Emergency and Urgent Care - Risk of Blood Clots in Lower Limb Immobilisation

Introduction

You have been provided with this leaflet as you have had your lower limb immobilised either in a plaster cast or walking boot/ splint.

This leaflet is to provide you with information and make you aware of the risk of blood clots that are linked with lower limb immobilisation, signs and symptoms, where to seek help and steps you can take to reduce to risk of developing a blood clot.

What is a blood clot and why am I at risk?

A blood clot, also known as Venous Thromboembolism (VTE) can be a complication associated with having your leg immobilised in a plaster cast or walking boot/splint. Clots usually occur deeper within the veins; these types of clots are commonly known as deep vein thrombosis (DVT).

You are at higher risk of developing a DVT when you have a plaster cast or walking boot/splint on as your normal range of movement will be limited. This could cause the blood flow in your legs to be reduced which could lead to the formation of a clot.

In rare cases parts of this clot can break off and relocate itself in your lungs. This is known as a pulmonary embolism or PE.

You will have a thorough risk assessment completed by your clinician before you leave the department. If your risk level is deemed to be lower, you will be given this advice leaflet and be expected to follow the advice to reduce your risk of developing blood clots.

If your risk level is deemed to be higher, you will be given some medication as well as this leaflet. The medication helps to reduce the formation of clots.

You will be advised on how to use the medication and how long for by your clinician before discharge. You must still follow the instructions below on how to reduce your risk of developing clots along with the medication.

What can I do to reduce my risk of developing a DVT?

There are several steps you can take at home to reduce your risk of developing a DVT. These include:

• Keeping hydrated with clear fluids such as water
• Maintain a healthy life style, including a healthy weight, diet and blood pressure
• Stop smoking (if you smoke)
• Mobilise as much as possible
• Perform exercises described below daily. The exercises promote contraction of the muscles and increase blood flow to the leg

Exercises for above knee plaster cast

• Ensure to keep your leg elevated on a bed, sofa or stool for periods through the day. Whilst the leg is elevated wiggle your toes for at least 10 seconds. Do this as often as possible throughout the day
• Keep as mobile as possible using crutches provided. DO NOT weight bear on the cast

Exercises for below knee casts

Follow the exercise stated for above knee casts. In addition to this it is important to regular bend and straighten at the knee joint during the day. This can be done in a seated position or a lying position.

• To do the exercises in a seated positon, start by sitting comfortable on a chair. Lift your leg by straightening at the knee joint as far as comfortable. Then bend the knee back to a 90 degree angle and place your foot on the floor. Movement should be slow and controlled throughout. This should be repeated ten times at regular intervals throughout the day
• To do the exercises in a lying position, start by lying on your stomach on a bed. Bend your knee as far as possible so your heel is touching your buttocks. Then straighten your knee to return it to this starting position. Movement should be slow and controlled throughout. This should be repeated ten times at regular intervals throughout the day

Exercises for a walking boot/splint

Walking boots are removable and should be removed when resting unless advised otherwise by your clinician. It is important to elevate your leg when resting to reduce swelling and encourage blood flow to the leg.

You can weight bear on the injured leg when the boot is in situ and it is important to do this as the contraction of the muscles in your leg will encourage blood flow and therefore reduce your risk of DVT.

You should also complete the exercises outlined in the above and below knee cast sections at regular intervals throughout the day.

Signs and symptoms of a DVT/PE

Signs of a DVT

• Throbbing or cramping pain in one leg, usually in the calf or thigh
• Swelling to one leg
• Discolouration around the painful area
• Warm skin around the painful area

Signs of a PE:

• Pain in chest or back
• Difficulty in breathing
• Coughing up blood

If you develop any of these signs or symptoms you must return to the Urgent Treatment Centre or your local A&E as soon as possible.

You can contact the Urgent Treatment Centre on 01706 517023 or contact NHS 111 for more advice.