Académique Documents
Professionnel Documents
Culture Documents
EBITIS
SANTOS, MARIA ERICKA B.
BSN III - 1
WHAT IS THROMBOPHELIBITIS?
Inflammation of the wall of a vein with associated thrombosis,
occurs when a blood clot blocks one or more of your veins,
typically in your legs.
a. Superficial Thrombophlebitis
This is when the inflammation is just below the surface of the skin.
Thrombosis of superficial veins produces pain or tenderness, redness, and
warmth in the involved area. The clots will gradually break apart as they
flow along with the blood. They could also be a symptom of deep vein
thrombophlebitis.
PATHOPHYSIOLOGY OF
THROMBOPHLEBITIS
Altered Coagulation
Increased blood coagulability occurs most commonly in
patients for whom anticoagulant medications have been
abruptly withdrawn. Oral contraceptive use and several
blood dyscrasias (abnormalities) also can lead to
hypercoagulability. Formation of a thrombus frequently
accompanies thrombophlebitis, which is an inflammation of
the vein walls.
Increased blood coagubility can result from inherited or
acquired disorders.
CLINICAL MANIFESTATIONS
Superficial Veins
Thrombosis of superficial veins produces pain or
tenderness, redness, and warmth in the involved
area. The risk of the superficial venous thrombi
becoming dislodged or fragmenting into emboli is very
low because most of them dissolve spontaneously. This
condition can be treated at home with bed rest, elevation
of the leg, analgesics, and possibly anti inflammatory
medication.
PREVENTION
Venous thrombosis, thrombophlebitis, and DVT
can be prevented esp. if patients who are
considered at high risk are identified and
preventive measures are instituted without delay.
Preventive measures include:
- Application of elastic compression stockings
- Intermittent pneumatic compression devices
- Special body positioning
- Exercise
MEDICAL MANAGEMENT
Objectives of treatment:
- Prevent thrombus from growing and
fragmenting and to prevent recurrent
thromboemboli.
PHARMACOLOGIC THERAPY
UNFRACTIONATED HEPARIN
- The advantages of thrombolytic therapy include less longterm damage to the venous valves and a reduced incidence
of post thrombotic syndrome and chronic venous
insufficiency.
FACTOR XA INHIBITOR
- Fondaparinux (Arixtra) selectively inhibits factor Xa.
- This agent is given daily subcutaneously at a fixed-dose,
has a half-life of 17 hours, and is excreted unchanged via
the kidneys (and therefore must be used with caution in
patients with renal insufficiency).
- Fondaparinux has no effect on routine tests of coagulation,
such as the aPTT or activated clotting time (ACT), so routine
coagulation monitoring is unnecessary (Weitz, 2004).
ORAL ANTICOAGULANTS
SURGICAL MANAGEMENT
Surgery is necessary for DVT when anticoagulant or
thrombolytic therapy is contraindicated, the danger of
pulmonary embolism is extreme, or the venous drainage is
so severely compromised that permanent damage to the
extremity is likely.
A thrombectomy (removal of the thrombosis) is the
procedure of choice. A vena cava filter may be placed at
the time of the thrombectomy; this filter traps large emboli
and prevents pulmonary emboli. Balloon angioplasty and
stent placement are being used in the iliac veins of
patients with acute and chronic venous disease.
NURSING MANAGEMENT
Assessing and Monitoring Anticoagulant
Therapy
- Continuous IV infusion by an electronic infusion device is the
preferred method of administering unfractionated heparin.
- To prevent inadvertent infusion of large volumes of unfractionated heparin, which could cause haemorrhage
Providing comfort
- Bed rest, elevation ofthe affected extremity, elastic compression
stockings, and analgesics for pain relief are adjuncts to therapy.
- help improve circulation and increase comfort.
Compression Therapy
STOCKINGS
- Elastic compression stockings usually are prescribed for
patients with venous insufficiency.
- These stockings exert a sustained, evenly distributed,
pressure over the entire surface of the calves, reducing the
caliber of the superficial veins in the legs and resulting in
increased flow in the deeper veins.
- The stockings maybe knee-high, thigh-high, or panty hose.
Thigh-high stockings are difficult for the patient to wear
because they tend to roll down. The roll of the stocking
further restricts blood (low rather than providing evenly
distributed pressure over the thigh.
WRAPS
Short stretch elastic wraps may be applied from the toes
to the knee in a 50% spiral overlap. These wraps are
available in a two-layer system, which includes an inner
layer of soft padding. These wraps are rectangular and
become squares on stretching, indicating the appropriate
degree of stretch and reducing the possibility of
wrapping a leg too loosely or too tightly. Three- and fourlayer systems are also available (Profore, Dynacare), but
these maybe used only once compared to the two-wrap
system, which can be used multiple times.
INTERMITTENTPNEUMATICCOMPRESSION DEVICES
- These devices can be used with elastic compression stockings
to prevent DVT. They consist of an electric controller that is
attached by air hoses to plastic knee-high or thigh- high
sleeves. The leg sleeves are divided into compartments, which
sequentially fill to apply pressure to the ankle, calf, and thigh
at 35 to 55 mmHg of pressure. These devices can increase
blood velocity beyond that produced by the stockings. Nursing
measures include ensuring that prescribed pressures are not
exceeded and assessing for patient comfort.