title: [Self-active physical thrombosis prophylaxis in the patients' bed with the Phlebostep: acceptance and measurement of venous blood flow in immobilized patients].
abstract: BACKGROUND
  Despite the broad use of low molecular weight heparin, deep vein thrombosis is still a relevant risk for immobilized patients in orthopedic surgery. Patients can reduce this risk by active training exercises with a muscle pump. The aim of this study was to test the acceptance and effect of a self-developed training device to accelerate venous return as well as a technical optimization. The device was installed for in-patients in orthopedic and traumatology departments.
  
  
  METHODS
  A simple pillow-like device was developed, which can be positioned against the foot end of the patient's bed (Phlebostep). The device gives a sound-based feedback to the patient while pushing actively against it with complete ankle flexion. A digital integrated counter device allows direct feedback to the physician and nursing staff at any time. Initial testing including duplex sonography for venous flow measurements were done on 10 orthopedic in-patients. Prior testing on 7 healthy volunteers was carried out to define the effect of various amounts of pressure on the Phlebostep on the venous blood flow. Additionally, a questionnaire on the general acceptance and user-friendliness was filled out by 84 patients who had used the Phlebostep.
  
  
  RESULTS
  The optimal pressure force was defined as 35 mmHg for further measurements. The venous flow measurements in the 10 postoperative patients revealed an increased venous blood flow in the affected leg by an average of 99.9%. Analysis of the questionnaire from the 84 patients showed a high degree of acceptance.
  
  
  CONCLUSIONS
  In addition to the technical feasibility, this study showed that use of the Phlebostep resulted on average in a doubling of venous return. The increase of venous flow offers an additional effective device for thrombosis prophylaxis through patient's own active movements and is clearly superior to the use of devices such as antithrombosis stockings alone. The Phlebostep found a high degree of acceptance with the patients.
authors.affiliation: St Josefs-Hospital, Klinik für Orthopädie, Unfall- und Handchirurgie, Krankenhausstr 13, Cloppenburg, Germany. l.olivier@kh-clp.de
authors.forename: L C
authors.initials: LC
authors.lastname: Olivier
authors.forename: D
authors.initials: D
authors.lastname: Ostovan
authors.forename: W
authors.initials: W
authors.lastname: Heywinkel
authors.forename: D
authors.initials: D
authors.lastname: Kendoff
authors.forename: U
authors.initials: U
authors.lastname: Wolfhard
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004867:Equipment Design; D005260:Female; D006801:Humans; D048228:Intermittent Pneumatic Compression Devices; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures; D017060:Patient Satisfaction; D026741:Physical Therapy Modalities / Q000295:instrumentation*; D011183:Postoperative Complications / Q000517:prevention & control*; D012648:Self Care; D013813:Therapy, Computer-Assisted / Q000295:instrumentation*; D020246:Venous Thrombosis / Q000517:prevention & control*