Quote from Saiderap
"Dont massage their legs because they can go into cariac arrest."
I have gathered this advice from several authorities including my first teacher and one clients own doctor.
If a patient is sedentary for too long you could set a blood clot loose that goes into their brain or their heart
and this is dangerous.
"It takes a doctor's order to massage their legs."
My question is about why I've seen charge nurses and other professionals massaging the legs of elderly
patients and they don't have any explanation for this.
They make no mention of a doctor's order and they
don't say anything about the condition of the patient or how they can tell if this is even safe.
One charge nurse said, "No," that this is not dangerous,
even when the supervisor of our department had told us to, "be careful around their legs," over and over.
Can anyone out there tell me why R.N.s and physical therapists massage the patients' legs
and they seem to have no doctor's order for it and don't have any justification for it.
First of all why would it take a doctor's order to massage their legs. I would consider this well within the realm of nursing care or PT. I would think that I would have to put an order not to massage their legs not the other way around (or communicate nicely please massage their legs) if I wanted it.
The problem is that their is a lot of of voodoo around DVTs. What we used to do is leave people on bedrest while we heparinized them. Then we would put them on Coumadin and let the INR get therapeutic. Then we would stop the heparin and let them out of bed. What we came to understand is that there is no increased risk of DVT with mobilizing the patient. On the other hand the cost in debilitation of bed rest is high. The article in chest pretty much put this to rest: Bed Rest or Ambulation in the Initial Treatment of Patients With Acute Deep Vein Thrombosis or Pulmonary Embolism* — CHEST
Furthermore the current guidelines for DVT treatment do not even mention bed rest.
Now on to the topic of massage indirectly. The initial though was that that ambulating would dislodge clots and cause more PEs which has been disproved. SCDs mimic the action of walking and are though to prevent DVTs not only through preventing vascular stasis but promoting natural anti-coagulation through endothelial activation. SCDs mimic massage (actually with pressures higher that you would normally get with massage). The evidence here is not as strong (a few studies such as this): Compression and walking versus bed rest in the tre... [J Vasc Surg. 2000] - PubMed result
The few small studies suggest that its safe and again the fact that the DVT guidelines don't even address it suggests that its pretty safe. Now that's in a patient with know DVT.
Take the example given above. The patient does not have a know DVT. If they are at risk for a DVT they should be on Heparin or SCDs (or both). In this case its even safer than a patient with a DVT (which seems to be pretty safe).
Bottom line there is a lot of misconception about DVT. The guidelines for treatment are easily available. Outside of this making up problems that don't exist doesn't help anyone. If my patients wanted their legs rubbed I'd do it.
David Carpenter, PA-C