09.05 Postpartum Thrombophlebitis

Overview

  1. Thrombophlebitis is inflammation of the vessel caused by a clot

Nursing Points

General

  1. Postpartum patients are at an increased risk due to the increase of clotting factors during this time
  2. Early ambulation after delivery is an important preventative measure

Assessment

  1. Diminished pulses
  2. Unequal swelling/edema
  3. Pain/tenderness
  4. Skin discoloration
  5. Monitor for Embolus
    1. Pulmonary Embolism
    2. Stroke
    3. Myocardial Infarction

Therapeutic Management

  1. Early Ambulation!
  2. Doppler studies if detected
  3. Maintain bedrest/restrict activity as ordered
  4. Watch closely for PE
  5. Heat packs may relieve some pain
  6. IV heparin may be ordered

Nursing Concepts

  1. Clotting
  2. Perfusion
  3. Patient Education

Patient Education

  1. Avoid massaging the area, restrictive clothing, crossing legs, prolonged sitting or standing
  2. Educate about discharge meds (anticoagulants) and follow-up appts
  3. Get up and walk around every hour
  4. Do NOT go on long car rides or plane rides within 4 weeks of delivery without discussing with your provider!

Reference Links

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Video Transcript

In this lesson I will explain thrombophlebitis in the postpartum patient and your role in providing care.

So what are we talking about with thrombophlebitis? It is inflammation of the vessel caused by a blood clot. Now our pregnant patients are more at risk. So let’s talk about why. So remember learning about how when you are pregnant you have more clotting factors, right? Well those clotting factors are super helpful because a big wound forms when the placenta detaches and we need to clot super fast so we don’t bleed too much. SO that is all great until now. So the patient is at an increased risk because they have extra clotting factors. You can see in this ultrasound image that the vessel has a big blood clot in it.
When we assess our patient that has a blood clot there are some different findings depending on where the clot is located. Ee might notice diminished pulses, nequal swelling and edema, pain and tenderness at the site and skin discoloration. This patient will need to be monitored for embolus. So this could be a pulmonary embolism or cause a stroke or MI. So many different additional symptoms if it advances. You can see on this patient how there is discoloration and more swelling on the right leg from a clot.
Education is going to be really important. The patient must avoid massaging the area, wearing restrictive clothing, crossing legs, or prolonged sitting or standing. We do not want to move the blood clot or cause more to form. If she is receiving medications at discharge she will need education on taking them and follow up appointments to make sure dosage is right and it is helping. The patient needs education on walking frequently so that she isn’t sitting too long. And she should avoid long car rides or planes for a while and be cleared by the doctor for this because this will increase the risk of a clot forming.
Our concepts are clotting and perfusion because we have a clot and perfusion problem. Patient Education is also important to ensure ambulation happens for prevention or activity restriction if a blood clot forms.
Alright so what is important to know? First it is inflammation in a vessel from a blood clot. Postpartum patients are more at risk for thrombophlebitis because of their increased clotting factors. Early ambulation is very important and the patient should never massage the area or wear restrictive clothing. Embolism symptoms are important to know and watch for. So things like shortness of breath, cough, dizzy, or fainting. Treatment will typically include anticoagulants.

Make sure you check out the resources attached to this lesson and review the items to avoid for prevention of embolism. Now, go out and be your best selves today. And, as always, happy nursing.

Read more

  • Question 1 of 9

Your patient has a history of DVT’s. She delivered her baby earlier today and you are caring for her during this postpartum period. Which of the following interventions is the priority in thrombophlebitis prevention at this time?

  • Question 2 of 9

Which best explains the increased risk of blood clots during the postpartum period?

  • Question 3 of 9

A nurse is caring for a postpartum client that delivered 2 hours ago. The client says “I need to get up and walk so I don’t get a clot like last time!”. Based on this information, what order should the nurse recommend to the provider?

  • Question 4 of 9

Your patient has a suspected DVT in one leg, what symptoms would lead you to believe this? Select all that apply.

  • Question 5 of 9

A nurse is planning care for a postpartum client with the goal of preventing the development of a DVT. Which of the following should be included? Select all that apply.

  • Question 6 of 9

A nurse is educating expectant mothers on the reason for their increased risk for blood clots. Which explanation by the nurse is the most appropriate?

  • Question 7 of 9

A nurse is caring for a postpartum client with a DVT. Which of the following should be included in discharge teaching?

  • Question 8 of 9

Your patient has a history of DVT’s. She delivered her baby earlier today and you are caring for her during this postpartum period. During your assessment, you noticed her right posterior tibial and dorsalis pedis pulses are diminished. Which of the following interventions would NOT be appropriate at this time? Select all that apply.

  • Question 9 of 9

A 36-year-old postpartum client is at increased risk of deep vein thrombosis based on her age and a history of a previous DVT. Which of the following nursing interventions is most appropriate to prevent DVT in this client?

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