1. By Dave Christensen

2. “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.

3. 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..

4. 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

5. Risk Factors 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.

6. Signs and Symptoms of Thrombophlebitis Superficial veins may be hard, swollen, and the person may have a fever. Warmth, tenderness, fever and pain in the affected area. Redness and swelling.

7. 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

8. Emergency Treatment of Thrombophlebitis Should the Clot Dislodge

9. 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

10. 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.

11. 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

12. 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 2- 10mg, 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

13. 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.

14. 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.

15. Hospital Treatment for Thrombophlebitis

16. 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.

17. 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.

18. 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

19. 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

20. 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

21. 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.

22. 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. 5) Pulmonary Embolism. Online. May 17, 2008 Bibliography continued

23. 6) Deep Vein Thrombosis. Online. May 1, 2006 7) Thrombophlebitis. Online. Unknown date. 8) Thrombophlebitis. Britannica Online Encyclopedia. May 2008. 9) Thrombophlebitis. Online. May, 24, 2006 10) Thrombophlebitis. Wikipedia Online. April 19, 2004 Bibliography continued Bibliography Continued

24. 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