PANGILINAN, LYZARUIZ, FRANCESCA VICTORIA

THROMBOPHLEBITIS

DEFINITION

THROMBOPHLEBITIS is an inflammation with the formation of blood clots.

When thrombophlebitis occurs in the postpartal period, it is usually an extension of an endometrial infection.

Thrombophlebitis is classified as superficial vein disease (SVD) or deep vein thrombosis (DVT)

FEMORAL THROMBOPHLEBITIS

It was formerly called milk leg or phlegmasia alba dolens (white inflammation)

The femoral, saphenous or popliteal veins are involved.

Although the site in thrombophlebitis is a vein, an accompanying arterial spasm often diminishes arterial circulation to the leg as well

With proper treatment, the acute symptoms of femoral thrombophlebitis last only for a few days, but the full course of the disease takes 4 to 6 weeks before it is resolved. The affected leg may never return to its former size and may always cause discomfort after long periods of standing.

PELVIC THROMBOPHLEBITIS

Involves the ovarian, uterine or hypogastric veins

Usually occurs after a mild endometritis

It often occurs around the 14th or 15th day of the puerperium

CAUSES

The fibrinogen level is still elevated from pregnancy, leading to increased blood clotting

Dilatation of lower extremity veins is still present as a result of pressure of the fetal head during pregnancy and birth

The relative inactivity of the period or a prolonged time spent in delivery or birthing room stirrups lead to pooling, stasis, and clotting of blood in the lower extremities

RISK FACTORS

OBESE WOMEN

VARICOSE VEINS

30 YEARS OF AGE AND OLDER WITH INCREASED PARITY

HIGH INCIDENCE OF THROMBOPHLEBITIS IN THE FAMILY

VENIPUNCTURE

CANCER OF THE ABDOMEN

INACTIVITY FOLLOWING SURGERY

PATHOPHYSIOLOGY

THROMBOSIS

CIRCULATORY STASIS (BLOOD)

ENDOTHELIAL INJURY (VESSEL)

HYPERCOAGULABLE STATE (FLOW)

VIRCHOW’S TRIAD

SIGNS AND SYMPTOMS

Classic Signs and Symptoms

Firm swelling of the calf or legPain or tendernessRednessIncreased local temperatureDull, aching tightness in the calf, especially

when walkingDilatation of the surface veins of the leg

Femoral Thrombophlebitis:

Chills and pain in the affected leg

Leg has a white or drained appearance

Increased diameter of leg and calf

Homan’s sign assessment - It is used to determine the

presence of a deep vein thrombophlebitis. The patient lies prone on the table with the knee fully extended. The examiner passively dorsiflexes the patient’s ankle while palpating the calf. Pain in the calf and/or pain with palpation is considered a positive test

Doppler ultrasonography or contrast venography usually is ordered to confirm the diagnosis

Pelvic Thrombophlebitis

Fever

Chills

General malaise

If infection is severe, it results to pelvic abscess

Could also result to lung, kidney or heart valve abscess

MANAGEMENT

Use side-lying or supine recumbent position for giving birth, rather than a lithotomy position

Don’t let mother sit with knees bent sharply

Avoid wearing constricting clothing. A bed cradle may be used to keep pressure of the bedclothes off the affected leg, both to decrease the sensitivity of the leg and to improve the circulation.

Ambulate as soon after birth as you are able.

When resting in bed, wiggle your toes or do leg lifts to improve venous return

If the mother smokes, explain to her that smoking increases the risk of thrombosis

Femoral Thrombophlebitis:

Nursing management:

Bed rest with the affected leg elevated

Never massage the skin over the clot; this could loosen the clot, causing a pulmonary or cerebral embolism

Apply moist heat for 15-20 minutes to relieve mild inflammation. Be certain that the weight of the hot pack or pad does not rest on the leg, causing an obstruction to flow of blood

Provide her with appropriate activities to exercise the other parts of her body to lower risk of blood clotting such as reading material about newborns.

Measure blood coagulation levels daily before administration of anticoagulant. Depending on the drug prescribed, a baseline activated partial thromboplastin time (APTT) or prothrombin time (PT) is obtained

Pharmacologic mangement:

Administration of anticoagulants to prevent blood clotting

Analgesics to relieve pain

Antibiotic to reduce the initial infection

PHARMACOLOGY:Heparin Calcium Injection (Hepalean, Liquamin Sodium)

Classification : Anticoagulant

Action: Heparin blocks the conversion of prothrombin to thrombin and of fibrinogen to fibrin, decreasing clotting ability and resulting in the inhibition of thrombus and clot formation. It is used to prevent thrombosis and pulmonary embolism

Pregnancy Risk Category: C

Possible Adverse Effects: Hemorrhage, bruising, thrombocytopenia, urticaria

Pelvic Thrombophlebitis

Nursing management:

Complete bed rest

Teach mother preventive measures to reduce risk of recurrence for future pregnancies

Avoid wearing constricting clothing. A bed cradle may be used to keep pressure of the bedclothes off the affected leg, both to decrease the sensitivity of the leg and to improve the circulation.

Caution mother to tell her physician before her next pregnancy about the complication

Surgical management:

If abscess forms, it can be located and incised by laparatomy if necessary.