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UNDERSTANDING DVTA patient and carer guide
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
