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Peripheral Thrombolysis

AMBULATORY CARE:

What you need to know about peripheral thrombolysis:

Peripheral thrombolysis is a procedure to break up or dissolve a blood clot in your arm or leg. The clot may be removed with a device during the procedure. You may need thrombolysis to remove a clot quickly so it does not break free. You may need the procedure to remove a blood clot from deep veins, called deep vein thrombosis (DVT). A DVT usually happens in a leg, but it can also happen in an arm. A DVT can also break free. A clot that breaks off in your arm or leg may travel to your lungs. This can be life-threatening.

Deep Venous Thrombosis (DVT)

How to prepare for the procedure:

Your healthcare provider will tell you how to prepare for your procedure. He may tell you not to eat or drink anything after midnight on the day of your procedure. He will tell you what medicines to take or not take on the day of your procedure. You may be given contrast liquid before or during the procedure to help your healthcare provider see the clot better. Tell your healthcare provider if you have ever had an allergic reaction to contrast liquid. You may also be given antibiotics to prevent an infection caused by bacteria.

What will happen during the procedure:

  • You will be given local anesthesia to numb the procedure site. Your healthcare provider may choose a vein or artery in your leg, arm, groin, or elbow. With local anesthesia, you may still feel pressure or pushing, but you should not feel any pain. Your healthcare provider will inject medicine into your IV that will help dissolve or break up the clot. It is most often given into a vein, but it may be given into an artery. A catheter is guided by x-ray so it is near the blood clot.
  • Your heart rate and blood pressure will be monitored. Healthcare providers may also frequently check your neurological (neuro) status. Your neuro status is checked to see how well your brain is working. Healthcare providers may check your eyes, your memory, and your hand grasp.

What will happen after the procedure:

Healthcare providers will apply pressure on the procedure site to stop any bleeding. You will be monitored closely for any problems. Do not get out of bed until your healthcare provider says it is okay. You will then be able to go home or be taken to your hospital room.

  • The catheter may be left in place if the medicine needs to continue to break up the clot. You will need to stay in the hospital if the catheter is left in place. Your healthcare provider will need to do the thrombolysis again to remove the rest of the clot.
    • You will be told not to move the leg or arm used for the procedure while the catheter is in place. You will need to lie still. Tell your healthcare provider if lying flat starts to cause back discomfort. If there is no bleeding, he may help you roll onto your side.
    • You must use a bedpan or a urinal until you are able to get out of bed and go to the bathroom. If you are unable to use a bedpan or urinal, a Foley catheter may be placed in your bladder. This catheter allows urine to drain from your bladder into a collection bag.
  • You may need to wear pressure stockings or inflatable boots if your procedure was for a leg clot. The stockings are tight and put pressure on your legs. The boots have an air pump that tightens and loosens different areas of the boots. Both of these improve blood flow and help prevent clots. You may need to continue wearing pressure stockings after you leave the hospital. Your healthcare provider will tell you when to start wearing the stockings and how long to wear them each day.

  • You will need to walk around the same day of your procedure, or the day after. Movement will help prevent blood clots. You may also be given exercises to do in bed. Do not get out of bed on your own until your healthcare provider says you can. Ask before you get up the first time. You may need help to stand up safely. When you are able to get up on your own, sit or lie down right away if you feel weak or dizzy. Then press the call button to let someone know you need help.
  • Medicines:
    • Anticoagulants are a type of blood thinner medicine that helps prevent clots. Anticoagulants may cause you to bleed or bruise more easily.
    • Antiplatelets help prevent blood clots. This medicine makes it more likely for you to bleed or bruise.

Risks of peripheral thrombolysis:

Thrombolysis increases your risk for bleeding. You may have increased nosebleeds or bleeding from your gums. You may also have bleeding in your stomach or brain. Bleeding can become severe and life-threatening. You may have an allergic reaction to the contrast liquid or to the medicine used to break up the clot.

Call 911 for any of the following:

  • You feel lightheaded, short of breath, and have chest pain.
  • You cough up blood.

Seek care immediately if:

  • Your arm or leg feels warm, tender, and painful. It may look swollen and red.
  • Your wound does not stop bleeding even after you apply firm pressure for 10 minutes.
  • The leg or arm used for your procedure is numb, painful, or changes color.
  • The bruise at your catheter site gets bigger or becomes swollen.
  • You have purple spots or blisters on your skin.

Contact your healthcare provider if:

  • You have a fever.
  • You have a new skin rash and itching.
  • You feel weak, lightheaded, or faint.
  • You have new swelling around your eyes.
  • You have questions or concerns about your condition or care.

Medicines:

  • Antiplatelets , such as aspirin, help prevent blood clots. Take your antiplatelet medicine exactly as directed. These medicines make it more likely for you to bleed or bruise. If you are told to take aspirin, do not take acetaminophen or ibuprofen instead.
  • Blood thinners help prevent blood clots. Examples of blood thinners include heparin and warfarin. Clots can cause strokes, heart attacks, and death. The following are general safety guidelines to follow while you are taking a blood thinner:
    • Watch for bleeding and bruising while you take blood thinners. Watch for bleeding from your gums or nose. Watch for blood in your urine and bowel movements. Use a soft washcloth on your skin, and a soft toothbrush to brush your teeth. This can keep your skin and gums from bleeding. If you shave, use an electric shaver. Do not play contact sports.
    • Tell your dentist and other healthcare providers that you take anticoagulants. Wear a bracelet or necklace that says you take this medicine.
    • Do not start or stop any medicines unless your healthcare provider tells you to. Many medicines cannot be used with blood thinners.
    • Tell your healthcare provider right away if you forget to take the medicine, or if you take too much.
    • Warfarin is a blood thinner that you may need to take. The following are things you should be aware of if you take warfarin.
      • Foods and medicines can affect the amount of warfarin in your blood. Do not make major changes to your diet while you take warfarin. Warfarin works best when you eat about the same amount of vitamin K every day. Vitamin K is found in green leafy vegetables and certain other foods. Ask for more information about what to eat when you are taking warfarin.
      • You will need to see your healthcare provider for follow-up visits when you are on warfarin. You will need regular blood tests. These tests are used to decide how much medicine you need.
  • Take your medicine as directed. Call your healthcare provider if you think your medicine is not helping or if you have side effects. Tell him if you are allergic to any medicine. Keep a list of the medicines, vitamins, and herbs you take. Include the amounts, and when and why you take them. Bring the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency.

Follow up with your healthcare provider as directed:

You may need to be checked for blood clots for up to 3 years after treatment. Write down your questions so you remember to ask them during your visits.

Wound care:

Keep your wound clean and dry. Ask your healthcare provider when you can bathe. You will need to keep the bandage in place and dry for a day or two after your procedure. Cover the bandage with a plastic bag and tape the opening around your skin to keep water out. When you are allowed to bathe without a bandage, carefully wash the wound with soap and water. Check the wound daily for signs of infection, such as redness, swelling, or pus. Dry the area and put on new, clean bandages as directed. Change your bandage if it gets wet or dirty.

Watch for bleeding and bruising:

It is normal to have a bruise and soreness where the catheter went in. Contact your healthcare provider if your bruise gets larger. If your wound bleeds, use your hand to put pressure on the bandage. If you do not have a bandage, use a clean cloth to put pressure over and just above the puncture site. Seek care immediately if the bleeding does not stop within 10 minutes.

Wear pressure stockings as directed:

Pressure stockings are used after treatment for a clot in the leg. The stockings help keep blood from pooling in your leg veins. Your healthcare provider can prescribe stockings that are right for you. Do not buy over-the-counter pressure stockings unless your healthcare provider says it is okay. They may not fit correctly or may have elastic that cuts off your circulation. Ask your healthcare provider when to start wearing pressure stockings after your procedure and how long to wear them each day. You may need to wear the stockings every day for up to 2 years.


Keep your leg or arm elevated as directed:

Keep the leg or arm that had the blood clot above the level of your heart when you are sitting. Prop the arm or leg on pillows to keep it elevated comfortably. Ask how long to keep your leg elevated each day. You will need to balance elevation with movement to prevent blood clots.

Prevent another blood clot:

  • Do not smoke. Nicotine and other chemicals in cigarettes and cigars can cause blood vessel and lung damage. Ask your healthcare provider for information if you currently smoke and need help to quit. E-cigarettes or smokeless tobacco still contain nicotine. Talk to your healthcare provider before you use these products.
  • Limit alcohol. Do not drink alcohol for 24 hours after your procedure. Then limit alcohol. Women should limit alcohol to 1 drink a day. Men should limit alcohol to 2 drinks a day. A drink of alcohol is 12 ounces of beer, 5 ounces of wine, or 1½ ounces of liquor.
  • Stay active. Your healthcare provider will tell you when it is safe to drive and start doing your other normal daily activities. Go slowly at first. Then increase your activity. An active lifestyle can help prevent blood clots. Try to get at least 30 minutes of activity on most days of the week. If you sit most of the day for work, stand or walk around every half hour. After a future injury or illness, try to become active again as soon as possible. Activity can also help you manage your weight. Overweight or obesity can put pressure on your leg veins and cause blood to pool. This increases your risk for another blood clot.
  • Manage other health conditions. Follow your healthcare provider's directions to manage health conditions that can cause a blood clot. Examples are high cholesterol and diabetes.
  • Drink liquids as directed. Liquids will help flush out the contrast material used during your procedure. Liquid can also help prevent blood clots. Ask your healthcare provider how much liquid to drink each day and which liquids are best for you.

© 2015 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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