Deep Vein Thrombosis physiotherapy. pptx

This Presentation will inform you about Deep Vein Thrombosis.
This will give you awareness on virchows triad.
This will throw light on pathophysiology & clinical manifestation of DVT.
This will give you the knowledge on diagnosis of DVT.
This ppt will bring the cup of knowledge on physiotherapy assessment & management of DVT

1. DEEP VEIN THROMBOSIS DR. ANERI PATWARI MPT-CARDIORESPIRATORY 03-01-2024 1

2. VENOUS  THROMBOEMBOLISM (VTE) Venous  thromboembolism (VTE) A condition in which a blood clot (thrombus) forms in a vein, which in some cases then breaks free and enters the circulation as an embolus, finally lodging in and completely obstructing a blood vessel, e.g., in lungs causing a PE (PULMONARY EMBOLISM) The most common type of venous thromboembolism is DEEP VEIN THROMBOSIS, which occurs in veins deep within the muscles of the leg,arm and pelvis. A superficial venous thrombosis (also called phlebitis or superficial thrombophlebitis) is a blood clot that develops in a vein close to the surface of the skin. These types of blood clots do not usually travel to the lungs unless they move from the superficial system into the deep venous system first. 03-01-2024 2

3. 03-01-2024 3

4. VTE OCCURS AS A RESULT OF “ VIRCHOW’S TRIAD ” IS A COMBINATION OF 03-01-2024 4

5. DVT Dvt (deep vein thrombosis) commonly occurs in lower extremities (calf & thigh), but also occur in upper extremities. The primary pathophysiological concern associated with dvt is immobilization. Dvt itself can also result in peripheral vascular compromise, infection & venous gangrene. Post-thrombotic syndrome is a chronic complication of dvt , damage to venous valves result in venous pooling. The superficial femoral and popliteal veins in thighs and posterior tibial and peroneal veins in calves are most commonly affected 03-01-2024 5

6. 03-01-2024 6

7. 03-01-2024 7

8. 03-01-2024 8

9. 03-01-2024 9

10. 03-01-2024 10

11. TERMINOLOGIES Thrombophlebitis a thrombus accompanied by inflammation of the vein (phlebitis). Phlebothrombosis - refers to a thrombus with minimal inflammation. Dislodgment and migration of a thrombus are known as thromboembolism. Which is common in phlebothrombosis. 03-01-2024 11

12. CLINICAL MANIFESTATIONS FREQUENT Calf pain or tenderness, or both Swelling with pitting oedema Increased skin temperature and fever Superficial venous dilatation Cyanosis can occur with severe obstruction LESS FREQUENT  Phlegmasia alba dolens , Phlegmasia cerulea dolens , and Venous gangrene. These are clinical spectrum of the same disorder. 03-01-2024 12

13. CLINICAL MANIFESTATIONS 03-01-2024 13

14. DIAGNOSTIC STUDIES  Clinical examination alone is able to confirm only 20-30% of cases of DVT Blood Tests The D-dimer Imaging Studies 03-01-2024 14

15. CLINICAL TESTS 03-01-2024 15

16. IMAGINING STUDIES INVASIVE venography, radiolabeled fibrinogen NON-INVASIVE ultrasound, plethysmography, MRI techniques 03-01-2024 16

17. VENOGRAPHY It detects  thrombi in both calf and thigh It can conclude and exclude the diagnosis of DVT when other objective testings are not conclusive.  03-01-2024 17

18. VENOGRAPHY ADVANTAGES  It is useful if the patient has a high clinical probability of thrombosis and a negative ultrasound. It is also valuable in symptomatic patients with a history of prior thrombosis in whom the ultrasound is non-diagnostic. DIS-ADVANTAGES It can primary cause of DVT in 3% of patients who undergo this diagnostic procedure. An invasive and expensive. Although Venography was once considered the gold standard for diagnosis of DVT, today it is more commonly used in research environments and less frequently utilized in clinical practice. 03-01-2024 18

19. RADIOLABELED FIBRINOGEN Because the radioactive isotope incorporates into a growing thrombus, this test can distinguish new clot from an old clot. Nuclear medicine studies done with I125- labeled fibrinogen . More commonly used in research. 03-01-2024 19

20. PLETHYSMOGRAPHY Principle- Blood volume changes in the leg lead to changes in electrical resistance. Venous return in the lower extremity is occluded by inflation of a thigh cuff, and then the cuff is released, resulting in a decrease in calf blood volume. Any obstruction of the proximal veins diminishes the volume change, which is detected by measuring changes in electrical resistance (impedance) over the calf 03-01-2024 20

21. NON-INVASIVE ULTRASONOGRAPHY Color-flow Duplex scanning is the imaging test of choice for patients with suspected DVT inexpensive, noninvasive, widely available Ultrasound can also distinguish other causes of leg swelling, such as tumor, popliteal cyst,abscess , aneurysm, or hematoma. MRI It detects leg, pelvis, and pulmonary thrombi and is 97% sensitive and 95% specific for DVT. It distinguishes a mature from an immature clot. MRI is safe in all stages of pregnancy. Test may not be appropriate for patients with pacemakers or other metallic implants, it can be an effective diagnostic option for some patients. 03-01-2024 21

22. 03-01-2024 22

23. 03-01-2024 23 MANAGEMENT

24. MEDICAL Measures for preventing or reducing blood clotting within the vascular system are indicated in patients with deep vein thrombosis. Unfractionated heparin: administered subcutaneously to prevent development of DVT, or by intermittent or continuous IV infusion for 5 days to prevent the extension of a thrombus and the development of new thrombi. Low-molecular-weight heparin (LMWHs): Subcutaneous LMWHs that may include medications such as dalteparin and enoxaparin are effective treatments for some cases of DVT; they prevent the extension of a thrombus and development of new thrombi.  Oral anticoagulants:  Warfarin is a vitamin K antagonist that is indicated for extended coagulant therapy. Factor Xa inhibitor : Fondaparinux selectively inhibits factor Xa. Thrombolytic therapy : Unlike heparins, catheter-directed thrombolytic therapy lyses and dissolves thrombi in at least 50% of patients. 03-01-2024 24

25. 03-01-2024 25

26. 03-01-2024 26

27. PHYSIOTHERAPY ASSESSMENT 03-01-2024 27

28. DEMOGRAPHIC DATA Name:- xyz Age/gender:-advance age Occupation:-mostly sedentary lifestyle Date of addmission :- Date of operation:- in operated cases Date of discharge:- Date of examination:- 03-01-2024 28

29. VITAL SIGNS:- RR- PR- BP- HR- SP02- HEART SOUND- CHIEF COMPLAIN:- Pain & swelling of back of the lower leg. Warm skin in the affected area. Red skin color of the affected area. Pain at walking 03-01-2024 29

30. HISTORY OF PRESENT ILLNESS 03-01-2024 30

31. Past medical history:-chronic predisposing modifiable and non- modifible risk factors. Past surgical history:- Family history:-of venous thromboembolism Surgical notes:- Immobilization for prolong period. Insertion of intra-vascular device. Personal history:- Maybe altered due to pain. B/b may be inserted catheter. Habits:-smoking 03-01-2024 31

32. PAIN ASSESMENT Site:- Side:- Type:- thrombing cramp like pain Onset:-gradual Duration:-since immobiliztion period Intensity:-vas At rest & during activity no pain maximum pain Aggrevating factor:-standing or walking Reliveing factor:- 03-01-2024 32

33. ON OBSERVATION Posture:-tightness of affected muscles. Swelling:-of affected muscles. Redness:- of affected muscles. Gait: antalgic gait 03-01-2024 33

34. ON PALPATION Tenderness:- of affected area. Swelling:- of affected area. Temperature:-increase localized temperature of affected area. 03-01-2024 34

35. ON EXAMINATION Girth measurement of calf muscle in figure of 8 manner. Range of motion Knee that is flexion and extension Ankle that is df,pf,eversion,inversion Manual muscle testing Knee that is hamstrings and quadriceps Ankle that is tibilis anterior and calf muscle Special test Homans sign : calf pain at df of foot 03-01-2024 35

36. 03-01-2024 36

37. ICIDH2 Body structure Direct:dvt Indirect:swelling ,redness Body function Direct:abnormal venous return, pain, decreased rom and muscle strength Indirect:gait , posture Activity limitation and participation restriction : proper weight bearing, adl 03-01-2024 37

38. PFD A 50+ OLD PATIENT HAVING PAIN,SWELLING,TIGHTNESS OF MUSCLE,ANTALGIC GAIT,IMPAIRED ROM,STRENGTH ASSOSITED WITH DEEP VEIN THROMBOSIS 03-01-2024 38

39. PHYSIOTHERAPY MANAGEMENT 03-01-2024 39

40. GOALS SHORT TERM GOALS To counsel the patient. To reduce pain and swelling. To increase range of motion. To increase muscles length. Early ambulation after surgery LONG TERM GOALS To reduce swelling or oedema Increase muscle strength Cardiopulmonary endurance Do’s & don’ts Ergonomics advice 03-01-2024 40

41. TO COUNSEL THE PATIENT Educate the patient about the condition. Explain its prognosis. Ask him to do regular exercises to prevent pulmonary embolism. Ask to do exercise at regular interval while travelling or doing the work at prolong static posture. 03-01-2024 41

42. TO REDUCE PAIN AND SWELLING Ice-pack at the affected area:- 15 minutes 3-4 times per day Elevate the affected area while sleepin or doing rest. Don’t keep your legs hanging while doing work. Wear gratuated compression stockings creating gentle pressure that keep blood cooling and clotting. 03-01-2024 42

43. TO INCREASE RANGE OF MOTION Active ankel toe movement. Ankle pumping. In case of lower limb Active knee flexion & extension Wrist flexion & extension. Wrist ulnar & radial deviation. Elbow flexion & extension. Early ambulation in case of major surguries or stroke. 03-01-2024 43

44. TO INCREASE MUSCLES LENGTH To strech the affected muscle Example:- for calf muscle Gastrocnemius-supine potion Procedure:-cradle the foot and stretch the muscle with full knee extension Soleus-supine position Procedure:-cradle the foot and stretch the muscle with 30` knee flexion. 03-01-2024 44

45. 03-01-2024 45

46. 03-01-2024 46

47. TO INCREASE MUSCLES STRENGTH Actively:- Gastrocnemius:-one leg standing position with two fingure support on table. Do knee flexion & extension with knee full extension. Soleus:-one leg standing position with two fingure support on table. Do knee flexion & extension with knee 30` flexion. With resistance Manual:-give resistance in every ankel and knee movement Elastic-resistance:-use theraband & theratube for every ankle & knee movement 03-01-2024 47

48. 03-01-2024 48

49. 03-01-2024 49

50. TO REDUCE SWELLING & OEDEMA Intermittent pneumatic compression is a therapeutic technique use in medical device that include air-pump & inflatable auxiliary sleeves, gloves in a system design to improve venous circulation in limbs of patient who suffer dvt . 03-01-2024 50

51. 03-01-2024 51

52. TO INCREASE MUSCLES STRENGTH Manual, mechanical & elastical resistance with increases its resistive capacity. 03-01-2024 52

53. CARDIOPULMONARY ENDURANCE 03-01-2024 53

54. DO’S Do exercise regularly Elivate your leg while sleeping or resting. Wear stockings Take walks Use ice pack Drink plenty of fluid DONT’S Avoid hanging your legs Avoid wearing tight socks Don’t do massage as it break and loose blood clots and travrl to unwanted areas of body like heart or lungs causing a fatal heart attack or a blocked artery Avoid coffee and alcohol as it will dehydrate us and makes veins narrower and blood thicker so more likely to get clot 03-01-2024 54

55. ERGONOMICS Do exercise on regular intervals. Use proper foot-rest. Don’t hang your legs. Use leg ergometer 03-01-2024 55

56. 03-01-2024 56

57. 03-01-2024 57