House Calls runs monthly. Today’s column is written by Doris Fitch, a registered nurse at Sutter Coast Hospital and trainer at College of the Redwoods.
Hospital care often involves prevention of deep vein thrombosis and pulmonary emboli.
Our bodies have a tendency to form clots when we are sedentary or bedfast for a period of time. Some people are more at risk than others. For example, individuals with leg swelling ulcers or varicose veins, pregnancy or postpartum less than one month, are considered high risk for getting clots if they are bedfast or sedentary.
During the admission process as an inpatient, the nurse will assess you for the risk factors and the doctor will order a prophylactic low molecular heparin called Lovenox or order pneumatic compression stockings, which squeeze your legs to prevent blood from stagnating after surgery.
The lovenox is given under the skin or subcutaneous tissue in your belly, rotating the sites. The dose is a small one, according to your weight in kilograms, given once a day. The nurse will teach you about what to report to the nurse, such as excessive bruising, pain, bleeding gums, stools or urine.
Using an electric razor is best during this therapy if you shave. This medication is in your system for only 24 hours, so a daily injection is necessary.
After surgery the doctor will usually wait to make sure you are stable before giving you the blood thinners, but the compression devices will be on your legs once you wake up in the recovery room. The devices need to be working while they are on you. So if you don’t feel the squeezing they need to be turned on by your nurse.
Once you are up and walking every two hours and moving freely with well-controlled pain, you may ask your doctor if they can be removed. Anytime the device causes pain or is in any way uncomfortable, let your nurse know.
Another intervention that may help prevent clot formation is graduated compression stockings. They help squeeze your legs, helping your veins and muscles move blood more efficiently.
Moving as soon as possible after surgery can help prevent pulmonary embolism and speed your overall recovery. This is one of the main reasons your nurse may push you to get up and walk as soon as one day after surgery.
Take preventive steps while traveling. Sitting during a long flight or automobile ride increases your risk of developing blood clots in the veins of your legs. To help prevent a blood clot from forming:
• Take a walk. Move around the airplane cabin once an hour or so. If you’re driving, stop every hour and walk around the car a couple of times. Do a few deep knee bends.
• Exercise while you sit. Flex, extend and rotate your ankles or press your feet against the seat in front of you, or try rising up and down on your toes. And don’t sit with your legs crossed for long periods of time.
• Wear support stockings. The firm, even pressure these stockings exert helps keep blood from pooling in deep veins. You can use a device called a stocking butler to help you put on support stockings.
• Administer a dose of heparin, if recommended by your doctor. If you have a history of DVT or VTE, talk with your doctor before a long trip. He or she may tell you to self-inject a long-acting dose of heparin just before traveling. Your doctor will also tell you whether you need to repeat the dose for your return trip.
• Drink plenty of fluids. Water is the best liquid for preventing dehydration, which can contribute to the development of blood clots. Avoid alcohol and caffeine, which contribute to fluid loss.