Thrombosis prophylaxis measures
The measures are based on the risk profile, a thrombosis to develop and according to the willingness to cooperate (compliance) of the person concerned.
General information on the topic of thrombosis prophylaxis can be found on the start page on the topic: Thrombosis prophylaxis
A significant risk factor in developing a Blood clot is immobility. Immobility causes the blood flow to slow down and thus the blood's willingness to clot is increased. The aim is to increase the blood flow, especially increase the blood flow back to the heart.
The immobility concerns e.g.
- Wheelchair users,
- People after an operation,
- People with broken bones,
- People with (chronic) pain etc.
The earlier the mobilization begins, the more likely the risk of a thrombosis lowered. The mobilization stimulates the circulation and activates the muscle pump. For the muscle pump to work properly, they must Venous valves be intact. The veins are, v.a. embedded in the extremities between muscles. With a muscle contraction, the muscle shortens and thickens and thus compresses the vein together. With intact venous valves, the blood can only go in one direction, namely back to the Heart, stream.
Another simple measure to promote the venous return flow is positioning.
Has a patient e.g. strict bed rest, the legs can e.g. be stored high with a pillow. An angle of around 20 ° is recommended. This is a simple and usually well accepted measure. The return flow can be increased by 20-30% due to gravity. Even with states like Fractures or Paralysis an elevated position makes sense. This doesn't just affect them legsbut also the arms.
Elevation may not be carried out if there is a disease that hinders the blood flow (e.g. arterial occlusive disease).
Stroking the veins
Stroking the veins supports the other measures. The leg is raised slightly and a second person, e.g. Caregiver, physiotherapist, etc., applying light pressure starting from the heel in the direction of hip crossed out.
Varicose veins are a contraindication.
The measures must be carried out several times a day.
There are three options for vein compression:
- Anti-thrombosis stockings
- Compression stockings
- Compression bandages with elastic bandages
In venous compression therapy, the pressure in the periphery, i.e. on the foot, must be higher than proximal (towards the thigh), because the blood should not be compressed, but the flow should be promoted.
After performing a vein compression, it is important to control your blood flow. If "tingling sensations" or pain occur, a doctor must be consulted who will check the blood circulation in the legs.
In addition, the type and pressure of venous compression must be selected so that an adequate blood supply is guaranteed.
Vein compression is often perceived as uncomfortable and requires a high willingness to cooperate (compliance).
A vein compression must not be used with existing
- arterial disease (AVK),
- decompensated heart failure
- extremely inflamed veins (septic phlebitis)
The antithrombosis stockings (ATS or MTS) are mainly used clinically for postoperative thrombosis prophylaxis. They belong to compression class 1 and exert a pressure of around 20 mmHg.
It is also important to choose the right size. To do this, the leg length and the thickest parts of the thigh and calf are measured. The stockings are put on when the veins are blocked. That means, immediately after the legs have been lying down for at least half an hour. The stockings must be worn for 24 hours and should be changed at least every 2 - 3 days.
Like the ATS, compression stockings must be prescribed by a doctor and should be worn for a long time. You will mainly be at
- Varicose veins (Varices),
- Ulcus cruris (skin ulcers on the lower leg in chronic venous insufficiency),
- Thrombosis or post-thrombotic syndrome
Depending on the compression class, the pressure increases from approx. 25 mmHg at level 2 to over 49 mmHg at level 4.
Compression bandings are available as an alternative to the ATS. Depending on the indication, the leg is wrapped from bottom to top with bandages. Short-stretch bandages and long-stretch bandages are available. The various wrapping techniques require specialist knowledge and should only be carried out by experts.
For more information, see: Compression bandage
Backflow promoting gymnastics
Active or passive carried out gymnastics additionally supports the venous return flow. There are a number of different exercises available that are easy to do in bed.
The aim is again to activate the muscle pump and thus the flow rate of the Blood to increase. These measures must be carried out several times a day and with self-motivation (independently).
For example, gymnastic exercises such as:
- "Cycling in bed"
- Circling your feet
- Press the soles of the feet against the lower end of the bed with parallel tension of the calf muscles
- Pull up the kneecap (use the thigh muscles).