Prophylaxis of deep venous thrombosis by ambulation in bed

Prophylaxis of deep venous thrombosis by ambulation in bed
  • These drawings demonstrate the author’s method for ambulating patients who must remain in bed longer than 24 hours postoperatively. Note that the bed is placed in slight reverse Trendelenburg position with the head higher than the feet. This is accomplished, if necessary, with blocks under the bedposts at the head of the bed. In most of the modern, electrically controlled hospital beds it can be done easily. The patient is also allowed a low to medium head rest. In this way the legs are made dependent. An overhead beam or Balkan frame is attached by uprights to the head and the foot of the bed. A trapeze hangs from this within reach of the patient’s hands so that he can use it to help move himself about and to raise his body up and exercise his arms. At the foot of the bed is a right-angled footboard made of an aluminum alloy that is placed under the end of the mattress with the vertical portion extending 30 cm. above it. This serves two functions: One is that the bed coverings are placed over it, which prevents the bed from being made up with them tucked too tightly under the mattress, thereby providing the patient with freedom to move his legs and feet, an important factor in the prevention of deep venous thrombosis. The other function is for the performance of the foot and leg exercises.
  • This demonstrates the patient pushing against the footboard with the balls of his feet, keeping the knees in extension as if he were rising on his tiptoes by con­tracting the calf and anterior thigh muscles.
  • After maintaining this position for a few seconds, the patient relaxes his muscles and allows his heels to return to the footboard as in the inset.

He is instructed to perform this exercise at least one thousand times a day, spread­ing them out over his waking hours rather than trying to do them in a short period of time. The actual number is not so important, but this number gives him a high goal to work for and impresses on him the importance of the exercises. It is explained to him carefully just why these exercises are important, namely, to prevent “blood clots.” The purpose of this type of exercise is to put into action the venous heart of the lower extremities to make the blood circulate and to prevent it from stagnating and clotting in the deep veins of the gastrocnemius, soleus and flexor muscles of the lower leg by pumping blood out of them toward the heart.

The method is also advocated for patients who are slow to return to normal ambulation, even though they are permitted out of bed. The exercises also have the great advantage that they are active and not passive, so the patient can do them by himself without bedside help from nurses or other hospital personnel. The slight reverse Trendelenburg position of the bed is maintained because it is believed better to keep the veins full of blood rather than empty, thereby avoiding intimal damage that might occur in the collapsed state, especially in the phlebo – sclerotic veins of the elderly. The slant of the bed tends to cause the patient to slide down, and pushing on the board and pulling on the trapeze to keep himself up provides additional exercise. Another advantage of this method of prophylaxis for the patient who must remain in bed is that the exercises keep his muscles in better condition so that when he does get up, walking is more easily accomplished. When possible, it is recommended that the patient be instructed in these exercises, simple as they seem, prior to operation. There can be no question in anybody’s mind that anything that can be done to prevent deep venous thrombosis and pul­monary emboli is of extreme importance and far better than attempting to treat the condition after it develops, and this method of bed ambulation has been found to be very successful.

Prophylaxis of deep venous thrombosis by ambulation in bed



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