DVTs!

[KalipsoRed]

So I would like the masses to provide me with their standards of care related to DVT patients. I've worked in several hospitals and there is the sect that says the patient should not get up and walk around at all, period, no matter what.

The second set, if they have been on anti-coagulation therapy for 24 hours then they can walk to the bathroom and you can use a wheelchair to take them to tests...minimal walking but they don't have to lay in bed all day.

Thrid set says there is no substantial proof that inhibiting a DVT patient from ambulating makes any real difference from them throwing a clot or not. So they can walk around if they want to.

So I was wondering what the majority around here do? As a traveler nurse I get rather thrown as I worked for the 'do not let them up ever' sect first, then the 'let them get up because it doesn't matter' sect second. I'm now working for a hospital that says no to getting up...didn't know that and let my patient go to doppler in a wheelchair...got my ass chewed by the nurse in the ultrasound area who was also kind enough to tell me what an idiot she thought I was.

As I've dealt with the different scenarios I'd really like to know the articles that say that preventing them from ambulating doesn't really help prevent throwing a clot...just so I can prove that I nursing thinking skills were not so off base as this woman thinks they were.

Thank you for your input.

[colnurse]

at my hospital the only policy restriction that I think off the bat is pt/ot won't work with a pt until after the doppler is done to say whether or not they have a dvt then, the doc is called and we go from there. some of our docs want bedrest for a specific period of time, some do weight based lovenox, some heparin drips and some ivc filters. but once we are able we get them up again out of bed continuing therapy and being ambulatory. So i don't know if that helps you, but where I am it is very doc dependent.

[ayla2004, ASN, RN]

dopplers, d-dimer, to confirm. no restriction on mobility although pain swelling may limit this anyway, treatment dose lmwh.

[MrChicagoRN, RN]

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2787576/

I'd probably limit activity until the pt was Dopplered and their wasn't a concern of the clot breaking loose

[KalipsoRed]

I guess what I don't understand is why the lady in Ultrasound chewed me out for sending a possible DVT to doppler in a wheelchair. It is pretty minimal activity, to me anyway, for a patient to get up from bed walk the 4 or 5 steps to the wheelchair, then for or 5 steps to the strecher for the doppler, then back again...I don't see how that little activity could be a real danger for someone with possible DVTs. (I hope it is needless for me to mention that I would not make someone who was having great pain walking or to unsteady and/or elderly to walk well in a wheelchair.)

Frankly I'm not finding the evidence that minimal activity (walking to a wheelchair for an exam, going to the bathroom, sitting up in a chair with feet elevated, etc) are poor things to allow a patient with a possible undiagnosed DVT to do. I haven't found a recent article that syas that these activities increase the likely hood of a patient throwing a clot.

Thanks for all the comments so far!