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DVT & PE: How early can I mobilize a patient ?? Hatoun Al-Abdulkarim

DVT & PE: How early can I mobilize a patient ??

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DVT & PE: How early can I mobilize a patient ??. Hatoun Al-Abdulkarim. DVT: Formation of a blood clot in a deep veins as complication of immobility that may contribute to Morbidity & mortality. -Pain -Tenderness -Swelling -Increased warmth & Redness - PowerPoint PPT Presentation

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Page 1: DVT & PE: How early can I mobilize a patient ??

DVT & PE:How early can I mobilize a

patient ??

Hatoun Al-Abdulkarim

Page 2: DVT & PE: How early can I mobilize a patient ??

DVT:

Formation of a blood clot in a deep veins as complication of immobility that may

contribute to Morbidity & mortality

Page 3: DVT & PE: How early can I mobilize a patient ??

Signs and symptoms:-Pain

-Tenderness

-Swelling

-Increased warmth & Redness

- Erythema Or Bluish skin discoloration

Page 4: DVT & PE: How early can I mobilize a patient ??

In Fact,

Over 50% of DVTs without Signs & symptoms

Page 5: DVT & PE: How early can I mobilize a patient ??

US

Page 6: DVT & PE: How early can I mobilize a patient ??

Pulmonary embolism (PE):

Blockage of the main artery of the lung or one of its branches by a substance that has

travelled from elsewhere in the body through the bloodstream (Usually DVT)

Page 7: DVT & PE: How early can I mobilize a patient ??

Signs and symptoms: - Shortness of breath ( suddenly, even at rest) - Chest pain ( worse with deep breathe, cough, or bend) - Cough

Other signs and symptoms may include: - Wheezing - Excessive sweating - Arrhythmia - Weak pulse - Fainting

Page 8: DVT & PE: How early can I mobilize a patient ??

-PE are reported as many as one third of

patients with DVT

-Most pulmonary emboli are multiple,

and the lower lobes are involved more

commonly than the upper lobes

Page 9: DVT & PE: How early can I mobilize a patient ??

Lung with PE

Page 10: DVT & PE: How early can I mobilize a patient ??

Incidence

900,000 PEs/ DVTs in USA in 2002

10-40% in medical or general surgery patients

40-60% following major orthopedic surgery

10% hospital deaths attributed to PE

*Heit J. ASH Abstract 2005.

Page 11: DVT & PE: How early can I mobilize a patient ??

Risk Factors Age (over 40)

A past history of DVT

A family history

Immobility

Recent surgery or an injury (especially hips or knees)

Page 12: DVT & PE: How early can I mobilize a patient ??

• Obesity

Pregnancy

Cancer and its treatments

Contraceptive pill that contains estrogen

Hormone replacement therapy (HRT)

Circulation or heart problems

Page 13: DVT & PE: How early can I mobilize a patient ??

Methods of Prophylaxis

Mechanical

Pharmacological

Page 14: DVT & PE: How early can I mobilize a patient ??

Early ambulationElastic stockingsIntermittent pneumatic compression

Mechanical

Page 15: DVT & PE: How early can I mobilize a patient ??

Pharmocologic Methods

Warfarin.Unfractionated Heparin.Low Molecular Weight Heparin.

Page 16: DVT & PE: How early can I mobilize a patient ??

When Can the Patient With DVT Begin to Ambulate?

Page 17: DVT & PE: How early can I mobilize a patient ??

Medical Approach for Mobilizing pts with a DVT has dramatically changed over the past several

years

Page 18: DVT & PE: How early can I mobilize a patient ??

Partsch and Blattler (2000)

New PE development was similar in a mobile group with graduated compression stockings and a bed rest group. They also found decreased pain and leg edema in the mobile group.

Page 19: DVT & PE: How early can I mobilize a patient ??

Aschwanden et al (2001)

New PE occurred in 10 % of mobile subjects while new PE occurred in 14 % of immobile subjects.

Page 20: DVT & PE: How early can I mobilize a patient ??

Romero-Villegas (2008)

2 PEs occurrences in a sample of 105 patients on bedrest

and 3 PEs in a sample of 114 patients who received early ambulation.

Page 21: DVT & PE: How early can I mobilize a patient ??

Compression and walking compared with

bed rest in the treatment of proximal DVT during pregnancy

2009

Page 22: DVT & PE: How early can I mobilize a patient ??

Group A:15 patients with elastic compression

bandages and early mobilization

Group B: 17 patients with compression bandages and

bed rest.

All patients received heparin therapy.

Page 23: DVT & PE: How early can I mobilize a patient ??

Subjective Pain was assessed daily with a (VAS)

Objective pain using Lowenberg test. Reduction of edema was recorded initially and on day 2, 4 and 7.

Ultrasound was repeated after 7 days.

Page 24: DVT & PE: How early can I mobilize a patient ??

RESULTS: Resolution of subjective pain was faster in group A

Objective pain& measurement of leg reduced in group A

There was no pulmonary embolism and progression of thrombus diameter.

Page 25: DVT & PE: How early can I mobilize a patient ??

A meta-analysis of bed rest

vs early ambulation

in the management of pulmonary embolism, DVT or both

2009 Sep Department of Cardiology, Cochin Hospital, AP-HP, René Descartes Paris V

University, Paris, France

Page 26: DVT & PE: How early can I mobilize a patient ??

METHODS- Considered all randomized studies and prospective registries that compared the outcomes of patients with DVT, PE, or both, managed with bed rest versus early ambulation, in addition to anticoagulation.

-For each study, data regarding the incidence of new PE, new or progression of DVT, and death from all causes, were used to calculate relative risks (RR) and 95% confidence intervals (CI).

Page 27: DVT & PE: How early can I mobilize a patient ??

RESULTS

The 5 studies retained in this analysis included a total of 3048 patients.

When compared to bed rest, early ambulation was not associated with a higher incidence of a new

PE (RR 1.03; 95% ).

Page 28: DVT & PE: How early can I mobilize a patient ??

Furthermore, early ambulation was associated with a trend toward a lower incidence of new PE and new or progression of DVT than bed rest (RR 0.79; 95% )

and overall mortality (RR 0.79; 95% ).

Page 29: DVT & PE: How early can I mobilize a patient ??

CONCLUSIONS

Page 30: DVT & PE: How early can I mobilize a patient ??

It appears that these studies support that early ambulation and mobilization does not increase the risk of PE compared to bedrest

and in some cases may result in actual improvement of other factors like pain and

edema.

Page 31: DVT & PE: How early can I mobilize a patient ??

Thank you