Potential DVT?

[Stiga9]

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I have a pt who is post-op ankle fusion 4 months ago. His MD wanted him in a boot and no exercises for 4 months. He comes in today with a physical therapy order and states his MD is ready for him to begin increasing ROM/strengthening/modalities, etc as stated on the script.

His ankle and calf is red and pretty warm, painful, as well as swollen. Homan's is positive (even though we know it's not such a good test anyway). He states his doctor told him that "is normal for him". He states he never received an ultrasound or anything to rule-out DVT so I told him to go ahead and set up an appointment to get one ASAP in which will most likely be next week .

In the mean time & before we find out the results, should I avoid ice pack? In orthopaedics we see a warm/swollen joint and we immediately think ice pack, but this is the first time I had this situation with a potential DVT. Thoughts?

 

[Azimuthal]

Four months out though? Anticoagulants? (might be off warfarin, etc. x4 weeks by that time) Was there skin grafts involved with the fusion? He wasn't given a home SCD unit throughout that time? Did you assess for venous back flow? Without seeing the patient, I'd say you made the correct choice in red flagging the case. I would have contacted the physician to discuss my concerns and document accordingly.

 

[Fiveoboy11]

I have questions.

Why was this patient referred 4 mo after surgery? Was the fusion hardware removed?

I would say that the physician is very likely on top of the possibility of a DVT. If the person is anticoagulated and have a IVC filter then who cares. Does he? Vast majority of people with DVT's are WBAT once anticoagulated. Do the wells clinical prediction rule for DVT and PE. Check his HR/SpO2. Tell him to monitor himself for inappropriate SOB, etc. If this individual still has a fused ankle he's going to always have increased risk of DVT on that side. If he's still fused consider recommending high top shoes or boots for footwear to reduce strain on the hardware and probably reduce pain. Oh yea, and don't do "ROM/stretching" of the ankle if it's fused.

Homan's is worthless. Ice pack is only going to temporarily alleviate some pain and swelling and I don't know why it couldn't be done.

 

[jdaniels360]

Try wells CPR for DVT...