Homans Sign

[babynurse32]

Are you routinely checking and documenting a Homan's sign on a normal lady partsl delivery patient? C-section?

[hypocaffeinemia, BSN, RN]

Yes I was taught the same thing when I was in nursing school. I just graduated in May 2008 and received my license in July 2008. hypocaffeinemia Do you have the literature that shows that? I told my coworkers about that today and they have never heard that you are not to do Homans Sign anymore. They want literature to support what I said.

Ned Tijdschr Geneeskd. 1999 Sep 11;143(37):1861-3

...Homans's sign has a very poor predictive value for the presence or absence of deep vein thrombosis...

http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat6.table.42211

Sensitivity: 13-48% (aka useless)

It only takes 30 seconds...Why not do it?

There's a theoretical risk of dislodging a thrombus by performing the test, although to the best of my searching skills, I can't find any literature or non-anecdotal case studies demonstrating this risk.

The reason not to do it, then, is because the evidence doesn't support it as a meaningful test. The majority of people with (+) DVT will have a (-) Homan's and it's likely many with a (+) Homan's may have (-) DVT.

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By the way, I think it should be Homans' instead of Homan's as the doctor it is named after was John Homans.

[morte, LPN, LVN]

It only takes 30 seconds...Why not do it?

read the whole post, "if it is a proximal DVT risk of dislodgement is increased with use of Homan's sign testing"

[morte, LPN, LVN]

http://www.emedicine.com/emerg/topic122.htm http://www.fpnotebook.com/hemeonc/cv/dpvnthrmbs.htm

[Woodenpug, BSN]

As with many nursing myths, we wait until the scientific community has moved on then reassert our previous misconceptions. Homan's sign has no clinical value and risks causing an embolism in the case of a proximal DVT.

Just wait long enough, people once again believe in suffocation by oxygen administration and renal dose dopamine. Some day, nurses will actually become scientists and test the truth rather than rely on popular beliefs. Hey, what ever happened to bleeding a patient with febrile symptoms? I don't seem to find any literature stating that bleeding a patient is harmful.

[justme1972]

Hospital where I was this summer, all the nurses checked for Homan's during every routine assessment at least times per day, lady partsl or c-section birth.

[damarystx]

I am new to L&D but came from a surgical/surgical ICU floor, learned in nursing school not to do homans, in the hospital I work at people do it so they can fill in the blank in meditech for homans, I never did it because I have read enough to defend myself in not doing it. But now that I am in L&D all of the nurses do it when they are checking for clonus, I was shown to check for clonus in the same way you perform homans.....if there is a chance of dislodging a clot with homans wouldn't there also be a risk when checking for clonus? or is there a different way to check for clonus?

[Woodenpug, BSN]

During my senior preceptorship, we checked for clonus by testing the knee jerk reflex.