Guest guest Posted November 14, 2003 Report Share Posted November 14, 2003 Is the DVT chronic? The patient probably has a greenfield IVC filter. If this is the case, it's OK to ambulate and provide ROM. If it's an acute DVT, the patient probably has been placed on blood thinners (normally Heparin or Coumadin). If this is the case, the patient should be ambulated and provided ROM treatment only after therapeutic levels are reached. Check with the patient's nurse regarding the therapeutic levels. Hope this helps... Jamil Abdallah, MBA, PT Director, Rehab Services Kindred Chicago Lakeshore Hospital > Hi everybody, > > Would like to know protocol and/or policy departments are following regarding ambulation with patients with DVT. We have a physician ordering ambulation and ROM immediately. I did a literature research and find that it may varies from 4 hours to 72 hours. > > Thank you for your help. > > > Brigitte Fontaine OTR/L, MSHSA > Director of Rehabilitation Services > Alice Hyde Medical Center > Malone, New York > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 16, 2003 Report Share Posted November 16, 2003 Brigitte, what database/literature did you use for this " 4-72 hours " duration prior to ambulation? We are also reviewing our clinical practice guideline with regards to this topic. Definitely our practice for suspected and newly-found DVT is to get clearance from MD. But dilemma comes when we feel an MD (who is neither an orthopedist or vascular surgeon) orders mobilization " too early " . Pending evidence, right now, we go by the advice of our " expert orthopedist " which I think makes sense. Wait until " acute clinical inflammatory signs and symptoms " are gone- redness, pain, and hotness of the affected extremity. Typically (base on clinical experience) this occurs at the average, 3 days post-anticoagulation. Please post whatever you can find out about this topic... I'm also anxious to come up with an evidence-based clinical guideline. Earnest Escobar, PT Bethesda Memorial Hospital Boynton Beach FL --------------- In a message dated 11/16/2003 7:03:58 AM Eastern Standard Time, PTManager writes: Ambulation and DVT >Date: Thu, 13 Nov 2003 17:59:42 -0800 > >Hi everybody, > >Would like to know protocol and/or policy departments are following >regarding ambulation with patients with DVT. We have a physician ordering >ambulation and ROM immediately. I did a literature research and find that >it may varies from 4 hours to 72 hours. > >Thank you for your help. > > >Brigitte Fontaine OTR/L, MSHSA >Director of Rehabilitation Services >Alice Hyde Medical Center >Malone, New York Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 18, 2003 Report Share Posted November 18, 2003 We have had this issue come up several times. There is an article from advance for directors from 2002 called " The Silent Killer " that addressed DVT and Rehab. It was written by Friedman, MD. He is an orthopedic surgeon and professor at the Medical University of South Carolina and a member of the Council for Leadership On Thrombosis Awareness and Management. He writes as part of the article, " Physical Therapy doesn't cause DVT or PE. Should DVT occur, don't change your course of therapy with the patient. Continue with the exercise regimen and incorporate additional exercises into the therapy. " Some of the other research I have done also supports this although is appears contrary to what most seem to have been taught or believe. If you have a good releationship with either a local cardiologist or vascular surgeon they may also give you guidance on this issue. Good Luck in resolving the issue at your facility. Tim Pedersen MS, PT Director of Rehabilitation Clifton Rehabilitation > Hi everybody, > > Would like to know protocol and/or policy departments are following regarding ambulation with patients with DVT. We have a physician ordering ambulation and ROM immediately. I did a literature research and find that it may varies from 4 hours to 72 hours. > > Thank you for your help. > > > Brigitte Fontaine OTR/L, MSHSA > Director of Rehabilitation Services > Alice Hyde Medical Center > Malone, New York > > > Quote Link to comment Share on other sites More sharing options...
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