DVT and Homan's sign

[HarmonyW]

I have been told two seperate things by two different teachers about DVT signs. One is saying to use Homan's sign of forcefully dosiflex the foot to check for DVT. Calf pain would indicate a positive Homan's sign and possible DVT. Another teacher is telling me they do not do Homan's anymore because of possibly dislodging the clot and to squeeze the calf with both hands instead to check for calf pain. I asked the other teacher about this and she said no squeezing the calf could dislodge the clot and not to do that. Help! Which should I do?

[TazziRN, RN]

I work ER and we still use dorsiflexion to test for Homan's. I've seen some docs use palpation, though. Between the two I would think the dorsiflexing would be more risky since +DVT pts are on bedrest.

[EricJRN, MSN, RN]

I think the trend is to move away from eliciting Homan's sign at all. It is being shown to be neither sensitive nor specific for DVT. For many, it's just one of those old habits that won't die. Here's one link to that effect:

http://www.emedicine.com/emerg/topic122.htm

[meandragonbrett]

Like Eric said, Homan's is not always specific and sometimes is totally inaccurate. we don't assess homan's in my facility

[snowfreeze, BSN, RN]

The facility I work in does not use Hohmans nor palpation, we just do dopplers for leg pain that has no other reason.

[fultzymom]

I have been told that many people with DVT are negative for Homan's sigh so it is not a good indicator. Look for the swelling, warmth, et pain. That is what we do at my facility. Many people complain of pain without doing the Homan's test. Squeezing the leg could dislodge the clot. You are not supposed to do that.

[Roy Fokker, BSN, RN]

I do:

Neuro checks

General observation

Location/description/intensity/onset of pain

Other secondary charecteristics

I work a surgical floor and I'm always super sensitive to compartment syndrome and DVTs :uhoh21:

cheers,

[time4meRN]

The latest in critical nursing, is never do the Homans. There are so many good non invasive ways to DX a DVT now , that the Homans is outdated and dangerous. Besides, you can document all of the pt symptoms etc. But as nurses we can't make a Dx. so why do the sign. Just document, redness, edema etc...never document that you did the Homans. (CYA)

[smk1, LPN]

I have been told two seperate things by two different teachers about DVT signs. One is saying to use Homan's sign of forcefully dosiflex the foot to check for DVT. Calf pain would indicate a positive Homan's sign and possible DVT. Another teacher is telling me they do not do Homan's anymore because of possibly dislodging the clot and to squeeze the calf with both hands instead to check for calf pain. I asked the other teacher about this and she said no squeezing the calf could dislodge the clot and not to do that. Help! Which should I do?

In clinical you ask your actual clinical instructor what she wants you to do and go by that. Do this with every new clinical instructor about any issue that has an area of grey around it. You follow the one who has the power to pass or fail you.

P.S. We were told the theory behind checking the homan's sign but were told not to do it due to the possibility of dislodging the clot.

[climberrn]

The latest in critical nursing, is never do the Homans. There are so many good non invasive ways to DX a DVT now , that the Homans is outdated and dangerous. Besides, you can document all of the pt symptoms etc. But as nurses we can't make a Dx. so why do the sign. Just document, redness, edema etc...never document that you did the Homans. (CYA)

I do agree that charting circumference, redness, etc. is more useful but you're not making a DX by charting Homan's (regardless of it's usefulness), you are reporting + or -, that's it. No CYA involved...

[crissrn27, RN]

I think time4me was refering to the fact that you could dislodge the clot, and if you charted you did homans sign it could be blamed on the nurse.

[momof3RN2B09]

so, I'm actually working on an EBP project on this discussion. Does anyone know if there is a way to use this site to survey nurses on this topic?