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THROMBOPHLEBITIS

PANGILINAN, LYZA RUIZ, FRANCESCA VICTORIA

DEFINITION
THROMBOPHLEBITIS is an inflammation with the formation of blood clots.
When thrombophlebitis occurs in the postpartal

period, it is usually an extension of an endometrial infection.


Thrombophlebitis is classified as superficial vein

disease (SVD) or deep vein thrombosis (DVT)

FEMORAL THROMBOPHLEBITIS
It was formerly called milk leg or phlegmasia alba

dolens (white inflammation)


The femoral, saphenous or popliteal veins are

involved.
Although the site in thrombophlebitis is a vein, an

accompanying arterial spasm often diminishes arterial circulation to the leg as well

With proper treatment, the acute symptoms of

femoral thrombophlebitis last only for a few days, but the full course of the disease takes 4 to 6 weeks before it is resolved. The affected leg may never return to its former size and may always cause discomfort after long periods of standing.

PELVIC THROMBOPHLEBITIS
Involves the ovarian, uterine or hypogastric veins Usually occurs after a mild endometritis

It often occurs around the 14th or 15th day of the

puerperium

CAUSES
The fibrinogen level is still elevated from pregnancy,

leading to increased blood clotting Dilatation of lower extremity veins is still present as a result of pressure of the fetal head during pregnancy and birth The relative inactivity of the period or a prolonged time spent in delivery or birthing room stirrups lead to pooling, stasis, and clotting of blood in the lower extremities

RISK FACTORS
OBESE WOMEN VARICOSE VEINS 30 YEARS OF AGE AND OLDER WITH INCREASED PARITY

HIGH INCIDENCE OF THROMBOPHLEBITIS IN THE FAMILY


VENIPUNCTURE CANCER OF THE ABDOMEN INACTIVITY FOLLOWING SURGERY

PATHOPHYSIOLOGY

CIRCULATORY STASIS (BLOOD)

ENDOTHELIAL INJURY (VESSEL)

THROMBOSIS

HYPERCOAGULA BLE STATE (FLOW)

VIRCHOWS TRIAD

SIGNS AND SYMPTOMS


Classic Signs and Symptoms
Firm swelling of the calf or leg Pain or tenderness

Redness
Increased local temperature Dull, aching tightness in the calf, especially when

walking Dilatation of the surface veins of the leg

Femoral Thrombophlebitis:

Chills and pain in the affected leg Leg has a white or drained appearance

Increased diameter of leg and calf

Homans sign assessment

- It is used to determine the presence of a deep vein thrombophlebitis. The patient lies prone on the table with the knee fully extended. The examiner passively dorsiflexes the patients ankle while palpating the calf. Pain in the calf and/or pain with palpation is considered a positive test
Doppler ultrasonography or contrast venography

usually is ordered to confirm the diagnosis

Pelvic Thrombophlebitis
Fever Chills General malaise If infection is severe, it results to pelvic abscess Could also result to lung, kidney or heart valve abscess

MANAGEMENT

Use side-lying or supine recumbent position for

giving birth, rather than a lithotomy position


Dont let mother sit with knees bent sharply Avoid wearing constricting clothing. A bed cradle

may be used to keep pressure of the bedclothes off the affected leg, both to decrease the sensitivity of the leg and to improve the circulation.

Ambulate as soon after birth as you are able. When resting in bed, wiggle your toes or do leg lifts

to improve venous return


If the mother smokes, explain to her that smoking

increases the risk of thrombosis

Femoral Thrombophlebitis: Nursing management:


Bed rest with the affected leg elevated Never massage the skin over the clot; this could loosen the

clot, causing a pulmonary or cerebral embolism

Apply moist heat for 15-20 minutes to relieve mild

inflammation. Be certain that the weight of the hot pack or pad does not rest on the leg, causing an obstruction to flow of blood

Provide her with appropriate activities to exercise

the other parts of her body to lower risk of blood clotting such as reading material about newborns.
Measure blood coagulation levels daily before

administration of anticoagulant. Depending on the drug prescribed, a baseline activated partial thromboplastin time (APTT) or prothrombin time (PT) is obtained

Pharmacologic mangement:
Administration of anticoagulants to prevent blood

clotting
Analgesics to relieve pain

Antibiotic to reduce the initial infection

Classification : Anticoagulant Action: Heparin blocks the conversion of prothrombin to thrombin and of fibrinogen to fibrin, decreasing clotting ability and resulting in the inhibition of thrombus and clot formation. It is used to prevent thrombosis and pulmonary embolism Pregnancy Risk Category: C

Possible Adverse Effects: Hemorrhage, bruising, thrombocytopenia, urticaria

PHARMACOLOGY: Heparin Calcium Injection (Hepalean, Liquamin Sodium)

Pelvic Thrombophlebitis Nursing management:


Complete bed rest
Teach mother preventive measures to reduce risk of

recurrence for future pregnancies

Avoid wearing constricting clothing. A bed cradle

may be used to keep pressure of the bedclothes off the affected leg, both to decrease the sensitivity of the leg and to improve the circulation.
Caution mother to tell her physician before her next

pregnancy about the complication

Surgical management:
If abscess forms, it can be located and incised by

laparatomy if necessary.

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