question-need to clear myself on this now or it'll bother me

[sweetieann]

I am a bit confused on what I would consider pretty basic nursing, so I just want to clear myself on this so I'm nto confused.

Ok, first off: I have heard it is controversial to elevate a patient's leg who has a DVT (because it could lead to a pulmonary emboli breaking off the thrombus). However, when I researched this online, it said to elevate the leg in cases of DVT. What do you nurses think is best practice and why?

I know that if someone had arterial insufficency, then you would dangle their legs in order to increase blood flow away from the heart and to the extremity. If they had venous insufficency, you would elevate their leg to return blood from the extremity to the heart. If someone's leg was cool to the touch and slightly cyanotic, I would assume this is arterial insufficency, and if their leg was red and hot to the touch, a venous problem. HERE IS MY QUESTION: I took care of a pt at a nursing home this past summer. Her leg was purplish and cold to the touch. Yet the MD prescribed leg elevation above the heart. Apparently, from wha tI could gather, her heart was failing and they were elevating her leg in an attempt to circulate her blood back to heart (since her failing heart couldn't circulate blood as well) so it could perfuse the body as best it could. I am stumped as to why they didn't dangle that leg in an effort to get blood to flow to it though. Any thoughts?

Maybe once I get more into my lectures, this will come come up..but I'd really liek to clear myself on this now.

Thanks so much for any help!!

[lady_jezebel]

Just a guess -- b/c it's more important for the actual pump to be perfused than the extremity. The pump (heart) sends blood to the brain, vital organs, and the extremities -- therefore, by making the heart work less hard, you will in fact perfuse the heart itself & the rest of the body.

[nursemike, ASN, RN]

Just a guess -- b/c it's more important for the actual pump to be perfused than the extremity. The pump (heart) sends blood to the brain, vital organs, and the extremities -- therefore, by making the heart work less hard, you will in fact perfuse the heart itself & the rest of the body.

That was my thinking, too. If the pump is inadequate, there are organs more vital than the leg.

I'm a little perplexed on the DVTs, myself. It seems like if a clot has formed, you wouldn't want it to have good return to the heart. Somewhere, I picked up the impression that if a clot breaks loose and the limb is elevated, it actually moves up--away from the heart. Do clots float? Sounds a little goofy, but I do know I was taught to elevate, even if I'm not so clear on why.

[maolin]

As a recovered DVT pt (ileofemoral venous clot w/ 95% occlusion), I can tell you that I was put on strict bed rest until I was anticoagulated (INR>2.5), and told not to elevate my legs. Once my INR was in range (about a week later), I was encouraged to elevate & exercise to promote venous return and minimize long term complications (PTS or venous insufficiency). My left leg was purple & swollen 2" more in diameter compared to right leg. I had pedal pulses, but slow cap refil. I don't recall if it was cool or warm to the touch. Swelling did not go down for a couple of months and even now (almost 2 yrs later) chronically swells, but not as drastically.

I never quite understood the rationale, but PE isn't considered a threat once anticoagulated - even though the clot is still there. The meds (Coumadin/Lovenox) don't dissolve the clot, just prevent it from further clotting and gives body a chance to dissolve. If the clot is large enough, the body will eventually convert some of the clot into scar tissue - this is why I still swell and have pain - the scarring causes inflammation and it irritates my sciatic nerve.

Also, I was advised not to wear compression/support stockings until my INR was therapeutic. For the same reason as elevation - before anticoagulated it increases blood turbulence and risk for PE, after it encourages venous return.