China Library Classification. R473.6 Document identification number A1672-3783 (2012) 08-0236-01Deep venous thrombosis refers to abnormal coagulation of blood in deep veins, which belongs to venous reflux disorder of lower limbs. The pathogenic factors are slow blood flow, vein wall injury and hypercoagulability. It is more common in the following groups: (1) People who have been braked and bedridden for a long time are prone to deep vein thrombosis. For example, patients who stay in bed for a long time after surgery will cause slow blood flow and increased blood viscosity, leading to thrombosis. (2) Thrombosis is easy to occur after vein wall injury, such as intravenous infusion of irritant drugs. Injury and infection can cause vein wall injury, and the damaged blood vessel wall is conducive to the formation of coagulation factors and thrombosis. (3) Hypercoagulability of blood is prone to venous thrombosis, and deep venous thrombosis of lower limbs can occur in any part of deep veins of lower limbs. There are two common types in clinic: calf muscle vein thrombosis and iliofemoral vein thrombosis. The former is located at the tip and is called the peripheral type; The latter is located in the center and is called the central type. Whether peripheral or central, it can spread anterograde or expand retrograde, involving the whole limb, which is called mixed type.

Clinical data of 1

From June 2007 to June 2007, there were 65,438 cases, 54 cases of deep vein catheterization and 5 cases of deep vein thrombosis, including PICC catheterization 1 case, and the rest were femoral vein catheterization. After active treatment, they all recovered.

2 Clinical manifestations

The most common is sudden swelling and local pain of one limb, which is aggravated when walking. The lighter person only feels heavy when standing, and the symptoms are aggravated when standing. Physical examination has the following characteristics. (1) swelling of the affected limb: accurately measure the development degree of swelling with a tape measure every day and compare it with the thickness of the healthy lower limb. (2) Tenderness: Tenderness often occurs in venous thrombosis. (3) Superficial varicose veins: Deep vein occlusion can increase the pressure of superficial veins, and superficial varicose veins can be seen after 1 ~ 2 weeks. If there is sudden severe pain, the affected limb is widely and obviously swollen, the skin is tense and shiny, cyanosis may occur, blisters may appear, the skin temperature is obviously reduced, the fluctuation of the posterior tibial and dorsal arteries disappears, and the systemic reaction is obvious. Most of the body temperature exceeds 39℃, and limb venous gangrene and shock often occur, which becomes bruises.

3 nursing

3. 1 bed holder

Early bed rest is very important. And raise the affected limb, the limb position is 20 ~ 30cm higher than the heart level, and at the same time, the knee joint slightly flexes 15 [1] to avoid compression at the popliteal fossa and move the ankle joint. Massage is forbidden to avoid blood clots falling off. People in shock should adopt shock posture and keep the environment quiet to avoid adverse stimulation. Encourage patients to get out of bed gradually after acute phase, but avoid strenuous activity.

3.2 Nursing care of patients with limb local intravenous infusion

Intravenous drip of drugs was used in the affected limb to make the drugs directly reach the thrombus site and increase the local drug concentration. Because of the swelling of the affected limb and unclear vein exposure, skilled technical operation is required, and the success rate of venipuncture is high, so as to avoid damaging blood vessels, the No.5 puncture needle is selected.

3.3 medication observation

3.3. 1 urokinase

When thrombolysis is performed, the doctor's advice should be accurately and timely, and aseptic operation should be strictly carried out. The dosage must be accurate and used in the process of use, so as not to reduce the titer. The application of infusion pump makes the liquid medicine enter the body accurately and evenly, which is conducive to maintaining the effective blood concentration [2], closely observing the changes of the disease, and making relevant examinations and records at any time.

heparin

Anticoagulant is the first choice, and the dosage can be adjusted according to prothrombin time, which is often used for subcutaneous deep fat injection of abdominal wall.

3.4 Psychological nursing

In clinical work, we found that most of these patients have varying degrees of mental stress, fear, depression or irritability. We take different nursing measures for patients collected by different medical education networks.

3.4. 1 Nursing care of patients with nervousness and fear

As the saying goes, "a good word warms three winters, and a bad word hurts people in June." We should take the initiative to care about the patient's condition changes, eliminate ideological pressure, and establish confidence in overcoming the disease.

3.5 Nursing care of complications

3.5. 1 bleeding

It is the most common complication of deep venous thrombosis of lower limbs. In the process of treatment and nursing, closely observe the changes of vital signs, whether there is a tendency of local bleeding, oozing blood and systemic bleeding. Strictly follow the doctor's advice and the dosage is accurate. Check coagulation time, urine routine and fecal occult blood test regularly, and accurately record prothrombin time. In this group, 2 cases had gingival bleeding when brushing their teeth 48 hours after the first thrombolytic therapy. After 72 hours, 1 patient had bleeding at the previous puncture point after tourniquet was put on the infusion; After the fifth day, 1 patient had bloody stool. Nurses found and reported to doctors in time, which avoided the occurrence of massive bleeding and alleviated the pain of patients. Press for 5min minutes after blood collection or intravenous injection.

pulmonary embolism

It is the most serious complication of deep venous thrombosis of lower limbs. In clinical nursing, we should attach great importance to patients with cough, chest tightness, chest pain, cyanosis of mouth and lips, expectoration with blood. In addition to closely observing the patient's condition changes, we should also inform the doctor in time.

3.6 diet and life guidance

Give a digestible diet with low fat, high protein and high vitamins, and those with heart failure should be given a low-salt diet. Nurses should assist patients to urinate and defecate in bed, keep the stool unobstructed, and prevent thrombus from falling off and aggravating heart load or heart failure.

4 discussion

In the daily nursing work, the author comes into contact with some children with deep vein thrombosis. After several years of accumulation, the author summed up the following experiences: (1) Measure the circumference of the affected limb accurately with a tape measure in each shift and compare it with the healthy side. (2) If one limb is found to be thicker than the other, or there is discomfort such as pain, CT examination should be done immediately. (3) Strengthen the psychological care of children, keep their emotional stability, and make them accept treatment optimistically and actively. (4) Patients with deep venous catheterization of lower limbs should properly move their lower limbs to prevent thrombosis. (5) Micro-pump nursing, ensuring good performance of micro-pump and strict aseptic operation.

refer to

[1] Wang Chunhua; Nursing experience of deep venous thrombosis of lower limbs [a]; Selected papers of the National Symposium on Peripheral Vascular Diseases of Integrated Traditional Chinese and Western Medicine [c]; 200 1

[2] Liu Xuehua; Health education for patients with deep venous thrombosis of lower limbs during hospitalization [a]; Compilation of papers from the national academic exchange and special lecture conference on internal medicine nursing [c]; In 2002

[3] Jiang; Nursing care of limb ischemia in arteriosclerosis obliterans [J]; Journal of medical forum; Issue 9, 2005

[4] Guo Yun; Progress in prevention, treatment and nursing care of lower extremity deep venous thrombosis [J]; Huaxia medicine; 2002 05 issue

[5] Zheng; Prevention and nursing progress of deep venous thrombosis of lower limbs [J] China Journal of Orthopaedics; July 2004 issue