1 / 31

DVT & PE: How early can I mobilize a patient ??

DVT & PE: How early can I mobilize a patient ??. Hatoun Al-Abdulkarim. DVT: Formation of a blood clot in a deep veins as complication of immobility that may contribute to Morbidity & mortality. -Pain -Tenderness -Swelling -Increased warmth & Redness

liluye
Download Presentation

DVT & PE: How early can I mobilize a patient ??

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. DVT & PE:How early can I mobilize a patient ?? Hatoun Al-Abdulkarim

  2. DVT: Formation of a blood clot in a deep veins as complication of immobility that may contribute to Morbidity & mortality

  3. -Pain -Tenderness -Swelling -Increased warmth & Redness - Erythema Or Bluish skin discoloration Signs and symptoms:

  4. Over 50% of DVTs without Signs & symptoms In Fact,

  5. US

  6. Pulmonary embolism (PE): Blockage of the main artery of the lung or one of its branches by a substance that has travelled from elsewhere in the body through the bloodstream (Usually DVT)

  7. - Shortness of breath ( suddenly, even at rest) - Chest pain ( worse with deep breathe, cough, or bend) - Cough Other signs and symptoms may include: - Wheezing - Excessive sweating - Arrhythmia - Weak pulse - Fainting Signs and symptoms:

  8. -PE are reported as many as one third of patients with DVT -Most pulmonary emboli are multiple, and the lower lobes are involved more commonly than the upper lobes

  9. Lung with PE

  10. Incidence • 900,000 PEs/ DVTs in USA in 2002 • 10-40% in medical or general surgery patients • 40-60% following major orthopedic surgery • 10% hospital deaths attributed to PE *Heit J. ASH Abstract 2005.

  11. Risk Factors • Age (over 40) • A past history of DVT • A family history • Immobility • Recent surgery or an injury (especially hips or knees)

  12. Obesity Pregnancy Cancer and its treatments Contraceptive pill that contains estrogen Hormone replacement therapy (HRT) Circulation or heart problems

  13. Methods of Prophylaxis • Mechanical • Pharmacological

  14. Mechanical • Early ambulation • Elastic stockings • Intermittent pneumatic compression

  15. Pharmocologic Methods • Warfarin. • Unfractionated Heparin. • Low Molecular Weight Heparin.

  16. When Can the Patient With DVT Begin to Ambulate?

  17. Medical Approach for Mobilizing pts with a DVT has dramatically changed over the past several years

  18. Partsch and Blattler (2000) New PE development was similar in a mobile group with graduated compression stockings and a bed rest group. They also found decreased pain and leg edema in the mobile group.

  19. Aschwanden et al (2001) New PE occurred in 10 % of mobile subjects while new PE occurred in 14 % of immobile subjects.

  20. Romero-Villegas (2008) 2PEs occurrences in a sample of 105 patients on bedrest and 3 PEs in a sample of 114 patients who received early ambulation.

  21. Compression and walking compared with bed rest in the treatment of proximal DVT during pregnancy 2009

  22. Group A: 15 patients with elastic compression bandages and early mobilization • Group B: 17 patients with compression bandages and bed rest. All patients received heparin therapy.

  23. Subjective Pain was assessed daily with a (VAS) • Objective pain using Lowenberg test. • Reduction of edema was recorded initially and on day 2, 4 and 7. • Ultrasound was repeated after 7 days.

  24. RESULTS: • Resolution of subjective pain was faster in group A • Objective pain& measurement of leg reduced in group A • There was no pulmonary embolism and progression of thrombus diameter.

  25. A meta-analysis ofbed rest vs early ambulationin the management of pulmonary embolism, DVT or both 2009 Sep Department of Cardiology, Cochin Hospital, AP-HP, René Descartes Paris V University, Paris, France

  26. METHODS - Considered all randomized studies and prospective registries that compared the outcomes of patients with DVT, PE, or both, managed with bed rest versus early ambulation, in addition to anticoagulation. -For each study, data regarding the incidence of new PE, new or progression of DVT, and death from all causes, were used to calculate relative risks (RR) and 95% confidence intervals (CI).

  27. RESULTS The 5 studies retained in this analysis included a total of 3048 patients. When compared to bed rest, early ambulation was not associated with a higher incidence of a new PE (RR 1.03; 95% ).

  28. Furthermore, early ambulation was associated with a trend toward a lower incidence of new PE and new or progression of DVT than bed rest (RR 0.79; 95% ) and overall mortality (RR 0.79; 95% ).

  29. CONCLUSIONS

  30. It appears that these studies support that early ambulation and mobilization does not increase the risk of PE compared to bedrest and in some cases may result in actual improvement of other factors like pain and edema.

  31. Thank you

More Related