrombosis drugs with active ingredients such as B. warfarin or phenprocoumon are used.

The surgical treatment methods for thrombosis

Recanalization: A catheter is inserted into the affected vein and the doctor tries to pull out the thrombus. At the same time, a drug that dissolves the thrombus is administered via the catheter.

Worth knowing

The earlier a recanalization is carried out in a thrombosis patient, the lower the risk of the so-called post-thrombotic syndrome occurring.

Thrombosis: what is the course of the disease?

Thrombosis should by no means be underestimated, because this disease is extremely serious and can have dire consequences - keyword: pulmonary embolism. But the vein blocked by the thrombus can also suffer permanent damage (e.g. post-thrombotic syndrome).

How can high-risk patients prevent thrombosis?

Efficient thrombosis profiling includes:

  • Sufficient exercise. Especially if you have to sit for a long time at work or on a flight.
  • Make sure you are hydrated enough to keep the blood thin.
  • Patients who have recently suffered an injury, had surgery, or are immobilized for other illness-related reasons should take medication to prevent thrombosis to prevent a blood clot from forming. Alternatively, thrombosis stockings can also help to ensure an evenly rapid blood flow.

How does thrombosis prophylaxis work in nursing?

The risk of thrombosis always increases in patients who suffer from movement problems. It is up to the caregiver to minimize the risk.

What is the purpose of thrombosis prophylaxis?

Thrombosis prophylaxis is intended to help prevent arterial thrombosis, acute arterial occlusion, thromobophlebitis and / or phlebothrombosis.

What are the main pillars of thrombosis prophylaxis for the nurse?

  • Early mobilization
  • Vein compression
  • Decongestant storage

Which three factors (Virchow's triad) can promote the development of a thrombosis?

  • The vessel walls change.
  • The composition of the blood changes.
  • The blood flow becomes slower.

Which patients belong to the risk group?

  • Patients in need of care who are on certain medications, such as B. cortisone, are dependent.
  • Partially immobile or immobile patients who, for. B. paralyzed or bedridden. But thrombosis prophylaxis can also be useful in the case of splints or plaster casts.
  • Patients suffering from phlebitis.
  • Seniors in need of care who are affected by age-related degenerative changes in the blood vessels (e.g. varicose veins)
  • Patients who maintain a constant relieving posture due to severe pain.
  • People affected by traumatic vascular damage, such as B. after injuries, operations or burns.
  • Patients experiencing fluid loss and / or dehydration.
  • Seniors who suffer from chronic venous insufficiency.
  • People who suffer from pathological cell proliferation, such as B. polycythemia.
  • Seniors who suffer from heart failure (heart failure).

Early Mobilization: The Facts

  • The nurse's task is to encourage / motivate the patient to do active and passive movement exercises at an early stage.
  • The patient's joints should be flexed to activate the muscle pump in the legs and improve the patient's breathing.
  • The physiotherapist or occupational therapist usually carries out active movement exercises with the person in need of care. This shows the patient exercises that he or she can or should carry out independently or with the support of nurses or relatives.
  • The nurse usually integrates passive movement exercises into the daily basic care. These are based on the patient's actual mobility.

tip

Post-May angled elevation can help improve venous blood flow and prevent clots. Elevating the legs also helps prevent edema (water retention). A pleasant side effect of the unwound elevation after May is that it can help that any existing edema can regress more quickly.

Danger

As long as there are no contraindications, the unwound elevated position should be carried out regularly after May.

How is the angled elevation carried out?

The patient's lower legs must be positioned parallel to the bed level at a height of between 15-25 cm. The patient's thighs are placed on a special foam block cushion at an angle of 35-45 degrees Celsius.