Thrombophlebitis And The Client with Cancer
By Morag Currin
A thrombus is a blood clot, and phlebitis is the inflammation of a vein, so thrombophlebitis is the inflammation of a vein due to a blood clot.
Two types of thrombophlebitis can occur:
- Superficial thrombophlebitis is when the condition occurs in the veins just under the surface of the skin, and it usually occurs in the legs, but it affects veins in other parts of the body in 10–20% of cases.
- Deep vein thrombosis (DVT) is when thrombophlebitis develops in a deep vein and it occurs most often in the lower leg, thigh, or pelvis, but sometimes it may occur in the arm.
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Some cancers such as pancreatic, stomach, brain, lungs, uterus, ovaries, kidney cancers as well as blood and lymph cancers are a greater risk for a blood clot.
The higher the cancer stage, the greater the risk for a blood clot. Staging cancer is determined by the location of the cancer in the body, the size, how far it has grown into nearby tissues, and if it has spread to nearby lymph nodes or other parts of the body.
Blood clots affect 900,000 people in the United States each year. 1 in 5 blood clots are related to cancer and its treatment.
Type of cancer treatment that can increase a person’s blood clot risk are treatments involve hospitalization, surgery, chemotherapy, hormonal therapy, and catheters (small tubes placed in veins to administer various treatments).
The risk of a dangerous blood clot is greatest in the first few months after a cancer diagnosis, the time when treatment generally occurs.
Besides cancer and cancer treatment, there are other risk factors for thrombophlebitis.
- Previous blood clot
- Family history of blood clots or inherited clotting disorder
- Hospitalization for illness or major surgery, particularly of the pelvis, abdomen, hip, or knee
- Broken bone or severe muscle injury
- Severe physical trauma, such as a motor vehicle accident
- Serious medical conditions, such as heart and lung diseases, or diabetes
- Sitting too long, such as traveling for more than 4 hours, especially with legs crossed
Immobility, such as extended bed rest or sedentary lifestyle, being obese and overweight, and smoking are added risk factors.
Among people with cancer, survival rates are lower for people who also have blood clots.
Treatment for thrombophlebitis depends on the severity and whether the condition occurs in the surface veins or deep veins.
5 Modifications For Spa Services
- Elevate the client’s affected leg – position the leg above heart level as this will help to reduce the swelling.
- Apply warm compresses to the affected area and cover with plastic wrap (stop moisture dripping over linen, mylar spa wrap (to keep heat in).
- Massage is contraindicated for a client presenting with DVT as it can dislodge a clot and cause a pulmonary embolism —which can lead to heart attack or stroke.
- No deep massage should be done if a client is at risk or has a blood clot, but if they have a history of past blood clots, and everything is under control, there is no reason why they cannot have massage. It is important that massage strokes, particularly on extremities (arms and legs) should always be toward the heart to assist venous return. Many spa professionals use strokes that go “back and forth” – they seem to have missed the importance of direction of strokes or they are ignoring this critical bit of information about physiology.
- Encourage the client to walk regularly to maintain and improve the strength of their circulatory system and to help prevent future blood clots. Walking may also help the client to lose weight or to maintain an ideal weight, but more importantly the calf (soleus) muscles are a considered a secondary heart. When a person walks, the calf muscles pump venous blood back toward their heart. The veins in calf muscles act like a reservoir for blood that the body does not need in circulation at any given time.
- Encourage your client who has just had surgery to get up and move as soon as possible. With increased mobility, their risk of DVT will go down.
- Intermittent pneumatic compression (IPC) devices such as FLOWPresso are used to help prevent blood clots in the deep veins of the legs. The devices use cuffs around the legs that fill with air and squeeze the legs. This increases blood flow through the veins of the legs and helps prevent blood clots.
Please note that the client may be wearing compression or elastic stockings which helps decrease swelling, or they may be taking medications to reduce pain or inflammation such as a nonsteroidal anti-inflammatory drug, such as ibuprofen (Motrin).
Sometimes, the client with deep vein thrombosis or more serious cases of superficial thrombophlebitis may involve anticoagulants. These are blood-thinning drugs that can help dissolve existing clots and help prevent further clots from forming. It is good for spa professionals to have some familiarity of commonly prescribed drugs, or at the least engage in a conversation with the client about their drugs.
Xa inhibitors such as rivaroxaban (Xarelto) which bind to the clotting factor Xa, which plays a critical role in the clotting process.
Standard Heparin (Hep-Lock) and enoxaparin (Lovenox) both decrease the clotting ability of the blood.
Warfarin (Coumadin) blocks substances necessary for clotting. It usually follows heparin therapy, and a person takes it over 3–6 months. Warfarin needs to be carefully monitored to ensure the dose is high enough to protect against clots but low enough to avoid excessive bleeding.
Deep vein thrombosis or more serious cases of superficial thrombophlebitis may require the administration of thrombolytics such as anistreplace (Eminase) which are clot-dissolving medications used if person has an extremely high risk of developing a pulmonary embolism.
Some people can have surgery if anti-coagulants do not work. A vena cava filter, a small device can be inserted into the main vein of the heart to filter clots before they reach the lungs.
Be Vigilant With Clients During Spa Services
Many spa services include touching the client so irrespective of what service we are providing we need to be vigilant in recognizing any unusual symptoms mostly in the lower quadrants of the body but to be aware these symptoms can occur in other parts of the body. The following are symptoms and causes of superficial thrombophlebitis and deep vein thrombosis.
H3 5 Symptoms of superficial thrombophlebitis include:
- Tenderness, redness, and slight swelling along part of a vein.
- Other veins in the area appear blue.
- Swelling in veins in the ankle, foot, and just above the knee.
- darkened skin if the condition has been present for a time and swelling has disappeared.
- hardened or knobby feel to a vein
In many cases, a deep vein thrombosis develops without symptoms, so it is difficult to diagnose, however, symptoms may occur in the leg containing the clot. They include:
- red or discolored skin
- pain or tenderness
- distended, or swollen veins
- a firmness to a vein, which is called a cord
Sometimes a pulmonary embolism may be the first indication of deep vein thrombosis and the symptoms can include coughing, shortness of breath, sudden chest pain or vomiting blood.