What is DVT [Homans Sign] Diagnosis and Nursing Interventions

by

Do you ever experience pain and soreness in your calves after long periods of sitting or standing? Many people don’t realize it, but this could indicate a serious condition called deep vein thrombosis (DVT). One test that can help diagnose DVT is a Homans sign. In this blog post, we will explore the Homans Sign, how to test for it, and why it’s essential for recognizing signs of DVT. Please read to learn more about the Homans Sign and its role in diagnosing health concerns.

What does the Homans Sign Indicates?

The Homans sign is a physical examination tool for diagnosing deep vein thrombosis (DVT). It involves pressing on the calf muscle to check for tenderness. If pressure on the calf causes pain, it could indicate DVT.

Positive Homan’s Sign

Positive Homans’ sign is a medical term that describes a physical indicator that can signal a potential blood clot in the leg. It involves pain in the calf area when the foot is flexed upwards towards the knee, with the knee itself straightened. While this symptom can sometimes be associated with other conditions, such as muscle strain or injury, taking this sign seriously and seeking medical attention immediately is essential. Being aware of Positive Homans’ signs and taking prompt action could help prevent a blood clot from becoming a more serious health complication.

Deep Vein Thrombosis (DVT) Nursing Diagnosis, Treatment & Prevention

What is deep vein thrombosis (DVT)?

DVT is a blood clot in one of the deep veins of your body. It usually occurs in the legs, but it can also occur in other parts of your body. DVT can cause pain and swelling and make it difficult to move or walk. If left untreated, DVT could lead to more severe complications such as pulmonary embolism (PE), a potentially fatal condition.

Symptoms of DVT (deep vein thrombosis)

Symptoms of DVT depend on where the clot is located and its size. Some common symptoms include:

  • Pain (throbbing pain in 1 leg (rarely both legs), usually in the calf or thigh, when walking or standing up)
  • Tenderness or swelling (1 leg (rarely both legs) in the affected area
  • Redness or discoloration of the skin
  • Warmth in the affected area – usually more noticeable when compared to other locations on that side of the body
  • A feeling of heaviness or fatigue in the affected area
  • swollen veins that are hard or sore when you touch them

Who is more likely to get DVT (deep vein thrombosis)

Anyone can be at risk of developing a DVT, but specific individuals are more likely to experience it. These include

  • pregnant women
  • take the contraceptive pill or HRT
  • have cancer or heart failure
  • have varicose veins
  • people over the age of 60 and
  • people with an existing medical condition that affects the circulation in their legs (such as diabetes, heart failure, or cancer).
  • are overweight
  • smoke
  • have had DVT before

Causes and Risk Factors

A blood clot causes DVT. The clot blocks a vein, preventing trusted Source blood from adequately circulating in your body.

Various factors can cause or raise the likelihood of developing a DVT. They include:

  • Injury: Narrowing or blockage of blood flow can occur when a blood vessel’s wall is damaged, potentially leading to the building of a blood clot.
  • Immobility: Sitting or lying down for prolonged periods can slow blood flow in your veins, leading to clots.
  • Family history: Your relatives who have had DVT may push you more likely to get it.
  • Medical conditions: Certain conditions, such as cancer or heart failure, can lead to clotting abnormalities.
  • Surgery: Invasive procedures may cause trauma to a vein. This enhances the risk of developing a DVT.
  • Smoking: This is concerned with a higher risk of DVT.
  • Pregnancy: Hormones released during pregnancy can increase your risk. Additionally, pressure from the growing baby may block some veins in your legs and pelvis.
  • Hereditary blood clotting disorders: A clotting disease makes you more susceptible to DVT.
  • Medication: Some medications used to treat medical conditions can also raise your risk of developing a DVT.
  • Trauma: Trauma to a blood vessel, such as during an accident or fall, can lead to a DVT.
  • Obesity. Carrying overweight can increase the strain on your legs and pelvis veins.
  • Catheter: The likelihood of a blood clot forming can increase when a catheter is inserted into a vein.

What is the Method of DVT Nursing Diagnosis?

 D-Dimer blood test: Doctors use various methods to diagnose deep vein thrombosis (DVT), including the D-Dimer blood test. This test measures a substance released when a blood clot breaks down, indicating the presence of a clot. It’s a quick and straightforward procedure that involves taking a small blood sample and analyzing it in a lab. While the test can detect DVT, it is only sometimes accurate and may also show positive results for other conditions. Therefore, doctors often combine the D-Dimer blood test with other imaging tests like an ultrasound for a more definitive diagnosis of DVT.

Venography: Venography involves injecting a special dye into the veins and then taking X-rays to look for blockages. The procedure can be painful and involves risks, such as infection or allergic reactions to the dye. Therefore, it’s usually reserved for cases where other imaging tests (such as ultrasound) don’t give enough information about a possible DVT.

Doppler ultrasound: Doppler ultrasound is a non-invasive imaging test that uses sound waves to detect blockages or changes in blood flow. It’s a painless procedure requiring no injections or incisions, making it one of the most common methods for diagnosing DVT. During the process, a technician will probe the affected area and use sound waves to create a detailed image of your veins. The photos can help to identify any blood clots that are present in the affected vein.

CT Scan or MRI: These tests use powerful magnets and computers to create detailed images of the body. They can be used to detect clots.

Treatment for DVT (deep vein thrombosis): Surgical & Nonsurgical

Nonsurgical Treatment

Anticoagulants. The primary action for treating DVT without surgery is administering anticoagulants—drugs that reduce blood’s ability to clot and aid in dissolving existing clots. Anticoagulant medications are typically administered as soon as the clot has been identified.

Anticoagulants can be dangerous if taken in too high a dose, as they may lead to bleeding complications. To ensure that the medication is appropriate, your physician may require regular blood tests to calculate how long it takes for your blood to clot. The medication level in your system mustn’t be too high, as this may cause abnormal bleeding; however, it needs to be at a level that is sufficient enough to stop clotting. Your doctor will closely monitor your anticoagulant use in the hospital or at home.

The most common anticoagulants used to treat DVT are Xa inhibitors, heparin, low molecular weight heparin (LMWH), and warfarin (Coumadin).

Xa inhibitors.

These drugs, such as rivaroxaban (Xarelto), apixaban (Eliquis), and edoxaban (Savaysa), work by blocking a specific enzyme in the body that is responsible for blood clotting. They are taken orally, and there is no need to monitor their levels in the blood.

Heparin and low molecular weight heparin (LMWH).

These drugs work by using proteins to prevent the clotting of blood and are administered intravenously or subcutaneously, depending on the type of medication used. The advantage of this type of anticoagulant is that they’re fast-acting but must be monitored closely and adjusted depending on the patient’s condition.

What you need to know about heparin:

  • Heparin is often given as a subcutaneous injection or a continuous infusion.
  • It’s essential to monitor the patient’s prothrombin time (PTT) afterward and look for signs of bleeding.
  • Suppose the patient recently had a lumbar puncture or has an epidural catheter. Heparin should not be given in that case as it may cause an epidural hematoma, leading to paralysis.
  • Keep an eye on the patient’s platelet levels, too – if they are low, check with a doctor whether the heparin is still necessary.
  • The reversal for heparin is protamine sulfate, administered intravenously.
  • Fibrinolytics such as alteplase dissolve the clot and can be delivered via a peripheral IV or central line or through a catheter placed directly at the clot site.
Warfarin (Coumadin).

This is a more traditional anticoagulant that is taken orally. Warfarin blocks vitamin K in the blood, preventing clotting. The dosage must be regularly monitored with blood tests to ensure it is correct, as too much of this medication can cause bleeding problems.

What you need to know about warfarin: 

  • It takes many days for blood levels to become therapeutic.
  • It must be monitored closely and adjusted according to the patient’s condition.
  • The dosage may need to be changed if you experience side effects such as bleeding or bruising.
  • It may take several days for warfarin levels to become therapeutically effective.
  • The patient’s INR (International Normalized Ratio) will be tested regularly; a normal INR is 1.0, but with warfarin treatment, it should be higher – typically between 2.0-3.0 or 2.5-3.0. When the INR is within this range, it’s considered therapeutic due to the intentional elevation of the levels.
  • To keep warfarin levels consistent, patients should maintain a steady consumption of leafy greens – as Vitamin K can reverse its effects. It is not true that spinach salads are entirely off-limits; instead, the patient should strive to have the same amount daily.
  • Should reversal become necessary, Vitamin K can be administered intravenously, as well as clotting factors found in fresh frozen plasma (FFP), prothrombin complex concentrates (PCCs), and recombinant activated factor VII (rFVIIa).
Surgical Treatment 

If a clot is large and causes significant symptoms such as swelling or pain, surgery may be recommended to remove or prevent further clots from forming. This may involve making an incision in the leg and manually removing the clot or placing a filter in the vein to catch any clots that may develop.

Prevention

To reduce your risk of developing DVT, it’s essential to make lifestyle changes if necessary and follow your doctor’s instructions for managing existing medical conditions.

  • Exercise: Regular exercise can help to improve circulation in the legs and reduce your risk of developing a DVT.
  • Maintain a Healthy Weight: Being overweight increases the pressure on veins in your legs, so maintaining a healthy weight helps reduce the risk of DVT.
  • Quit Smoking: Smoking increases your risk by making blood thicker and more likely to clot.
  • Stay Hydrated: Staying hydrated helps keep your blood thin, reducing your risk of DVT.
  • Wear Compression Stockings: Compression stockings pressure the leg veins and help improve circulation. This can help reduce your risk of DVT.
  • Avoid Sitting for Long Periods: Prolonged sitting reduces blood flow in the legs, so taking regular breaks and moving around throughout the day is essential.
  • Talk to Your Doctor: If you are at high risk for developing a DVT due to medical conditions or lifestyle factors, talk to your doctor about ways to lower that risk. They may recommend medications such as anticoagulants to prevent blood clots.

Preventing DVT can be essential to overall health and well-being, so taking steps to reduce your risk is necessary if you are at a higher-than-average risk of developing a clot. Consulting with your doctor is the best way to ensure you take all the required precautions.

Complications

A significant complication of DVT is a pulmonary embolism. A pulmonary embolism may occur if a blood clot travels to the lungs and obstructs a blood vessel.

If you experience symptoms of a pulmonary embolism, such as damage to your lungs or other parts of your body, seek prompt medical attention. These signs include:

  • rapid breathing
  • coughing up blood
  • rapid heart rate
  • dizziness
  • sweating
  • chest pain that gets worse with coughing or inhaling deeply

References

  • https://en.wikipedia.org/wiki/Homans_sign
  • https://www.mayoclinic.org/diseases-conditions/deep-vein-thrombosis/symptoms-causes/syc-20352557
  • https://www.nhs.uk/conditions/deep-vein-thrombosis-dvt/