I've never personally dealt with thrombi, although I have taken preventative measures every day to reduce my patient's chances of developing DVT (deep vein thrombosis.) It can be dangerous, the clotting spreading like crystals forming, then break loose and wind up in a large vessel - causing a limb to die, or stuck in the heart, lungs or brain, with far worse consequences. Surgery increases the risk, partly through the immobility during the procedure, after the vessel opening (vasal dilation) from the anesthetic drugs during induction. Most of the time, it's a highly treatable condition, if painful.
So, I make sure people have TED, or compression stockings on, or SCD (sequential compression device) boots on. Air filled pressure boots that mimic the accessory pumping of blood back from the extremities (legs) usually done by big ole leg muscles. The tubed sleeves puff up, then empty, repeatedly over the course of surgery, and are often left on and hooked up, until the patient is up and walking. Not unpleasant short term, I'm told they are very irritating over days. The machines that kept the cycles going used to be very touchy, they've gotten better. I've seen consumer models for sale in airline catalogues.
"I've got some squeezy boots to put on you, they are to help keep the circulation good in your legs." Part of my patter, along with "I have a seatbelt for you, because whenever you go on a trip..." and "Please keep your arms and legs inside the ride at all times and enjoy your stay..." The last for the gurney journey through doorways and halls.
I've put those tough, tight stockings on unconscious people right after total knee replacements, which is work. Having a hole in the toe (for access to assess circulation) means that the little plastic bag they come in can slide over the toes (the hardest bit) and the stocking can bunch up there without sticking. An old nurse trick, taught to me by an old nurse.
Sometimes, when I am talking to ICU nurses, I think I've forgotten so much of what I learned in school, I can barely consider myself a real nurse. I don't know meds or lab results for crap, wouldn't have a clue how to deal with an arterial line, aside from assisting the anesthesiologist. Then I get their questions about a particular surgery that their patients have been through, and I know it clear, through and through, and I figure, well, ok, then.
I remember what I understand and do.
Happy to translate, anytime. It's what I do.
Labels: science, surgery, work