12- Physical Therapy for Deep vein thrombophlebitis (DVT) (1).pdf

PHYSICAL THERAPY FOR DEEP VEIN THROMBOPHLEBITIS (DVT) BY DR. AHMED MOHAMED ABDEL-HALIM MECHANISM OF DEEP VEIN THROMBOPHLEBITIS (DVT) • Clot formation and acute inflammation in a deep vein. • Usually occurs in lower extremity, associated with venous stasis (bedrest, lack of leg exercise), hyperact...

PHYSICAL THERAPY FOR DEEP VEIN THROMBOPHLEBITIS (DVT) BY DR. AHMED MOHAMED ABDEL-HALIM MECHANISM OF DEEP VEIN THROMBOPHLEBITIS (DVT) • Clot formation and acute inflammation in a deep vein. • Usually occurs in lower extremity, associated with venous stasis (bedrest, lack of leg exercise), hyperactivity of blood coagulation, and vascular trauma. • The clot may result in damage to the venous valves, causing reflux and a condition known as post-thrombotic syndrome (PTS). The blood clot may break off and travel to the lungs, resulting in a pulmonary embolism (PE). PE may also be fatal. CLINICAL FEATURES OF DVT • Signs and symptoms: • Asymptomatic early • Inflammation • Tenderness and pain • Swelling and warmth • Skin discoloration. • Positive Homan's sign (test for DVT of calf vein ). RISK FACTORS FOR DVT • Active cancer (treatment ongoing, within previous 6 months) • Paralysis, paresis, or recent plaster immobilization of the lower extremities • Recently bedridden for > 3 days or major surgery within 4 weeks • Localized tenderness along the distribution of the deep venous system. • Entire lower extremity swelling • Hyperactivity of blood coagulation • vascular trauma. CLINICAL PREDICTION RULE FOR DVT • Calf swelling > 3 cm when compared with the asymptomatic lower extremity. Measured with a tape measure 10cm below the tibial tuberosity • Pitting edema (greater in the symptomatic lower extremity) DIAGNOSTIC PROCEDURES • Homans' Sign: • The patient's foot is passively dorsiflexed with the knee extended. Pain in the calf indicates a positive Homans' sign for DVT. • Tenderness is also elicited upon palpation of the calf. • Compression ultrasound/Duplex Ultrasound • produce an image of the involved vein. • Venography • This test is invasive and carries some risk. This procedure involves an x-ray of the veins (venogram) taken after a special dye is injected into the bone marrow or veins. MANAGEMENT • Anticoagulation • Thrombolysis • Bedrest • Compression stockings Compression stockings are tight at the feet with a gradually looser fit on the leg (graduated compression). • Elastic compression stockings should be routinely applied "beginning within 1 month of diagnosis of proximal DVT and continuing for a minimum of 1 year after diagnosis COMPRESSION STOCKINGS HOW TO PREVENT DVT? • Intermittent pneumatic compression • Elevation • Exercises • Compression stocking INTERMITTENT PNEUMATIC COMPRESSION • Intermittent pneumatic compression (IPC) is an effective treatment for a variety of circulatory disorders as: • venous thromboembolism prophylaxis • treatment of lymphedema • improves walking distance in patients with intermittent claudication INTERMITTENT PNEUMATIC COMPRESSION • The device, consists of a pneumatic pump that inflates air into garments wrapped around the foot, calf, thigh, or combinations. • Devices with multiple chambers can provide sequential compression in an ascending pattern up the limb. • Pumps vary in their timing cycle and amount of pressure produced, ranging from low- pressure, slow-inflation to high-pressure, and rapid-inflation devices. PHYSIOLOGIC EFFECTS OF INTERMITTENT PNEUMATIC • PC reduces venous stasis • increases venous flow velocity in the deep veins. • decreased venous pressure • decreased interstitial edema. THANK YOU