The Rollin' RN's

Blood Clot Awareness Month


Being in traffic, gum in your hair, that single piece of popcorn kernel lodged in your teeth. All are examples of things that get stuck. However, blood platelets are the one thing in your life that you really don’t want to add to this list. March is Blood Clot Awareness Month and time for a review. Anyone, including the Rollin RNs, can be prone to this issue at one time or another, so here is some background, treatment, and prevention regarding blood clots.


The main role of blood clotting is to stop you from bleeding. These clots are made of platelets, proteins, and cells in the blood that stick together. When you get injured, a clot forms to stop the bleeding. Normally, after the bleeding stops and the injury heals, the body breaks down and removes the clot. But when clots don't break down as they should, they can become dangerous and may create opportunities for further damage to the body.


Types of clots:


Thrombosis: These blood clots are stationary and are capable of blocking blood flow. A Deep Vein Thrombosis (DVT) is a blood clot in a deep vein, usually in the lower leg, thigh, or pelvis. This type of clot can create a blockage in a vein and lead to damage to the leg. DVT signs and symptoms can include pain in your leg. The pain often starts in your calf and can feel like cramping or soreness. Since many of us with a spinal cord injury (SCI) don’t feel pain, it’s important to look for these other signs and symptoms while doing your daily skin assessment.


  • Swelling in the affected leg. Rarely, there's swelling in both legs. (And not to be confused with dependent edema caused by sitting for long periods.)

  • Red or discolored skin on the leg.

  • A feeling of warmth on the skin of the affected leg.


DVTs are dangerous because they can occur with or without noticeable symptoms. If you develop signs or symptoms of a DVT, it’s important that you DO NOT MASSAGE YOUR EXTREMITY!!! Massaging may dislodge the clot. Instead, contact your doctor immediately.



Embolism: These are blood clots that break loose. Emboli are dangerous because they can travel to other parts of the body. A Pulmonary Embolism (PE) can happen when a DVT breaks off and travels through the bloodstream to the lungs. It can damage your lungs and prevent your other organs from getting enough oxygen. PE symptoms can vary greatly, depending on how much of your lung is involved, the size of the clots, and whether you have underlying lung or heart disease.


Common signs and symptoms of a PE:

  • Shortness of breath. This symptom typically appears suddenly and always gets worse with exertion.

  • Chest pain. You may feel like you're having a heart attack. The pain is often sharp and felt when you breathe in deeply, often stopping you from being able to take a deep breath. It can also be felt when you cough, bend or stoop.

  • Cough. The cough may produce bloody or blood-streaked sputum.

Other signs and symptoms that can occur with a PE include:

  • Rapid or irregular heartbeat

  • Lightheadedness or dizziness

  • Excessive sweating

  • Fever

  • Leg pain or swelling, or both, usually in the calf caused by a deep vein thrombosis

  • Clammy or discolored skin (cyanosis)

PEs can be life-threatening. Seek urgent medical attention immediately if you experience unexplained shortness of breath, chest pain, or a cough that produces bloody sputum.

Your health care provider may use many tools to diagnose blood clots:

  • A physical exam

  • A medical history

  • Blood tests.

  • Imaging tests, such as Ultrasound, CT Scan or X-rays of the veins (venography) or blood vessels (angiography) that are taken using an injection of a dye that shows up on the x-ray and allows the provider to see how the blood flows.


Treatments for blood clots depend on location and severity and may include:

  • Blood thinners are the most common medications used to treat DVT. They prevent the blood from clotting.

  • Other medicines, including thrombolytics, which dissolve blood clots.

  • Inferior vena cava (IVC) filter. Your doctor may insert a small, cone-shaped filter inside your inferior vena cava if blood thinner medication doesn’t work. The filter will capture a large clot before it reaches your lungs.

  • Surgery to remove the blood clots

  • Compression Stockings: These special socks are very tight at the ankle and get looser as they reach your knee. This pressure prevents blood from pooling in your veins.


Other factors that increase your risk of developing a blood clot:


  • Obesity

  • Pregnancy

  • Smoking

  • Oral contraceptives

  • Trauma

  • Certain surgeries

  • Age (increased risk for people over age 60)

  • Covid 19

  • Chronic inflammatory diseases

  • Diabetes

  • High blood pressure

  • High cholesterol

  • Cancer and cancer treatments

  • Family history of blood clots

  • Staying in one position for a long time, such as being in the hospital or taking a long car or plane ride

  • Atrial Fibrillation

  • Prior central line placement

Certain risk factors, such as obesity, slow the flow of blood in the veins, while others, such as age, can increase the body's natural ability to clot. Even certain medications can affect how quickly your blood clots.


Tips to aid in the prevention of blood clots:

  • Avoid sitting for long periods. This statement speaks for itself but what about those of us with limited mobility in our lower extremities? We still require movement in the legs to promote circulation. Livestrong had these stretching suggestions that would do the job: If you can sit with your ankle on your knee, you can adequately stretch your ankle by pulling your foot up and then down. You can stretch your hamstrings by straightening your knee, placing your foot on your couch or coffee table, and leaning forward. Stretches should be held 15 to 30 seconds on each side for 3 to 5 repetitions daily.These are all good ideas with the goal being to move your extremities every few hours to keep blood and circulation flowing. If you cannot move your extremities yourself, have a friend assist you.

  • Move. After you've had surgery or been on bed rest, the sooner you get up and move around, the better.

  • When traveling. Drink plenty of fluids. Dehydration can contribute to the development of blood clots. Get up and move around. If you travel by airplane, walk the aisle periodically. For long car trips, stop and walk around frequently. For those of us that cannot get up to move, try out the stretches suggested above.

  • Change your lifestyle. Lose weight, lower high blood pressure, stop smoking and exercise regularly.

  • Wear support stockings (compression stockings). Your doctor may recommend these to help promote circulation and fluid movement in your legs.

  • Blood thinners. Some people at high risk may need to take blood thinners to prevent blood clots.


In summary, it’s important to be aware of the signs and symptoms of a blood clot when your mobility is decreased, and here’s why. Walking, running, exercising; whatever we did before our SCI, moved the blood from our lower extremities back up to our heart to be cleaned and then circulated back throughout our body. Since we are unable to move our lower extremities as we once did, the blood can pool there and as it sits, the blood becomes like a sludge allowing tiny clots to form. More blood then attaches to these clots creating a DVT deep in the vein (most commonly in the leg.) If this clot dislodges it can travel to your lungs causing a PE which is a medical emergency. Blood clots are among the most preventable types of blood conditions. It’s important to do your part such as controlling your risk factors. If you think you may be at risk because of genetic or behavioral factors, talk with your health care provider. Also, make sure your doctor is aware of all the medications you are taking and any family history of blood clotting disorders.



Thanks to March for reminding all of us to be mindful of the formation of blood clots and how to avoid those nasty creatures.


It’s all good, so keep on moving your body,

The Rollin’ RNs ™

Roberta Palmer, RN and Patty Kunze, BSN, RNC



References:

https://www.webmd.com/dvt/blood-clots

https://www.webmd.com/dvt/types-of-blood-clots

https://medlineplus.gov/bloodclots.html

https://www.mayoclinic.org/symptoms/blood-clots/basics/definition/SYM-20050850?p=1

https://www.livestrong.com/article/536991-leg-circulation-exercises-while-sitting/


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