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Deep Vein Thrombosis – Guidance and Safety Measures

A guide to assessing whether a client has DVT, including COVID-19 risk, by Earle Abrahamson

If you’ve never heard of it or are not sure what I’m talking about when referring to a DVT, it stands for “Deep Vein Thrombosis,” which is the formation of a blood clot in the lower limb.

The big issue with this is if the clot dislodges it can become a pulmonary embolism blocking blood vessels in the lung, which, depending on the size of the clot could be life-threatening. If it is a smaller size clot, at a minimum it can cause damage to the lungs.

Those who have recovered from COVID-19 may be at risk from DVTs. Read this article for more information.

So, how do we know if this is what our patient has when they come in complaining of pain in the lower legs?

Well, first off, we need to get a good thorough health history from the patient. When we look at the causes of a DVT, you could easily ask some questions that would throw up some red flags as an indicator without even observing the area of complaint. Some of the risk factors that cause a DVT include:

  • family history of DVT
  • overweight or obese
  • damage to blood vessels
  • broken bones
  • severe muscle damage
  • during surgery
  • varicose veins
  • vasculitis.

Conditions that cause blood to clot more readily:

  • cancer
  • heart and lung disease
  • thrombophilia
  • Hughes syndrome (an immune disease that causes increased clotting)
  • Being inactive or immobile for extended periods:
  • Sitting for extended periods on a plane during travel (this is an important one)
  • long duration surgeries
  • Pregnancy.
  • Women on birth control or hormone replacement therapy.

Think about turning all of the above factors into questions during your intake. If your client reports any of the above, it’s a good sign to investigate a little deeper before progressing with your treatment. It is also worth noting, this typically happens unilaterally, so hopefully, only one side is of concern.

If you get to the point of doing an assessment on the painful area some of the symptoms look like:

  • Heavy ache
  • Pain, swelling, and tenderness in the area
  • Red, warm skin, especially around the back of the leg close to the knee

Homans Sign” - this test has come under some scrutiny lately. One study showed Homan’s sign was positive in 33% of patients with an actual DVT, but also in 21% of the patients who had no thrombosis. The estimated accuracy of the test ranges from 8% to 56% and also positive in more than 50% of patients who were symptomatic but did not have a DVT. So, it’s fair to say this orthopaedic test is not a reliable test for us to use.

There is also occurrences of upper limb DVTs, which can affect any veins of the upper extremity or thoracic inlet, including; jugular, brachiocephalic, subclavian, and axillary veins as well as the more distal brachial, ulnar, and radial veins.

Some of the risk factors in this case include:

  • High body mass index
  • Pregnancy
  • Surgery
  • Smoking
  • Malignancy
  • Foreign body in the vascular system (more than half the patients who had this, was because of pacemaker).

The more typical signs and symptoms are:

  • Swelling
  • Pain
  • Oedema
  • Cyanosis.

Some other symptoms like localized neck and shoulder pain, weakness, paresthesia, and elevated body temperature can occur but are less likely.

Yet, another reason why our clinical reasoning has to be used when interviewing our clients. If we see any combination of the above signs and symptoms mentioned for lower or upper limb DVT, we MUST at a minimum refer out to a doctor to ensure an accurate diagnosis, and of course to ensure client safety.

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