DVT and leg elevation

[medicalmeg]

Hi everyone,

I am studying DVTs, including how to prevent them and what interventions to take when your patient has one. The idea of elevating the legs confuses me. I keep reading that elevating the legs is a comfort measure used to reduce swelling and discomfort by increasing venous return. My concern is that wouldn't this increase the risk of a pulmonary embolism or heart attack? I have also read that applying SCDs is contraindicated because of the risk of dislodging the clot. This makes sense to me but how is leg elevation different? Also, how does the application of heat help?

I am sure that I have just overlooked something but I would really appreciate if someone would explain this to me! Thank you.

[mrsboots87]

The way I reason it out is this.

You want to have better venous return so that the the area below the clot doesnt swell too much. Venous return from the affected limb is limited because one of the large deep veins is blocked off. Fluid can then start to pool in the limb a little easier. Also, elevating a limb reduces blood flow to that limb. I have been told by my instructors that we dont apply heat because it could increase the risk of dislodging the clot. We basically want to rest the limb, elevate it, and heparinize the patient so the clot does not grow while the body breaks it apart.

[MunoRN, RN]

Early ambulation is actually now recommended for patients with a new DVT. Based on conjecture, it was assumed patients with a new DVT should be on bedrest to avoid a PE or other complications, but a relatively significant amount of evidence has shown that there is no increased incidence of PE or other complications in patients with a DVT who are ambulatory, and that ambulation actually decreases the symptoms and their duration. There isn't a lot of research on the use of SCD's, which essentially mimic ambulation, because these patients should be ambulatory and therefor not requiring SCDs.

[Stephia87RN]

The way I reason it out is this.

You want to have better venous return so that the the area below the clot doesnt swell too much. Venous return from the affected limb is limited because one of the large deep veins is blocked off. Fluid can then start to pool in the limb a little easier. Also, elevating a limb reduces blood flow to that limb. I have been told by my instructors that we dont apply heat because it could increase the risk of dislodging the clot. We basically want to rest the limb, elevate it, and heparinize the patient so the clot does not grow while the body breaks it apart.

Thanks for the explanation! I get it now 😀 For the longest time, I tried to rationalize this in my brain.

[Dranger]

Hi everyone,

I am studying DVTs, including how to prevent them and what interventions to take when your patient has one. The idea of elevating the legs confuses me. I keep reading that elevating the legs is a comfort measure used to reduce swelling and discomfort by increasing venous return. My concern is that wouldn't this increase the risk of a pulmonary embolism or heart attack? I have also read that applying SCDs is contraindicated because of the risk of dislodging the clot. This makes sense to me but how is leg elevation different? Also, how does the application of heat help?

I am sure that I have just overlooked something but I would really appreciate if someone would explain this to me! Thank you.

I have never read studies specifically stating SCDs could release a clot, maybe in a very acute DVT but doubtful in most situations. I often hear the same same thing and it seems to be one of those nursing tall tales you always hear about but no one can confirm.

Think about it what do SCDs do? They aren't just physical squeezers, SCDs help release endothelial factors that prevent platelet aggregation.

In my opinion I feel SCDs in known DVT situations don't benefit but also do not harm the situation. There is already a DVT present and the patient should be on anti-coagulation anyways.

Also what Munro said....

[mrsboots87]

Early ambulation is actually now recommended for patients with a new DVT. Based on conjecture, it was assumed patients with a new DVT should be on bedrest to avoid a PE or other complications, but a relatively significant amount of evidence has shown that there is no increased incidence of PE or other complications in patients with a DVT who are ambulatory, and that ambulation actually decreases the symptoms and their duration. There isn't a lot of research on the use of SCD's, which essentially mimic ambulation, because these patients should be ambulatory and therefor not requiring SCDs.

I know I am late to return to this, but thank you Muno. I will have to read into this more. My instructors are usually pretty up to date, but they have missed things in the past.