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Warm and Red — Assess for DVT

  Submitted by: Marcia Buchs on January 12, 2018
  HomeGrown Solution Number: 292
Identification of the Problem
The use of tactile senses in patient assessment is a vital skill for nursing students to learn and practice during their nursing education. Most manikins that offer opportunities for use of the student’s tactile sense offers pulses where students can sense pressure. Most manikins in use in sim labs do not have the capability to develop sustained warm areas on their skin. Because assessment for DVT in a bed patient is often done while the patient is in the supine position and the visual clues for a common lower leg DVT occur on the posterior aspect of the calf, creating a solution that allowed the student to use their tactile sense to assess for warmth and edema was a priority in our DVT scenario.
Unique Idea
The solution was to create a 6x4 inch red oval pocket out of high nap material and insert a disposable hand warmer. The hand warmers stay warm for about 7 hours so are good for a whole day of simulation. Once the warmer is activated and in the pocket, the pocket is can be placed between the fabric “skin” and foam of edema leggings. The nappy material keeps it in place. This creates a slightly elevated (swollen) area on the back of the calf that is noticeably warmer if touched. If the fabric “skin” is transparent at all, the red colored fabric also allows for the look of discoloration if the student views the area. The pocket could also be easily used under a nylon stocking placed on the patient’s leg if only localized, not diffuse pedal edema is desired along with the warmth.
Objectives
1. Provide opportunities for students to use tactile assessment skills specifically for Deep Vein Thrombosis. 2. Students will identify heat, redness and edema on the back of the calf of a standardized patient/manikin and initiate appropriate nursing interventions.
Supplies/Ingredients
1. 1/4 yard (or scraps) of high nap red material such as corduroy, velvet or fleece
2. Red thread (I used white for contrast in my pictures)
3. Ruler/tape measure
4. Paper to make pattern
5. Scissors
6. Sewing machine
7. Disposable hand warmers found in the outdoor section of sport good or agricultural stores – approximately $5/10 pair
Steps to Creating the Solution
1. Make a paper pattern of a 4x6 inch oval.
2. Cut out two ovals from the material.
3. At the top of each of the ovals separately, using a wide, tightly spaced stitch, zig zag approximately 3 inches of the edge.
4. Place the wrong sides of the two ovals together. Using the wide zigzag stitch, sew the two ovals together starting where the stitching in the previous step started and sew all the way around to where it ended, leaving the opening at the top.
5. Activate the hand warmer (by removing from the package and exposing to the air) and insert into the pocket.
6. Place the pocket between the fabric "skin" and foam of an edema legging or under a nylon stocking on the leg of a standardized patient or manikin.