Lower Limb Immobilisation and Blood Clot Prevention

Lower Limb Immobilisation and Blood Clot Prevention

When the lower leg is put into a splint, plaster cast or similar it can increase the risk of a blood clot, often called a deep vein thrombosis (DVT) or pulmonary embolism (PE). All patients who require immobilisation of their lower leg due to injury are required to undergo risk assessment for potential blood clots. If you have been assessed to be at increased risk of a blood clot during the time you require immobilisation you will receive medication to help prevent this. In addition to medications there are things you can do to reduce your risk of blood clots further and these are recommended for all patients irrespective risk.

What else can I do to reduce the risk of developing a blood clot?
It is difficult to predict who will get a blood clot, and whilst medication may help there are steps that can be taken to try and reduce this risk further:

• Drink plenty of fluids.
• Mobilise as much as is comfortable.
• Stop smoking (if you smoke) – this will also help your bone to heal.
• Perform the exercises described below (perform 3 times per day).

Exercises for reducing the risk of DVT in lower limb casts whilst you have to wear a cast, any activity which promotes contraction of muscles and increased blood flow is helpful.

For any cast on the legs
Wiggle your toes while lying in bed or whilst sat up with your leg elevated. Try and do this for at least 10 seconds, and as often as you can. This promotes blood flow and can help reduce the risk of blood clotting. Inside the plaster cast, if it is safe to do so, try and move your ankle up and down. It will not move very much as the cast will stop it. Repeat 10 times.

For below knee casts only
Regularly bend your knee. Sit down on a chair, bend your knee and then straighten your knee. Repeat ten times.

Lie on your tummy on the bed and bend your knee, bringing your heel towards your bottom. Slowly lower your foot back down to the bed, keeping the movement slow and controlled.

Lie on the bed or sitting up with your leg elevated. Keep your leg straight and brace your knee down by tightening the muscles on the front of your thigh.

How will I know if I have a DVT or PE?

When you have a DVT the blood flow in the vein is partially or completely blocked depending on the width of the clot. A calf vein is the common site for a DVT. A thigh vein is less commonly affected. Rarely, other deep veins in the body form clots.

The affected area of the blood clot may become swollen or painful, and possibly turn red or feel hot to touch as the flow of the blood is blocked. You may also develop swelling, which is the build-up of fluid in the skin tissues surrounding the clot. If the clot is somewhere other than in your leg, there may be no physical signs of DVT.

Sometimes bits of the clot can break up and lodge in the lungs causing a Pulmonary Embolism (PE) causing chest pain, difficulties with breathing, and coughing up blood streaked sputum. It may also cause sudden collapse.

Sometimes a DVT occurs for no apparent reason, and it becomes more common with age. Each year one in every 1,000 people in the UK is affected by DVT.

If you develop any of the signs or symptoms mentioned in this leaflet, please seek medical attention. Should you develop severe shortness of breath, chest pain or sudden collapse you or the person you are with should dial 999 for an ambulance, should you experience leg pain, swelling, redness, or warmth of your leg you should contact your GP or NHS111.

Where can I find out more?

Please ask your doctor or nurse for more information. Alternatively, the NHS Choices website provides patient information on blood clots: www.nhs.uk

Patient Experience
We know that being admitted to hospital can be a difficult and unsettling time for you and your loved ones. If you have any questions or concerns, please do speak with a member of staff on the ward or in the relevant department who will do their best to answer your questions and reassure you.

Feedback
Feedback is really important and useful to us – it can tell us where we are working well and where improvements can be made. There are lots of ways you can share your experience with us including completing our Friends and Family Test – cards are available and can be posted on all wards, departments and clinics at our hospitals. We value your comments and feedback and thank you for taking the time to share this with us.

Patient Advice and Liaison Service (PALS)
If you have any concerns or questions about your care, we advise you to talk with the nurse in charge or the department manager in the first instance as they are best placed to answer any questions or resolve concerns quickly. If the relevant member of staff is unable to help resolve your concern, you can contact the PALS Team. We offer informal help, advice or support about any aspect of hospital services & experiences.

Our PALS team will liaise with the various departments in our hospitals on your behalf, if you feel unable to do so, to resolve your problems and where appropriate refer to outside help.

If you are still unhappy you can contact the Complaints Department, who can investigate your concerns. You can make a complaint orally, electronically or in writing and we can advise and guide you through the complaints procedure.

How to contact PALS:
Telephone Patient Services: 0300 123 1732 or via email at: wah-tr.PALS@nhs.net
Opening times:
The PALS telephone lines are open Monday to Friday from 8.30am to 4.00pm. Please be aware that you may need to leave a voicemail message, but we aim to return your call within one working day.
If you are unable to understand this leaflet, please communicate with a member of staff.

For additional medical advice, if your symptoms or condition worsens:
Contact your GP
NHS 111: Telephone 111
Get help with your symptoms, NHS111: https://111.nhs.uk/
Information to help you manage your health: www.nhs.uk
In an emergency telephone 999

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