By Dave Christensen
“Thrombo” means “Clot”.
Phlebitis is an inflammation
of a vein.
Thrombophlebitis occurs
when a blood clot causes
inflammation in a vein.
Blood clots typically form in
the legs or pelvis. On rare
occasions,
thrombophlebitis can affect
veins in the arms and neck.
Thrombophlebitis is caused by
prolonged inactivity, such as
sitting during long periods of
travel or from lengthy periods of
bed rest. Such inactivity
decreases the blood flow through
the deep veins and causes a
blood clot to form. Clots can
form in superficial veins..
Paralysis, certain types of
cancer and use of the
hormone estrogen can also
lead to thrombophitis.
Inherited tendency for blood
clotting makes a person at
higher risk.
Protein S deficiency is an Inherited
clotting disorder
RiskFactors
•Inactive for long periods of time.
•Confined to bed for long periods of
time.
•Cancer that causes increased
procaoagulants – Substances necessary
for clotting blood.
•Paralysis in arms and legs from a CVA.
•Are pregnant or have just had a baby.
•Use of oral contraceptive or hormone
replacement.
•Have a family history of clotting
disorders.
•Overweight .
•Have varicose veins.
•Smoking.
Signs and Symptoms of
Thrombophlebitis
Warmth, tenderness,
fever and pain in the
affected area.
Redness and swelling.
Superficial veins may be hard, swollen, and
the person may have a fever.
Pre-Hospital Treatment of Thrombophlebitis
-assess and maintain ABC’s
-Administer O2 P.R.N.
-IV in fore arms or AC T.K.O.
-Monitor Vitals and EKG changes
-Move the pt. as little as possible
-Administer Morphine and Fentanyl as needed
-If clot is in the arm, do not use that arm for blood pressures
-Immobilize the arm or leg and keep it from moving
CPR and intubation may be needed
if condition of pt worsens
Emergency Treatment of
Thrombophlebitis
Should the Clot Dislodge
Pulmonary Embolism
If a deep vein clot becomes
dislodged, it may travel to the
lungs, where it can block an
artery and cause a potentially
life-threatening situation.
X Permanent damage to
the affected lung
X Low oxygen levels in
your blood
X Damage to other organs
in your body from not
getting enough oxygen
Signs and Symptoms are: Sudden SOB,
chest pain, wheezing, leg swelling,
pale/cool/ clammy skin, diaphoretic,
anxious, weak/thready pulse, syncope and
fever
Treatment Of a Pulmonary
Embolus:
-Assess and maintain Airway, Breathing and
Circulation.
-Monitor vitals and do an EKG.
-Administer O2 with an Non-rebreather
mask at 15 LPM or what pt can tolerate (may
need to possibly Intubate pt.).
-IV 18g in the forearm or AC T.K.O..
-Transport Pt to hospital for fibrinolytic care.
Remember that you may have to start CPR
since pt may become unresponsive during
care.
Heart Attack
A traveling clot can enter the
coronary arteries of the heart and
cause a blockage of the blood
supply to the heart muscle. This
is a serious condition in that it can
cause damage to the smooth
muscles of the heart. This can
cause life threatening
arrhythmia's, lack of oxygen to
other vital organs. A heart attack
can lead to kidney failure.
Signs and symptoms of a hear attack are chest
discomfort, pressure or burning, chest pain
that radiates to other parts of the body, SOB,
dizziness, diaphoretic, N/V, general weakness,
and a sense of “impending doom’, and
indigestion pain
Treatment of Heart Attack
-Assess and monitor Airway, Breathing and Circulation.
-Administer oxygen at 15 LMP by nonrebreather mask.
-Monitor and interprete EKG – Perform a 12 lead as soon as
possible.
-I.V. 18 g or larger to the forearms or AC.
-Administer Aspirin 325mg, Morphine 210mg, and Nitro .4 mg SL or by spray (re
checking vitas after giving each medication.
-Transport to the hospital as soon as
Possible.
Begin CPR if necessary
Stroke
Strokes happen when a blood clot
causes a blockage. This causes
decrease flow of blood to your brain.
Within minutes, brain cells begin to
die.
Symptoms of stroke are:
-Sudden numbness or weakness of the
face, arm or leg (especially on one side
of the body).
-Sudden confusion, trouble speaking
or understanding speech.
-Sudden trouble seeing in one or both
eyes.
-Sudden trouble walking, dizziness,
loss of balance or coordination
Sudden severe headache with no
known cause.
Treatment
of CVA:
-Establish and maintain an airway.
Have suction available.
-Administer O2 with a nonrebreather
if pt tolerates. Adjust flow rate at 15
LPM.
-Complete a detailed history.
-Keep pt suspine and in a recovery
position.
-Check blood glucose level.
-IV T.K.O..
-Monitor rhythm and changes.
-Protect paralyized extremities.
-Reassure pt.
-Transport to hospital without delay.
Hospital Treatment
for Thrombophlebitis
Screening for Thrombophlebitis:
1) Ultrasounds: A US Tech will use a wand like instrument over the legs which sends out
waves. As the sound waves travel through the tissue and back, the computer will take and
form a picture on the screen of the clot.
2) CT and MRI: both computerized tomography (CT) and magnetic resonance imaging
(MRI) provide images your veins and will show if a clot is present. They may find a
thrombosis when they are looking for other medical problems.
3) Venography: A dye or contrast agent is injection into a large vein in the foot or leg and
an X-ray procedure creates an image of the veins looking for clot. This test is not used
as much due to being an invasive procedure.
4) Blood test: The doctor will order blood test on these pt’s. Usually they will order a
CMP, a CBC, and a D-Dimer. A D-Dimer test is not always conclusive of a thrombosis,
due to being elevated for other conditions.
Treatment of Thrombophlebitis
1) Medications: The doctor will inject the pt. with heparin and then administer Coumadin
for several months to prevent the clots. The doctor may also prescribe other medications
that break up the clots while at home.
2) Support stockings: support stockings are to help prevent recurrent swelling and will
reduce the chance of complications associated with thrombophlebitis. These stocking
also come in prescription strength
3) Filters: filters may be placed in the Vena Cava and will prevent clots that can
break loose in the legs and travel to the lungs.
4) Varicose Vein stripping: the doctor may surgically remove varicose veins that cause
pain or recurrent thrombophlebitis. This procedure is done on an out pt basis and
involves removing a long vein through several small incisions. This procedure is
routinely done for cosmetic reasons and recovery is usually a couple of weeks depending
on the health of the individual.
5) Clot removal or bypass: Sometimes surgery is the last resort. Doctors may bypass the
affected vein or they may do a nonsurgical procedure called angioplasty to open up the
vein. In this procedure the doctor will place a small wire mesh tube to keep the vein
open. This is a similar procedure as placing a stint in a heart attack patient.
Prevention of Thrombophlebitis:
1) Quiet smoking since smoking increases your chances of developing thrombophlebitis.
2) Since sitting during long flights or car rides can cause a thrombus to develop, it is
recommend that you walk around the cabin of the plane once an hour and if your driving
it is recommended to stop and get out and walk once every hour and walk around. If your
unable to get up and walk around then you want to flex your ankles and feet against the
seat in front of you.
3) If on a flight or car ride for more than four hours it is recommend that you:
A) Avoid tight fitting clothing around your waist
B) Drink plenty of fluids to avoid dehydration
4) These foods are useful in avoiding Thrombophlebitis:
A) Fresh fruits, vegetables, raw nuts and seeds, soybean products and whole grains
Prevention continued
Prevention of Thrombophlebitis:
5) Foods that could lead to thrombophlebitis:
A) Red meat, dairy products, sugar fried and salty foods, and processed or partially
hydrogenated vegetable oils
6) Herbs that are useful for reducing thrombophlebitis:
A) Cayenne – Thins the blood, reduces blood pressure and improves circulation
B) Hawthorn leaf or berry: Protects the heart
C) Ginger, skullcap, and Valerian root: this is used to dilate the blood
vessels and aides in circulation
D) Gingko Biloba: aides in improving circulation and brain function and is also
a powerful antioxidant
Prevention continued
Prevention of Thrombophlebitis:
7) Nutritional Support:
A) Aceytl-L-caritine: protects the heart from fat buildup
B) Coenzyme Q10: also protects the heart and improves circulation
C) Flaxseed oil: provides the needed fatty acids that minimizes blood clot formation and keeps
the veins and arteries soft and pliable.
D) Garlic: Improves circulation and thins the blood
E) Magnesium plus calcium: Calcium works with magnesium, which magnesium is a natural
blood thinner that helps reduce abnormal clotting
F) Pycnogenol or grape seed extract: they are antioxidants that help restore the flexibilty to
arterial walls and reduce the risk of thrombophlebitis
G) Vitamin C: Aides in circulation and helps reduce clotting tendencies
H) Vitamin A & E: helps protect endothelium and has an anti-peroxidative effect. They also
increase anti-aggegant factors and increase the good HDL ( cholesterol )
I) Vitamin B6: helps provent arterial damage due to the buildup of homocysteine (amino acid)
Prevention continued
Prevention of Thrombophlebitis:
8) Lifestyle Recommendations:
A) Get regular exercise. Walking, swimming or other forms of exercise will improve your
circulation and help prevent sluggishness in the veins decreasing your chance of developing blood
clots.
B) Avoid wearing tight fitting clothing that can reduce circulation such as knee socks.
Bibliography
1) “Thrombophlebitis” Taber’s Cyclopedic Medical Dictionary. Nineteenth
edition 2001.
2) “Thrombophlebitis”. The Merck Manual. Seventh Edition 1999.
3) Bledsoe, Porter, Cherry. Paramedic Care, Practices and Principles. Brady
books 2006.
4) Thrombophlebitis. Online. March 1998.
<http://www.compassionateacupuncture.com/thrombophlebitis.html>
5) Pulmonary Embolism. Online. May 17, 2008
<http://www.mayoclinic.com/health/pulmonary-embolism/DS00429/DSECTION=2>
Bibliography continued
Bibliography Continued
6) Deep Vein Thrombosis. Online. May 1, 2006
<http://www.emedicinehealth.com/blood_clot_in_the_legs/article_em.html>
7) Thrombophlebitis. Online. Unknown date.
<http://www.answers.com/topic/thrombophlebitis?cat=health>
8) Thrombophlebitis. Britannica Online Encyclopedia. May 2008.
<http://www.britannica.com/EBchecked/topic/594097/thrombophlebitis>
9) Thrombophlebitis. Online. May, 24, 2006
<http://www.nlm.nih.gov/medlineplus/ency/article/001108.html>
10) Thrombophlebitis. Wikipedia Online. April 19, 2004
<http://www.wikipedia.org/wiki/thrombophlebitis>
Bibliography continued
Bibliography Continued
11) Riddle, Kathy. Property Manager. Date of interview: May, 10, 2008
12) 35 y.o. Female pt at Oregon Burn Unit. Date of Interview: May 23, 2008
13) How to write a bibliography. Online. April 2005
<http://www.downersgrovelibrary.org/pages/writeabiblio.html>