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?

[AKSkier]

I read an article in Nursing 09 - April about venous thromboembolism. It does not say anything in the section about recognizing DVT about using the Homan's sign. I would just assess for and document the other signs and not worry about Homans. It is not very accurate but I am not sure if it is dangerous. Have not seen in writing anywhere that it is dangerous I should say.

Also you mentioned patients with DVT to remain on bedrest. I don't think this is the case anymore. In this article it also mentions that the American College of Chest Physicians recommend anticoagulation and early mobilization. This is new to me. Definitely follow the physicians orders where you work, but we may see that they are no longer keeping patients on bedrest.

[HeartsOpenWide, RN]

We learned in school that checking for Homan's Sign is controversial because you can throw a DVT in the process. Some instructors even said we should not check for it at all. The way my OB teacher taught me how to do Homan's Sign is to have the patient point their toes and then flex and ask them if they have any sharp pain when they do it. VS having the patient push down with their feet while you squeeze the calf. Do you check Homan's Sign, and if so what is your method?

[fromtheseaRN, BSN, RN]

my instructor told my class that it is done the way your OB teacher described, but is it strictly against our school's policy to do it due to the danger of throwing a DVT.

[FLArn]

I haven't checked for a Homan's sign in many years for the reason you cited. In most cases at risk patients are put on Lovenox prophyllaxis (sp?) unless their medical condition contraindicates.

[Saf1, BSN, MSN, RN, APN, APRN, NP]

I did a lot of clinical hours on postpartum as a student and we did Homan's on everyone -- I even remember an NCLEX practice question saying you were supposed to do it as part of a postpartum assessment. I've also heard the same stuff about it possibly throwing the clot though and wondered if Homan's is still considered evidence based practice. We were taught to do it by lifting the patient's calf with one hand, then pulling back on the foot (dorsiflecting) with the other hand. Thanks to the OP for posting this question...I've wondered about this myself for a while!

[turnforthenurse, MSN, NP]

I was taught to support the leg with one hand and then dorsiflex the foot with the other. If the patient feels a sharp pain then it is a positive Homan's Sign, but I was also told a positive Homan's always isn't indicative of a DVT. I don't see these done very often.

[HamsterRN, ADN, RN]

From what I remember, a positive Homan's sign is when there is pain the calf resulting from dorsiflexion (toes towards knees). I've sort of intentionally let my memory of it go because it's supposedly of little clinical value if any. Many people with a DVT have a negative Homan's sign, and many people with a positive Homan's sign have no DVT. Ultrasounds with (or even sometimes without) a positive D-Dimer seem to be pretty common these days for detecting a DVT.

[SCgrl1]

From what I remember, a positive Homan's sign is when there is pain the calf resulting from dorsiflexion (toes towards knees). I've sort of intentionally let my memory of it go because it's supposedly of little clinical value if any. Many people with a DVT have a negative Homan's sign, and many people with a positive Homan's sign have no DVT. Ultrasounds with (or even sometimes without) a positive D-Dimer seem to be pretty common these days for detecting a DVT.

I think this is becomming more the standard these days.

[vindy]

I just asked my professor about this yesterday, as I thought we weren't supposed to perform Homan's on a patient. She said if there are no obvious signs and symptoms of a DVT such as the warmth, redness and swelling of the calf we can perform it, but if there are obvious s/sx of a possible DVT then don't perform it because that can cause the clot to dislodge.

[Baloney Amputation, BSN, LPN, RN]

Just a little friendly FYI, because this term is misspelled often...the term is actually Homans' sign, not Homan's sign. It is named for John Homans.

http://www.whonamedit.com/synd.cfm/2371.html

[cheska_rn, ASN, RN]

We were taught it (and even tested on it), but told we were not allowed to use it in clinicals for the reasons listed above.

[klone, MSN, RN]

It's not a very reliable method for determining DVT. Nevertheless, the charting at my work requires that we perform it. I ask the pt to do it (which is really no more invasive or risky than having them walk around, and we certainly don't tell all our pts not to walk around for concern about dislodging clots). I also firmly run my hands over their calves and ask if there are any tender spots.

I just learned the other day that new research in pre-eclampsia finds that women who have >8 proteinuria in a 24-hour urine are at greater risk of developing DVTs postpartum, and that current recommendation is to have them on subcut heparin during their hospital stay. I had questioned the doctor because I had a s/p MgSO4 pt secondary to pre-eclampsia, and I was wondering why she was on heparin, as when I questioned her, she didn't have any risk factors that I could determine.