PHLEGMASIA

Tracy Groller & Deb Halliday Journal Article Presentation

MEDU 610Professor: Camie Modjadidi

April 7, 2011

OBJECTIVES

Define Phlegmasia

Understand the Disease Process

Understand the Treatment Options Care of the Phlegmasia Patient

NORMAL BLOOD FLOW

YouTube - CIRCULATION

DEEP VEIN THROMBOSIS FORMATION

YouTube - How DVT forms

DEFENITIONS Phlegmasia /phleg·ma·sia/ (fleg-ma

´zhah)- Old term for inflamation of the veins caused

by Deep Venous Thrombosis (DVT) which is a blood clot.

Phlegmasia al´ba do´lens-Milk leg; DVT of the femoral vein with swelling of the leg.

Phlegmasia ceru´lea do´lens-   An acute form of DVT, with pronounced

edema (swelling) and severe cyanosis (blue discoloration) of the limb (leg/arm).

CAUSES OF PHLEGMASIA

Pregnancy May-Thurner’s

Syndrome (Compression)

Surgery Trauma Malignancy Untreated DVT

Vena Cava (Filter)

Legs

PHLEGMASIA ALBA DOLENS

Pathophysiology Clot Affects Deep Veins Return of Some Blood Flow Less Severe

Symptoms Edema (swelling) Pain Blanching (white leg) without cyanosis

(blue leg)

PHLEGMASIA ALBA DOLENS

PHLEGMASIA CERULA DOLENS

Pathophysiology Clot Affects Deep and Superficial Veins Mostly found in Left Leg Absolutely No Return of Blood Flow

Symptoms Severe Edema (Significant Swelling) Agonizing Pain Cyanosis (Blue Color) Loss of Movement Loss of Feeling Compartment Syndrome—which may lead to

limb loss

PHLEGMASIA CERULA DOLENS

DIAGNOSTIC STUDIES

Non-Invasive (Without Puncture) Ultrasound—Most

Reliable MRI/MRV

Invasive (With Puncture) Venogram

COMPLICATIONS OF UNTREATED PHLEGMASIA

Pulmonary Embolism

Valvular Insufficiency

Venous Gangrene/Ulceration

Limb Death

Death

TREATMENT OPTIONS

Anticoagulation

Possible Inferior Vena Cava Filter

Mechanical Debulking

YouTube - Thrombectomy animation

TREATMENT OPTIONS

Catheter Direct Thrombolysis (CDL) TPA/Retavase (Clot

Buster)

Stenting

TREATMENT OPTIONS

Surgical Thrombectomy

Fasciotomy• Compartment

Syndrome Treatment

Amputation

CARE FOR THE PHLEGMASIA PATIENT

Vital Signs (O2 Sat)

Bedrest with Limb Elevation

Pulse Evaluation

Motor and Neurological Function

Wound Assessment and Care

Catheter-Direct Thrombolysis Patient Care

BLOOD CLOT CYCLE

RESOLVECHRONIC

BLOOD CLOT

ACUTEBLOOD CLOT

DECREASED RETURN BLOOD FLOW

REFERENCES

"Blood Flow"   Retrieved from YouTube 4/2/11.

Dardik, A., Rahhal, D. (2009). Phlegmasia alba and cerulea dolens. Retrieved from: http://emedicine.medscape.com/article/461809-print.

http://medical-dictionary.thefreedictionary.com/phlegmasia

“Thrombectomy Animation” Retrieved from YouTube 4/2/11.