Thrombophlebitis | University of Maryland Medical Center Venous blood clot References Ginsberg JS. Peripheral venous disease. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 81. Poi MJ, Lin PH. Deep venous thrombosis. In: Cameron JL, Cameron AM, eds. Current Surgical Therapy. 11th ed. Philadelphia, PA: Elsevier Saunders; 2014:963-967. Rathbun S. Superficial thrombophlebitis. In: Cronenwett JL, Johnston KW, eds. Rutherford's Vascular Surgery. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 54. Version Info Last reviewed on 1/10/2016 Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA.

Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team. A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission ( URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation ( ) The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2013 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Thrombophlebitis - Symptoms, Diagnosis, Treatment of Thrombophlebitis - NY Times Health Information In general, treatment may include support stockings and wraps to reduce discomfort as well as medications such as: Analgesics (pain killers) Antibiotics (if infection is present) Anticoagulants (blood thinners) to prevent new clots from forming Nonsteroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen to reduce pain and inflammation Thrombolytics to dissolve an existing clot You may be told to do the following: Keep pressure off of the area to reduce pain and decrease the risk of further damage Raise the affected area to reduce swelling Surgical removal, stripping, or bypass of the vein is rarely needed but may be recommended in some situations. Back to Top Prevention Routine changing of intravenous (IV) lines helps to prevent thrombophlebitis related to IVs. If you are taking a long car or plane trip, walk or stretch your legs once in a while and drink plenty of liquids. Wearing support hose may help. If you are hospitalized, your health care provider may prescribe medicine to prevent deep venous thrombosis. Ginsberg J. Peripheral venous disease.

In: Goldman L, Shafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 81. More Information on This Topic News & Features Review Date: 5/5/2012 Reviewed By: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc. A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission ( URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M.

is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation ( A.D.A.M. Copyright The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2008 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited. Thrombosis - body, causes, How Does Thrombosis Happen?, Phlebitis, Causes Thrombosis Thrombosis Thrombosis is the formation of a blood clot, called a thrombus, that blocks part or all of a blood vessel, such as a vein. KEYWORDS for searching the Internet and other reference sources Cardiovascular system Circulatory system Within moments after a finger is cut, platelets in the blood begin to gather at the injury. Platelets are tiny disc-shaped cells in the blood, much smaller than even a red blood cell.

The platelets react with calcium and with other substances in the body's tissues to form a semisolid, stringy protein. The cut covers with a scab and eventually heals. For injuries like cuts, clots are good things. But when clots form inside blood vessels, the condition is called thrombosis, and it can be life threatening. How Does Thrombosis Happen? Phlebitis Thrombosis usually begins as an inflammation of the vein known as phlebitis * . Phlebitis develops when blood flows slowly or pools in veins. This usually occurs in the legs and causes injury to the walls of the vein. Just as platelets gather to form clots on cut fingers, they also may start to form clots along the injured walls of veins. People with phlebitis may experience pain and tenderness along the vein, skin discoloration, swelling and edema, a rapid pulse, and mild fever. If untreated, many people with phlebitis develop thrombosis in the inflamed vein. Causes There are many possible causes. Inactivity, such as sitting for long periods of time or resting in bed, is a major cause.

Surgery, tumors * , and injuries to the leg also may cause thrombosis. Certain infections and cancers may alter the clotting substances in the blood and cause thrombosis. Women are especially at risk, because the female hormone estrogen is linked to thrombosis. Pregnant women have very high levels of estrogen. Estrogen is also found in birth control pills and in the hormone replacement medications that some women use after menopause, although thromboses due to these medications are not very common. What Are the Signs and Symptoms of Thrombosis? The major symptoms of thrombosis are pain in the affected area and swelling, which can occur suddenly. If the thrombosis involves a leg vein, the leg also might appear red and feel warm to the touch. Veins close to the skin surface may look larger than normal and reddish-blue in color. The biggest danger is when a clot forms in the large veins that are deep within the legs. If the blood clot grows, it may break off. The clot may then travel toward and then through the heart and block the pul-monary * artery, which is a major blood vessel, causing a pulmonary embolism * .

This serious complication of thrombosis may cause death if not treated rapidly and effectively. How Do Doctors Diagnose and Treat Thrombosis? Doctors use several tests to determine if patients have thrombosis. They may inject a dye into the veins and then use an x-ray to look for clots. They may use an ultrasound machine, which uses sound waves to create an internal view of veins similar to an x-ray. Or they may test blood pressure above and below the suspected location of the clot to measure differences. Thrombosis can be treated with medications that prevent the blood from clotting as easily. This can stop the clot from growing larger and lower the risk that the clot will break free and cause an embolism. Clot-dissolving drugs also may be injected into the vein. A procedure called balloon angioplasty widens the vein around the clot by inserting and inflating a small balloon that pushes out the narrow walls of the vein. Another surgery involves inserting a small, mesh tube within the vein to keep it open. * phlebitis (fle-BY-tis) refers to inflammation of a vein. * tumor refers to an abnormal growth of body tissue. Tumors may or may not be cancerous.

* pulmonary refers to the lungs. * embolism is a blockage in a blood vessel caused by a blood clot, air bubble, fatty tissue, or other substance that traveled through the bloodstream from another part of the body. For people at high risk for developing thrombosis, doctors sometimes recommend preventive measures such as the use of drugs that interfere with blood clotting and special compression stockings that help keep blood from pooling in the deep veins of the legs. See also Spinal Cord Injury: Paraplegic and Quadriplegic Injuries | International Encyclopedia of Rehabilitation Spinal Cord Injury: Paraplegic and Quadriplegic Injuries Dr. Jean-François Désert Médecin au Centre de Rééducation Neurologique de Coubert Paraplegia is the paralysis of both lower limbs resulting (with exceptions) from a spinal cord injury, most often the result of some sort of trauma caused by accidents, but sometimes due to medical conditions (illness). This term often encompasses both paraplegia in the strictest sense (thoracic, lumbar and sacral injuries) and quadriplegia (cervical injuries).

Most individuals with paraplegia or quadriplegia are wheelchair users, but this visible disadvantage is combined with associated impairments that, even though often hidden, are nevertheless troublesome, source of complications. What are paraplegia and quadriplegia? Paraplegia is the result of damage to the spinal cord and nerve roots, or severe injury to the nerve roots in the cauda equina ( figure 1 and figure 2 ): in the strict sense, paraplegia means paralysis of the lower limbs, and is most commonly caused by spinal cord injuries. Quadriplegia is when the damage is located in the cervical region of the spine; tetra means four (limbs). Quadriplegias account for one third of all spinal cord injuries. Accidents are the most common cause of spinal cord injuries; the number of cases is between 1000 and 1500 annually. Young adults are thus the most commonly affected population (15-35 years old), and they tend to be male more often than female.

Overall, the estimated number of paraplegic and quadriplegic individuals in France varies between 25,000 and 30,000, including not only spinal cord injuries, traumatic or not, that are described in this article, but also similar conditions such as spina bifida. Figure 1: Lateral view of the spinal cord in the spinal cavity Vertèbre : Vertebra Nerfs rachidiens : Spinal nerves What are the clinical signs? There are many signs and symptoms of damage to the spinal cord related to its physiology. They include: Motor disorders Urethral and anal sphincter disorders Respiratory disorders Motor disorders The injury affects: Voluntary motor control, damage involve paralysis (complete injury: no movement possible) or paresis (incomplete injury: movement is possible, but weak). Distribution of paralysis depends on the injury level ( figure 2 ).

It can homogenously spread in the affected area, or on the contrary, variably distributed, for instance between the right and left side, or in the proximal (upper back, upper limbs) and distal parts (extremities), which are the areas that are the most commonly affected in incomplete injuries (paresis); Autonomic motor control (regulating muscle tone). Two cases are usually possible: Either an increase in the muscle activity caused by disruption between the spinal cord and central nervous centers regulating motor control (brain). Then mobilization of the limbs is observed, as well as stiffness against muscle stretching that increases with speed. This stiffness or hypertonia, also called spasticity, leads to abnormal autonomic reflexes called contractures (sometimes mistaken for involuntary jerks); Or a loss of tonus triggering the flaccid state of muscles or hypotonia. This is referred to as flaccid paraplegia. This state is the result of either complete or partial injury associated with specific root levels. It may be a transitory (at the onset) or a persistent state. Individuals with severe muscle atrophy (muscle mass loss) have an increased risk of developing pressure sores and phlebitis.

Figure 2: Vertebral levels (Roman numerals) and spinal cord segmental levels or metameric units (neurological) Nerfs cervicaux : Cervical nerves Nerfs sacrï¿½s : Sacral nerves Nerf coccygien : Coccygeal nerve Queue de cheval : Cauda equina Sensory disorders They affect: Superficial sensibility ( figure 3 and figure 4 ) associated with all cutaneous sensations: fine tactile discrimination (sense of touch), pain, hot and cold, and gross tactile discrimination. The lack of superficial sensibility is called anesthesia, whereas a partial loss of sensibility to sensory stimuli is called hypoesthesia. Multiple levels of damage may be present in a single patient, where tactile sensibility may be preserved with total loss of pain sensations, which expose the patient to the risk of unintentional injury or burn that often may go unnoticed. When there is a total loss of sensibility, patients are at greater risk of developing pressure sores; Deep sensibility is responsible for the knowledge of the exact position of the body in space, as well as of the pressure and shear force exerted on the skin.

This explains why individuals sustaining spinal cord injuries must look at their legs or feet to know exactly where they are and why quadriplegic individuals look at their hands in order to be able to use or protect them. This form of disorder is also causing trunk balance problems, associated with paralysis of abdominal muscles, and feelings of "vertigo" or fear of heights that most of them are experiencing. Figure 3: Dermatomes (areas of the skin that are mainly supplied by a single spinal nerve) Adapted from O. Foerster and M. Maury Figure 4: Testing areas used in assessing levels of cutaneous sensory loss and spinal cord injuries Adapted from O. Foerster and M.

Maury Figure 5: Cross-section of spinal cord Cordon postérieur : Posterior funiculus Racine postérieure du nerf périphérique : Posterior root of the peripheral nerve Nerf rachidien (périphérique) : Spinal nerve (peripheral) Cordon latéral : Lateral funiculus Racine antérieure du nerf périphérique : Anterior root of the peripheral nerve Cordon antérieur : Anterior funiculus Sillon antérieur : Anterior median fissure Canal épendymaire : Central canal of the spinal cord Corne antérieure : Anterior horn Différents faisceaux du cordon latéral : Various tracts of the lateral cord The posterior part of the spinal cord or dorsal (posterior) horns transmits: Superficial (extreroceptive) sensations (tactile, pain, hot temperatures); Deep (proprioceptive) sensations (perception of the body in space, pressure, vibrations, balance, etc. ); and visceral sensibility.

The anterior part of the spinal cord or ventral (anterior) horns transmits: Motor impulses to the striated muscles (which are contracted by voluntary command); Autonomic impulses to the nonstriated muscles of the internal organs, blood vessels, and glands. Figure 6: Nerves involved in the sphincter function of internal organs such as rectum and anus Centre frontal : Frontal area Bowel function Urethral and anal sphincter disorders Impaired motor control, sensibility and reflexes ( figure 6 ) cause urinary bladder disorders. Following an initial period of total retention when treatment is not immediately implemented, there may be urinary and fecal overflow. These are involuntary overflow of small amounts of urine and feces caused by the overfilling of the bladder and rectum, which cannot be fully emptied. For this reason, aids in evacuation of bladder and bowel are always needed. There are usually two types of sphincter dysfunction whether spasticity is involved (presence of reflexes) or flaccidity, respectively the automatic (hypertonic bladder or rectum) or autonomic function (hypotonic bladder or rectum). Management is different in either case.

Autonomic disorders They occur in cases of high cervical and dorsal injury (level ≥ D6): Autonomic dysreflexia ( AD ) or hyperreflexia: intense, sudden increase in blood pressure, associated with pounding headaches, profuse sweating with erythema (redness of skin), shivering and piloerection ('goose bumps'). AD can be triggered in many ways: the most common triggering stimuli are urinary in nature (distended bladder, catheterization, urinary tract infection), but also related to the skin, rectum (anal fissure, hemorrhoids), and bladder. Hyper- or hypothermia: variations in the body temperature caused by the impaired regulation of vasomotion and sweating in the area below the level of injury (in the part of the body located below the spinal injury). Pain There are two main categories of pain: Pain triggered by hyperstimulation: pain above the level of injury where sensibility is normal, for muscular, articular and bone origin: Injury pain (at the injury level), through radicular pain (nerve root injury) depending on the spinal injury, sometimes due to complex regional pain syndrome; Pain arising on the visceral, vascular and muscular parts that are below the injury level.

Pain induced by release of inhibition: Pain at the level of injury: it is located in a region with hyperesthesia (aggravated by external contact), or anesthesia (most often burning sensations); Pain below the level of injury: often polymorphous and associated with posterior cord pain (damage to the posterior cords of the spine causing shooting and grinding pain) and spinothalamic type of pain (damage to the sensory pathways ï¿½ Cf. Physiology of the spinal cord and figure 4 ) with severe burning sensations. Genital and sexual disorders Men experience deep changes in their genital and sexual function. The reflex erection potential, which is essential to sexual intercourse, is compromised when the injury is complete and located in the sacral segment of the spinal cord ( Cf. figure 2 ); however, psychogenic erection potential is preserved. In other cases, it is possible to achieve erections using appropriate stimulation techniques and physical stimuli. Ejaculation, which is essential to sperm banking for future procreation if desired, is only to be considered when segmental levels D11, D12, and L1 are far from the damaged level. Otherwise, appropriate techniques are implemented, often requiring an appointment with a paraplegia specialist.

In women complete analgesia of the perineum affects sensations during sexual intercourses. Orgasm remains possible as long as lumbosacral reflex pathways are intact. After 1 to 9 months without periods, which is common after sustaining traumatic spinal cord injuries, women become fertile again and can get pregnant and carry their pregnancies to termï¿½rigorous monitoring is necessary, especially in order to treat urinary tract infections, monitor kidney function, and above all in cases of previous history of pyelonephritis (kidney infection). Delivery can be achieved through natural or vaginal birth or under epidural anesthesia, especially if there is a risk of hyperreflexia; forceps are used when the mother's abdominal muscles are paralyzed. The decision of using contraception is considered after a careful overall physical assessment due to the increased risk of phlebitis and infections. Couple education is recommended about the genital and sexual potential of the injured partner for, of course, this is a case-by-case matter. Respiratory disorders These occur as a result of the impairment of respiratory muscles: abdominal and intercostal muscles are impaired, as well as the diaphragm (see table below) in the highest levels of injury (C4).

At first, respiratory disorders force the use of mechanical ventilation (intubation or tracheotomy). Later, the physiotherapist ensures proper postural drainage, focusing on breathing out and forced coughing. This preventive technique is then taught to the individual who will perform it regularly and in cases of bronchopulmonary obstruction. Abdominal muscle deficiency is compensated by wearing an abdominal belt, which is critical, at least during the first months of verticalization, in cases of high cervical and dorsal damage (D6 and above). Respiratory damage and spinal level Level of segmental cord damage Respiratory muscle group affected Abdominal muscles Other disorders Besides difficulties in the initial stage, circulatory disorders are the result of cardiovascular deconditioning during physical effort, which is primarily caused by impaired venous drainage of the blood returning to the heart. Paralysis of muscles in the lower part of the body, especially when it is flaccid paralysis, leads to a venous stasis aggravated by a vasoplegic syndrome. Muscles surrounding small blood vessels are no longer regulating blood flow, which decreases and cannot increase normally under physical effort, causing extreme fatigability, hypotension, discomfort, etc.

Peripheral venous stasis causes edemas, which may in return cause skin fragility and thrombophlebitis. Hence, it becomes essential to wear compression stockings on a regular basis. Forced immobilization leads to bone demineralization, or osteoporosis, and increased risk of urinary calculi. Thus, a significant diuresis must be induced by drinking large amounts of liquid during the first months following the injury. What are the causes? Traumatic causes (accidental injuries) are by far the most common: between 70 and 80% of the total number of spinal cord injuries. They lead to traumatic spinal cord injuries with para- and quadriplegiaï¿½hence, the term "spinal cord injured" used to refer to individuals who have sustained these injuries. Para or quadriplegias are often treated as the only cases of spinal cord injuries caused by trauma even though 25% of them are caused by medical malpractice.

Causes of paraplegia and quadriplegia Traumatic causes (spinal cord injured or traumatic spinal cord injuries with para- or quadriplegia) Car accidents are the most common causes, followed by sports accidents, suicide attempts, gunshot and stabbing injuries. Work-related injuries may be encountered in all mentioned categories (excluding suicide attempt), but some injuries are most commonly occurring in the workplace. Workplace injuries include falls from high rise, blast injuries, electric shock injuries, diving accidents related to sudden depressurization. Other causes: toxic causes (spinal injections), arachnoiditis (inflammation of the membrane that surround and protect the nerves of the spinal cord), pathologic fractures due to rheumatic diseases (spinal fractures caused by progressive weakening of the bone rather than by accident such as in ankylosing spondylitis, rheumatoid cyst) Medical causes Infectious or parasitic causes: spinal cord abcess, Pott's disease (tuberculous abcess), tuberculous epiduritis, schistosomiasis or bilharziosis (parasitic disease).

Vascular causes: ischemic softening of the spinal cord (spinal cord infarction or myelomalacia), spontaneous spinal extradural hematomas, spinal arteriovenous malformations (angioma), aortic aneurysms. Tumor-related causes: neurilemmomas, metastases to the spine from various forms of cancers, neurofibromatoses, Hodgkin's disease and myeloma. The occasional "surgical accidents" responsible for spinal cord injuries can either be traumatic (injuries) or medical in nature (lesions resulting from the lack of oxygen supply to the spinal cord ï¿½ anoxia ï¿½ during anesthesia). How are they progressing? Prognosis: Acute and subacute lesions of traumatic or medical nature It is known that, in terms of prognosis, it all starts at the moment of trauma, or in the hours following the onset of paraplegia caused by a medical accident ('acute' means 'sudden'). Mechanisms of injury are better understood. At the clinical level, there are more chances that individuals who have sustained an incomplete injury recover immediately compared to those with a complete injury. Incidentally, the speed of recovery is an important feature.

The prognosis generally emerges in the first weeks following the injury. After two months and no sign of recovery, the recovery potential decreases very quickly over time. However, no definite conclusions can be drawn formally until after a post-traumatic follow-up period of 8 months in the case of spinal cord injuries per se and 18 months for associated root and peripheral nerve injuries. Injuries due to slow compression of the spinal cord (neurilemmomas, meningiomas, etc. ) After compression was diagnosed and treatment has been implemented, the prognosis will depend upon the severity of the injury and the speed of intervention. In cases of complete injury prior to treatment, the prognosis is usually severe, for the more incomplete an injury is, the greater are the chances of recovery. Symptoms that usually take longer to fade away or wear off are deep sensibility disorders and spasticity. The mechanism of injury to the spinal cord: preventive considerations (in traumatic injuries, or else acute and subacute medical injuries) Mechanisms of injury Three mechanisms of injury can be described: Circulatory and hemodynamic disorders (blood pressure). Spinal cord blood flow has decreased significantly in the 15 minutes following the spinal cord trauma and will keep decreasing in the first following days.

Injuries can be aggravated by blood pressure disorders; Inflammatory reaction: white cells gather at the level of injury in 8 to 24 hours. These inflammatory phenomena are causing oedema that aggravates injuries. They also occur during the healing process; Biochemical phenomena: there are various interactions between complex biochemical phenomena that can be described. They end up causing the progressive destruction of the nerve tissue. Research and perspectives Neurophysiologists continue to work on the spinal cord regeneration issue. Recent studies have shown that, on the one hand, peripheral nerve grafting might lead to the axonal regeneration of central neurons of the spinal nerve and that, on the other hand, the implantation of brain tissue or embryonic cells through an experimental cavity in the spinal cord are followed by peripheral nerve regeneration through a nerve graft. Current experimental studies on spinal cord lesions show some promising treatments: Preventing complications of second traumatic spinal cord injuries through early use of medication. It is not impossible that a product may be discovered in the upcoming years that would stop or at least limit the progression of paraplegia; Stimulating the neural regeneration by reducing the wound-barrier layer, through adding growth factors and controlling of synaptogenesis (formation of new synapses).

The latter is to take long years before showing any hard results. Complications At first, the risk of death is present in traumatic spinal cord injuries with para- and quadriplegia in the very first hours and during the resuscitation phase, especially in cases of multiple traumas. It is critical to avoid any complications of the spinal cord injuries (during casualty collection and transportation, as well as in positioning of the patient for complementary examinations). Immobilizing patients in positioning devices such as eggshell mattresses is the standard for any transportation until fractures are reduced and fixed (with lateral restraint devices or through osteosynthesis). Prevention of pressure sores should start at the same time in the desensitized areas (special mattresses, frequent position changes every 2 or 3 hours), particularly as blood pressure and thermal disorders may be present. In quadriplegia, protecting patients against bronchial obstruction is often a priority due to paralyzed abdominal muscles and inability to cough). Subsequent onset of pulmonary atelectases (area of the lung that is no longer ventilated) causing infection is very common. They can be prevented once again by frequent position changes and by sessions of guided breathing exercises and chest percussion therapy.

Afterwards, the complications that may become frequent are urinary tract (pyelonephritis, cystitis) and genito-urinary infections (prostatitis, urethritis), kidney and bladder calculi, as well as thrombophlebitis. Other rare complications include: osteomas (abnormal bony outgrowths) or paraosteoarthropathies ( POA ) in large joints (risk of ankylosis), pathologic fractures occurring at the level of injury and causing minor trauma due to bone demineralization and the postponed diagnosis due to analgesia, as well as bowel obstruction caused by a lack of proper fecal discharge. What are the suggested treatments and management strategies? There is still no specific treatment for spinal cord injuries per se. Initial treatment This is the treatment of the causes of the injury. It encompasses the reduction and fixation of fractures, as well as the assessment of spinal and nerve injuries in cases of trauma and treatment of compression in some medical injuries, which are surgery techniques. Rehabilitation The physiatrist and all the rehabilitation unit team carry on with treatment by implementing specialized rehabilitation care.

The goal of the treatment is to enable the injured individual to regain the fullest level of independence possible, using all the residual force potential of the muscles located above the level of injury, and learning to control residual functions located at the level of injury and below. Kinesitherapy addresses the range of motion of joints located in affected areas, prevent muscle shortening caused by contractures, and reinforces non-paralyzed muscles. Treatment is carried out progressively with a set of customized routine exercises based on the individual's capacity: how to get out of bed the first few times, proper positioning in the wheelchair, work on balance in seating position, independent seat and wheelchair skills. Whenever possible, exercises of rehabilitation in the standing position (most often combined with bracing) and gait training are used. Occupational therapy is especially useful to the tetraplegic patient: learning and advanced training in personal hygiene care, dressing and eating), review of the technical aids, as well as home and transportation adaptations required (powered wheelchair, adapted car). Sports play an important role in the rehabilitation process.

Swimming, basketball, competitive sports, ping-pong, but also tennis, archery, canoe and kayak, as well as skiing are practicable and recommended, both during the active phase of the rehabilitation process and in further training. Bladder and urethral sphincter retraining exercises are used to restore a normal continence/micturition cycle that is compatible with social life and achieve complete bladder emptying with each act of urination. In cases of an automatic or reflex bladder function, techniques are used to trigger urination reflex through suprapubic tapping. When no reflex is achieved, urine flow may be provoked by applying suprapubic pressure. During the rehabilitation phase, bladder emptying is achieved through catheterization by a nurse, or whenever required and possible, by patients themselves. Intermittent self-catheterization is commonly used and safe when properly performed. When there is urine leakage, urinal bags are fixed to the penis of men with pressure sensitive adhesives, and women have to wear diapers. In some cases, indwelling catheters are necessary (attached around the thigh in women and to the penis in men, maintaining it into vertical position).

Bowel retraining works on restoring the normal defecation reflex through appropriate stimulation techniques. When reflex is impaired, manual bowel evacuation techniques are used. Balanced diet rich in fibers and large amounts of liquids usually help the intestinal transit, as well as regular abdominal massages 15 minutes prior to having a bowel movement. Prevention of pressure sores involves that patients themselves learn prevention and monitoring techniques. Patients must take meticulous care of their skin, change clothes and garnitures in cases of unexpected leaks. When redness of the skin occurs, the golden rule is to eliminate all pressure on this area until redness disappears or fades significantly. It is essential in any case to look for the underlying cause in order to apply the appropriate prevention strategy. Insensible body parts should be kept far from heat sources such as radiators, hot water pipes or central heating plinth heaters, particularly to protect legs and feet from burns. Special attention should be taken to cigarette ashes, and to the hot steaming cup of tea placed in the lap, even when using a tray! Preparation for returning home is settled immediately after the prognosis is known and was announced to both patients and his/her family.

Figure 7 The first step to preventing pressure sores is to achieve the proper positioning of the patient in the wheelchair. Improper positioning in wheelchair; the patientï¿½s knees are too high, risk of ischiatic pressure sores. Improper pressure distribution on a single ischiatic bone due to pelvic obliquity. Proper pressure distribution. Basic rules to prevent intestinal stasis (by preventing stasis, you also prevent incontinence) Adjusted diet and large amounts of liquids. Stimulation and facilitation of bowel movement (position changes; activities: wheelchair skills, wheelchair sports, verticalization techniques; massage and tapping of the large intestine). Regular attempts to bowel movements. Non-aggressive provocation maneuvers to trigger bowel movement. Prevention of pressure sores in the para- and tetraplegic patients Relief and pressure changes: seating position: lift buttocks regularly; lying position: change positions regularly (if unable, try using water or inflatable mattresses). Avoid sitting on hard surfaces, always use a cushion (foam, gel, inflatable cushions). Skin check: routine inspection of the skin with a mirror or by palpating gently the areas at risk. Personal hygiene: always keep the skin dry and clean, especially in the perineal area.

Living with paraplegia or tetraplegia Organization of daily life starts with home accommodation (or else by looking up for accessible housing or considering the building of one): entrance, kitchen, bathrooms, restrooms, bedrooms and living rooms must be accessible. Individuals who cannot achieve full independence will require assistance for personal care and for daily living tasks. Prevention of complications and medical follow-up. Circulatory disorders edemas, phlebitis, embolisms) are generally avoided by wearing compression stockings, placing the person in a slight sloping position during the night (elevated feet), as well as avoiding clothes that are very tight around the knees and hips. Monitoring by a specialized physician should be made once every year or two, or more if required. As for general follow-up, an attending physician who is aware of the clinical history should be helpful for every intervention at home and in treating intercurrent conditions. Wheelchairs are prescribed by the rehabilitation team and adjusted so that pressure be distributed to the fullest extent possible ( figure 7 )ï¿½by adjusting the height of foot plates for instanceï¿½and driving be easy and safe for the user (risk of rear tipping). Transportation.

The most common mode of transportation is the car, which can be use either by adapting the driving space for paraplegic patients (hand controls), or adapting the car to allow wheelchair access. Leisure, vacations, sports. APF : Association des Paralysés de France, 17 bd Blanqui, 75013 Paris. Club de loisirs et d'entraide, Hôpital Raymond Poincaré, 92380 Garches (revue : Le Point carré). Suggested readings Phlebitis Treatment and Symptoms Phlebitis Pictures Phlebitis Definition Phlebitis (fle-BYE-tis) is a condition in which a vein becomes inflamed (phleb=vein + it is=inflammation). The inflammation may cause pain and swelling. When the inflammation is caused by a blood clot or thrombus, it is called thrombophlebitis. Thrombophlebitis usually occurs in leg veins, but it may also affect the veins in the arms.

There are two sets of veins in the arms and legs, 1) the superficial veins that run just under the skin, and 2) the deep veins. Superficial phlebitis affects veins on the skin surface. The condition is rarely serious and usually resolves with local treatment of the inflammation with warm compresses and anti-inflammatory medications. Sometimes superficial phlebitis can be associated with deep vein thrombophlebitis and medical evaluation may be needed. Phlebitis in the deep veins is referred to as deep vein thrombophlebitis (or DVT , deep vein thrombosis ) affects the veins located deeper in the arms and legs. Blood clots (thrombi) that form may embolize or break off and travel to the lungs . This is a potentially life-threatening condition called pulmonary embolism . Medically Reviewed by a Doctor on 2/9/2016 Medical Author: Intravenous Catheter Complications Anesthesia Intravenous Catheter Complications About 25 million Americans have intravenous catheters placed each year.

Intravenous catheters (or IVs) are a very important part of medical treatment for acute illnesses, cancer, surgery, anesthesia, and trauma, allowing medications to reach as quickly and effectively as possible, via the bloodstream, the parts of the body where they work. IV catheters can be placed in a hand, arm or leg. These are known as "peripheral" IVs. IVs placed in the central circulation, like the internal jugular vein (neck) or subclavian vein (just beneath the collar bone), are known as "central lines". The rest of this article will deal with peripheral IVs, the most common type of IV. During the placement of an IV, a needle is inserted through the skin and into an accessible blood vessel. A Teflon (plastic) cannula is then slid over the needle, which is withdrawn. No needle remains in your body. (So-called "butterfly" needles are an exception to this). Some healthcare providers use a little bit of local anesthetic beforehand, with a very tiny needle, to numb the area of skin where the IV is inserted. Local anesthetic cream is sometimes applied 45-60 minutes beforehand to achieve the same effect.

This is particularly helpful in the care of children. Complications Serious complications related to peripheral IVs are uncommon, but problems do occur, especially with prolonged use. That is why there are guidelines in different hospitals about the recommended duration that a peripheral IV should be in place. As with any side effect or complication of health care procedures, early detection, and good communication between the patient and healthcare provider are important. Listed below are complications of IV catheters and their treatments. Phlebitis Phlebitis is a term that means inflammation of a blood vessel. Phlebitis occurs quite commonly after the insertion of intravenous catheters. The exact frequency of phlebitis is anywhere from 2.5 to 45% or more. The frequency depends on how phlebitis is defined, the site of IV insertion, the duration that the IV has been in place, the type of material that the IV is made of, the length of the IV catheter, and on the existence of other disorders as diabetes. In phlebitis the inflammation causes localised redness and warmth at the IV insertion site and perhaps a short distance along the course of the vein in which the IV has been placed.

Most times, phlebitis is no more than a minor inconvenience. Thrombophlebitis Thrombophlebitis is similar to phlebitis but a thrombus (or clot) is in addition involved. As the IV cannula stays inside your body, it may irritate the vein leading the body to trigger its clotting mechanisms. You may notice a hardened area corresponding to where a clot has formed in the vein. This kind of small clot does not have the same potentially life-threatening consequences as blood clots in the deeper and larger veins in the body. Thrombophlebitis is not usually associated with infection. Treatment - Treatment of phlebitis and thrombophlebitis is aimed at relief of the symptoms including: anti-inflammatory medicine, such as ibuprofen, acetaminophen for pain, or local heat. If the condition worsens, especially if pain or the area of redness increases, medical attention should definitely be sought. Septic Thrombophlebitis In more serious cases the vein can become infected.

This is a rare condition, known as septic phlebitis or septic thrombophlebitis, which can spread infection throughout the body via the bloodstream. One sign of infection is the presence of enlarged lymph nodes under the arm on the affected side. This can occur with simple phlebitis but should cause you to seek medical attention, especially if you have a fever and feel generally unwell. Treatment - If you suspect an infected vein, see your healthcare provider immediately. Hospitalization may be needed and antibiotics will be used to control the bacterial infection. Local Infection In any case where there is an open wound on the body, disrupting the protective lining of skin, an infection can occur. A microscopic organism may use the tiny hole in the skin created by the IV catheter to find its way into the body, and cause an infection. Common signs of local infection ("abscess") include a large lump that is painful and hot to touch. Treatment - If you suspect an infection, see your healthcare provider immediately. Antibiotics may be used to control the bacterial infection. Infiltration This occurs when the catheter unintentionally enters the tissue surrounding the blood vessel.

In this case the IV fluid and associated medications will go into the tissues and there will be a lump where the IV has been inserted. It would be cool to touch (this differentiates it from inflammation due to infection, which is warm to the touch). Treatment - If you notice this inform your healthcare professional and they will administer appropriate care immediately. Infiltrated IVs are not a big problem usually unless the medication being administered is very irritant, such as certain chemotherapy and circulatory medicines. The intravenous infusion must be stopped, obviously, to avoid putting any more fluid or medication into the tissues. Another IV may need to be started elsewhere. Hematoma A hematoma is a collection of blood caused by internal bleeding. This happens when the catheter punctures through the vein and causes a hematoma. Hematomas generally occur with unsuccessful IV insertion but can also happen when an IV is taken out. This is why pressure must be applied to the insertion site, to try to make the hematoma as small as possible. A hematoma may appear as a visible bruise or a lump. Treatment - A hematoma normally recovers over time (a few hours or days) without treatment.

Nerve Damage It is also possible for the IV needle to penetrate and injure a nerve, and for bruising and bleeding to irritate a nerve. Nerves are invisible from the skin surface so it?s easy to understand how this could happen. If you feel a sudden sharp pain radiating along your arm as the IV is inserted, let your healthcare provider know immediately as this may be a sign that the needle has come into contact with a nerve. A 1996 study of 419,000 blood donations showed that 1 in every 6300 donors had a nerve injury. Fortunately, most got better within a month. The symptoms included excessive or radiating pain, and loss of arm or hand strength. Fifty-two of 56 donors achieved a full recovery, and 4 other donors had only a mild, localized, residual numbness. Treatment - Nerve damage tends to repair itself in a few weeks to a few months. If you suspect a nerve injury contact your doctor. In rare instances (such as persistent weakness) specific treatment, even surgery, may become necessary.

More articles about Anesthesia: Phlebitis Phlebitis Synonyms and Keywords Phlebitis Overview Phlebitis (fle-BYE-tis) means inflammation of a vein. Thrombophlebitis is due to one or more blood clots in a vein that cause inflammation . Thrombophlebitis usually occurs in leg veins, but it may occur in an arm. The thrombus in the vein causes pain and irritation and may block blood flow in the veins. Phlebitis can occur in both the surface (superficial) or deep veins. Superficial phlebitis affects veins on the skin surface. The condition is rarely serious and, with proper care, usually resolves rapidly. Sometimes people with superficial phlebitis also get deep vein thrombophlebitis, so a medical evaluation is necessary. Deep vein thrombophlebitis affects the larger blood vessels, usually deep in the legs. Large blood clots can form, which may break off and travel to the lungs . This is a serious condition called pulmonary embolism . Phlebitis Causes Superficial phlebitis can be a complication due to a medical or surgical procedure.

Injury to a vein increases the risk of forming a blood clot. Sometimes clots occur without an injury. Some risk factors for thrombophlebitis include the following: Prolonged inactivity - Staying in bed or sitting for many hours, as in a car or on an airplane, creating stagnant or slow flow of blood from the legs in a dependent position (This pooling of blood in the legs leads to thrombus formation.) Sedentary lifestyle - Not getting any exercise Phlebitis Symptoms Superficial phlebitis There is usually a slow onset of a tender red area along the superficial veins on the skin. A long, thin red area may be seen as the inflammation follows a superficial vein. This area may feel hard, warm, and tender. The skin around the vein may be itchy and swollen. The area may begin to throb or burn. Symptoms may be worse when the leg is lowered, especially when first getting out of bed in the morning. A low-grade fever may occur. Sometimes phlebitis may occur where a peripheral intravenous line was started. The surrounding area may be sore and tender along the vein.

If an infection is present, symptoms may include redness, fever, pain, swelling, or breakdown of the skin. Deep vein phlebitis This can be similar in presentation to superficial phlebitis, but some people may have no symptoms. One may have pain and swelling throughout the entire limb. For example, the lower leg may swell for no apparent reason. Some people also get fever from a superimposed bacterial infection and skin discoloration or ulcers if the condition becomes chronic and was inadequately treated earlier. When to Seek Medical Care Call your health care provider if you have signs and symptoms of swelling, pain, and inflamed superficial veins on the arms or legs. If you are not better in a week or two or if it gets any worse, get reevaluated to make sure you don't have a more serious condition. Deep vein thrombophlebitis requires immediate medical care.

If you have any of these signs and symptoms, go to a hospital emergency department for evaluation: High fever with any symptoms in an arm or leg Lumps in a leg Severe pain and swelling in an arm or leg New, unexplained significant shortness of breath, which could be the first tip-off that a blood clot has already traveled to your lung ; call 911if you are having trouble breathing. Exams and Tests Your health care provider will examine you and ask questions about your symptoms. D-dimer is a blood test that measures a substance that is released as a blood clot dissolves. If this blood test is negative, and you have no risk factors, then it is unlikely that you have a blood clot. Ultrasound can detect clots or blockage of blood flow, especially in larger, more proximal (upper leg) veins. A small hand-held instrument (probe) is pressed against your skin to help identify blood clots and where the obstruction is. This is a painless, noninvasive test. Occasionally a venogram is needed to identify blood clots in the smaller, more distal veins.

This is an invasive procedure that requires injecting X-ray dye or contrast material into a vein on the foot, then an X-ray is taken of the flow of the dye up the leg. Phlebitis Treatment Self-Care at Home An anti-inflammatory drug, such as aspirin or ibuprofen , can help lessen the pain and inflammation of superficial phlebitis. But check with your doctor first. If you increase your walking, you increase blood flow. This helps prevent blood clots from developing. Prescription leg compression stockings ( knee or thigh high) improve your blood flow and may help to relieve your pain and swelling. Avoid bed rest for prolonged periods. It can make your symptoms worse. If you have deep vein thrombophlebitis, you may need to stay in the hospital for a few days for diagnosis and treatment to ensure that no complications occur. Medical Treatment If your evaluation shows superficial phlebitis and you are otherwise healthy, you can likely go home. You will need to use compression stockings and probably anti-inflammatory medications to control your symptoms. Additional management involves elevation of the arm/leg and application of warm compresses. Only a few cases require antibiotics .

If you have a history of deep vein thrombophlebitis, or if the phlebitis might possibly spread to the deep veins, you will need to take a blood thinner (anticoagulant). The duration of anticoagulant treatment is usually between 3-6 months. If you have signs of infection, you will need to take an antibiotic. If the superficial phlebitis has progressed to involve the deep veins, then it is a serious condition that may even require hospital admission for treatment and further evaluation. Next Steps Outlook Phlebitis in the superficial veins is rarely serious and usually responds to pain control, elevation, and warm compresses for 1-2 weeks. Multimedia How does deep vein thrombosis (DVT) affect the body? - Blood Clot (Thrombus) - Sharecare Blood Clot (Thrombus) How does deep vein thrombosis (DVT) affect the body? Topics | Heart and Circulatory System | Vascular Disease | Blood Clot (Thrombus) | How does deep vein thrombosis (DVT) affect the body? A Answers (2) A Dr. Frank J.

Arena, MD , Cardiology (Cardiovascular Disease), answered on behalf of Lakeview Regional Medical Center Deep vein thrombosis (DVT) can not only cause pain in the body, but also cause a life-threatening pulmonary embolism. In the body, the heart pumps down; it does not suck up. When the heart pumps to the legs, the legs have to pump the blood back up. If the veins are blocked, the leg pumps don't work and the blood pools in the legs, causing pain and swelling. If you have DVT, a clot can also break off, go upstream and block the blood flow to the lung. The resulting pulmonary embolism (PE) can be quickly fatal if not treated. Helpful? 1 person found this helpful. A Honor Society of Nursing (STTI) answered Pulmonary embolism may result when the blood clot detaches and travels to an artery in the lungs. This blood clot may block the artery and prevent the flow of blood from the heart to other parts of the body, resulting in death if not treated immediately. Signs of this include chest pain during inhalation, fast heart rate, and sudden shortness of breath, but often there are no symptoms.

Another effect is the development of sores on the skin of the affected area, due to blood escaping from damaged veins and swelling and pooling. Scar tissue in the veins as a result of healing may cause post-phlebitic syndrome, a chronic condition also marked by discolored skin, pain, and swelling in your legs. Phlebology College Australia & New Zealand - Signs and Symptoms of DVT Deep Vein Thrombosis Introduction ’Thrombosis’, or blood clotting, is a natural protective mechanism that prevents excessive bleeding when the body is injured. However, clotting becomes a problem when it obstructs blood flow. Clotting can occur in deep and superficial veins. Deep veins lie within muscles or body cavities, whereas superficial veins lie beneath the skin in the fat layer. Superficial veins connect with deep veins via ‘perforating veins’. What is deep vein thrombosis? Deep vein thrombosis (DVT) is the development of a blood clot in a deep vein. Although the deep veins of the legs are most commonly affected, a DVT can also affect the deep veins of the arms, pelvis or abdomen.

When clots form in superficial veins, this is called superficial venous thrombosis (SVT). If SVT leads to inflammation of the adjacent skin and fat, red tender lumps develop. This is called superficial thrombophlebitis (STP), or simply ‘phlebitis’. While blood clots in superficial veins rarely cause serious problems, DVT requires immediate medical evaluation. Prompt treatment of DVT is vital to minimise immediate or long-term complications. DVT can damage the affected deep vein, leading to chronic pain, swelling and skin changes of the affected limb. This is called post-thrombotic syndrome. DVT can also interfere with the return of blood to the heart, and result in swelling, pain and inflammation of the affected limb. If part of the blood clot breaks off and travels to the lungs, it creates a condition called pulmonary embolism (PE), which may be life threatening. Signs of PEcan include chest pain, palpitations, shortness of breath, coughing (with or without blood) and even sudden death. Signs and symptoms Symptoms of DVT can include swelling, tenderness and sometimes warmth of the affected limb.

However, up to 50 per cent of patients with a DVT show no symptoms. These are called ‘silent’ or ‘asymptomatic’ DVTs. Silent DVTs may resolve by themselves, or can lead to complications such as PE. Other conditions may present with similar symptoms to a DVT. These include soft tissue injury (muscle strain), inflammation of superficial veins (phlebitis), infection (cellulitis), skin inflammation (dermatitis) or a ruptured cyst behind the knee (ruptured Baker’s cyst). What causes DVT? Many external factors contribute to the formation of a DVT. One of the most common risk factors is immobility caused by long distance travel or hospitalisation. Some people are naturally predisposed to DVT because of an inherited tendency to clotting. Several risk factors need to be present for a DVT to develop. An example is a female who is taking an oral contraceptive (risk factor 1) who has a sprained ankle (risk factor 2), is travelling from Sydney to New York in a plane (risk factor 3) and carries an inherited tendency to clotting (risk factor 4).

DVT Risk Factors Reduced mobility Contraction of the calf muscles during walking results in blood flow in the veins towards the heart. With immobility, blood flow becomes sluggish and the blood is more likely to clot. This leads to an increased risk of DVT. Patients over 60 are generally at greater risk, although patients of any age with reduced mobility (such as during long distance travel, or through illness or hospitalisation) can be affected. Long distance travel with prolonged sitting ‘Long distance’ is defined as any trip of more than five hours. This includes car, coach and plane travel. In addition, the lower oxygen levels and humidity in an aeroplane cabin may further increase the risk of blood clots in the lower leg. Injuries Blood vessels may be damaged through trauma to the leg. Examples of such injuries include physical trauma, surgery or radiation therapy for cancer. Traumatic injuries damage the inner lining of veins, which can then trigger clot formation. Obesity Obesity is a known risk factor for cardiovascular diseases (strokes and heart attacks). Obesity is usually associated with reduced mobility, which adds to the DVT risk. Pregnancy Pregnancy increases the risk of DVT by several-fold.

Most cases occur in the third trimester and immediately following delivery. Oral contraceptives and hormone replacement therapy (HRT) Hormonal preparations such as oral contraceptive pills or HRT increase the risk of clotting, particularly when combined with other risk factors like smoking, high blood pressure, obesity and inherited clotting disorders. Patients with a history of DVT should not take these preparations. Cancer and other medical illnesses Cancers may increase the blood’s tendency to clot. Cancers of the ovaries, pancreas, lymphatic system, liver, stomach, and colon are particularly likely to provoke DVT. Infections and medical conditions such as systemic lupus erythematosus (SLE), Crohn’s disease, rheumatoid arthritis, and glomerulonephritis may also stimulate the blood clotting process and promote DVT. Inherited clotting disorders (Thromobophilia) If blood clots occur in more than one person in a family, there may be an inherited clotting disorder. Genetic mutations can cause defective blood clotting factors. Factor V (five) Leiden and the prothrombin gene mutations are among the most commonly encountered gene mutations in the community.

Individuals who inherit one of these mutations from either parent (heterozygous) may experience recurrent episodes of DVT, but the risk is highest if both parents were affected (homozygous). Other inherited causes include deficiencies of certain blood components (antithrombin, protein C, and protein S) that ordinarily help dissolve blood clots. Some genetic mutations can lead to increased amounts of homocysteine in the circulation. Homocysteine is a compound that increases the tendency for the blood to clot, as well increasing the risk of stroke and heart attack. Smoking The role of smoking is controversial. In principle, smoking reduces the amount of oxygen in the blood stream and may damage vessel walls, potentially leading to clot formation. How to reduce the risk of DVT • If you are scheduled for surgery or other procedures, notify your doctor if you have suffered from a blood clot in the past. • If driving long distances, break up the trip with frequent rest stops every two hours to walk around. • If you are on a plane, perform calf stretching exercises at regular intervals and walk around when you can. • Avoid sitting still for long periods. When watching TV or reading, get up and move around once an hour.

• When sitting, perform heel/toe lifts frequently. This causes the calf muscle to contract and move the blood in your veins, making it less likely to clot. • If at risk, drink plenty of fluids, but avoid alcohol, coffee and tea, which can contribute to dehydration and increase the risk of clotting. • If you have an inherited risk of clotting, do not use birth control pills. • There are blood tests available to determine if you have an inherited problem. If there is a history of DVT in your family, discuss this with your doctor. • If you have had a DVT in the past, are pregnant, or have varicose veins, it may be helpful to wear compression stockings. Discuss this with your doctor. • Do not smoke. If DVT is suspected, the following tests may be useful to confirm the diagnosis. Duplex Ultrasound This is a combination of ultrasound and Doppler (hence ‘duplex’) technology to assess the blood flow. The ultrasound waves travel through the tissue and back, enabling a computer to transform them into a moving image. Duplex ultrasound is the most popular method for diagnosing DVT; it is painless, non-invasive and relatively easy to perform.

Venography Venography involves the injection of a dye into a large vein in the foot or ankle. An x-ray image is then taken to reveal the location of possible clots. Venography is one of the most accurate ways to identify deep vein thrombosis, but it may be uncomfortable. Occasionally it may cause phlebitis, an inflammation of the superficial veins. For these reasons, venography is no longer used routinely for DVT diagnosis. Magnetic Resonance Imaging (MRI) MRI uses a strong magnet to create a clear, high quality image of the body’s internal structures. It can be very effective in diagnosing DVT, especially in the thigh and pelvic areas. However, it is an expensive procedure and is only used in special circumstances. Diagnosing Pulmonary Embolism The symptoms of pulmonary embolism (PE) are not very specific, and can be present with many other conditions. Up to 75 per cent of patients suspected of having PEdo not actually have this condition. Special diagnostic tests, therefore, need to be performed. The three tests currently used to diagnose PE are pulmonary angiography, nuclear medicine lung scans and spiral CT scans.

Treating DVT Once a DVT is diagnosed, treatment begins immediately to reduce the risk of the clot extending further or breaking off. Early treatment also reduces the risk of post thrombotic syndrome. If you have been diagnosed with a DVT, your doctor may recommend treatment at home or in hospital. The type of treatment depends on the location of the clot and the likelihood of further complications. It is important that treatment be started as soon as possible. Patients who receive early treatment will significantly reduce their chances of developing PE. To treat blood clots, doctors use various drugs, including anticoagulants. Standard anticoagulant medications include heparin and warfarin. Heparin is given either through a vein (intravenously) or as an injection under the skin. Warfarin is given orally as a tablet. Heparin acts immediately, while warfarin takes several days to become effective. Both are usually started at the same time, but heparin is discontinued after warfarin becomes effective. Regular blood tests are required to monitor the effectiveness of warfarin. It is important to take warfarin as directed and to record all dosages. Two types of heparin are available for treatment of DVT.

Unfractionated heparin (UH) is given in hospital, whereas low-molecular-weight heparin (LMWH) can be self-injected at home, which usually is more convenient and less expensive. LMWHhas the added benefit of not usually requiring periodic blood tests to monitor its effects. An example of low-molecular-weight heparin is enoxaparine. Contrary to popular belief, anticoagulants do not actively dissolve the clot; they prevent new clots from forming and reduce the risk of PE. In rare cases, clot dissolving (thrombolytic) agents are administered. For patients who are unable to tolerate medications, surgical removal of the clot (thrombectomy) may be performed, as well as insertion of a filter in a major vein that acts like a clot sieve. To minimise any pain, discomfort or complications associated with the treatment of a DVT, you should: • elevate the affected leg whenever possible • wear graduated compression stockings • avoid long periods of immobility. How long do patients need to be treated for a DVT? Depending on the underlying condition that caused the DVT, treatment may be needed for as little as four weeks, or for the rest of the patient’s life.

In patients with an obviously reversible cause of a DVT (for example, trauma, after orthopaedic surgery or prolonged bed rest), four to six weeks of therapy are usually adequate. The risk of a recurrent DVT in these patients is very low. In patients with an identified cause of DVT that cannot be reversed (for example, cancer, inflammatory bowel disease or inherited conditions), therapy should continue for at least six to 12 months, and may need to be continued indefinitely. Patients with no identifiable cause of their DVT have been shown to experience a high incidence of recurrent blood clots if they are treated for three months or less. Most physicians, therefore, recommend at least six months of anticoagulant therapy for these patients. With treatment, the clot stabilises and attaches firmly to the wall of the vein. The risk of the clot breaking off and travelling to the lungs, therefore, decreases over time. Long-term consequences of DVT & PE Very early in the development of a DVT, the body actually produces blood factors that help dissolve the clot. If the clot is in a superficial vein of the leg, or even in a calf vein, the clot frequently will dissolve totally.

However, almost 90 per cent of patients with a large DVT in the thigh or groin will be left with some abnormality in the deep veins, even after adequate treatment. In about 25 per cent of cases, DVT damages the affected vein and leads to long-lasting post-thrombotic syndrome (PTS). This presents as brownish discoloration of the skin, itching, swelling, slow-healing sores and pain. The affected skin becomes scarred and fragile, and can easily break down into an ulcer. It can also increase the risk of additional blood clots. PTS almost always occurs within two years of the initial diagnosis of DVT. The damage may be partially prevented, however, if the patient wears graduated compression stockings as part of their long-term care for DVT. A small number of patients suffer from recurrent pulmonary emboli, which can lead to high blood pressure in the lungs. This condition, in turn, can cause problems with the functioning of the heart and may require further medical or surgical treatment Frequently Asked Questions 1. Can DVT affect young and healthy people? DVT mainly affects the older age group (over 60), but all ages are affected.

Be aware of the DVT risk factors and adopt strategies to reduce this risk. Individuals carrying the abnormal clotting genes may suffer multiple blood clots at a young age. 2. Is the oral contraceptive pill a risk factor for DVT? Yes. However, the vast majority of women on the pill do not suffer from blood clots. Other risk factors, such as prolonged immobility, should be avoided when taking the contraceptive pill. 3. Does being overweight increase the risk of DVT? Obesity is a known risk factor for cardiovascular diseases, including the development of DVT. Obesity is usually associated with reduced mobility, which compounds the DVT risk. 4. If I develop DVT, do I have to be on treatment forever? No, not usually. In patients with a clear DVT trigger that is reversible, treatment usually takes six to 12 weeks. For cases in which the risk of developing new thromboses remains high (such as in patients with certain cancers or genetic abnormalities), therapy may need to be continued for months to years. Some patients remain on oral medication for life. 5. What can I do to help prevent DVT on a long flight? Wear comfortable, loose-fitting clothes for travel.

Drink plenty of water or juice, but avoid drinking alcohol. When seated, shift the position of your body periodically. You can also do simple exercises, or walk around the plane when safely permitted. Wear compression stockings, and avoid sleeping tablets. Sometimes, a preventative anticoagulation is used, which can be self-injected by the patient 6. Can sclerotherapy treatment on leg veins cause DVT? The DVT risk associated with sclerotherapy is exceptionally low, making it one of the safest procedures for vein treatment. Post-treatment compression and walking are important factors that help prevent DVT. 7. Does taking aspirin prevent DVT? Although commonly taken and prescribed, there is no evidence that aspirin reduces the likelihood of DVT. 8. Can surgery on leg veins cause DVT? The DVT risk associated with surgery can be quite significant. Reports of five per cent DVT after varicose vein operation on one leg, and 15 per cent after varicose vein operation on both legs, have appeared in scientific literature. The risk varies depending on patient factors such as age, weight, gender and degree of mobility after surgery.

Most patients are discharged on the same day and are mobile fairly quickly, which is important in prevention of DVT. Australasian College of Phlebology Inc. PO Box 705, Chatswood NSW 2057 Level 5, 7 Help Street, Chatswood NSW 2067 Phone: +612 9386-1811

Question: What specific part of the body is affected by phlebitis?
Answer: Veins