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[Venous thromboembolism in connection with physical restraint]
E Hem1, S Opjordsmoen, P M Sandset
1Avdeling for akuttpsykiatri Klinikk for psykiatri, Ullevål sykehus, Oslo.
Summary
Physical restraint in psychiatric care may increase the risk of deep venous thrombosis and pulmonary embolism. This case highlights the potential physical side-effects of immobilisation, urging caution and further research.
Area of Science:
- Psychiatry
- Vascular Medicine
- Clinical Case Study
Background:
- Physical restraint and seclusion are used in psychiatric settings to manage agitation and prevent harm.
- While effective in acute situations, these interventions carry potential physical and psychological risks.
- Venous thromboembolism (VTE) is a significant concern, particularly with prolonged immobility.
Observation:
- A 29-year-old male with paranoid schizophrenia experienced an exacerbation requiring admission and physical restraint.
- Seven days post-restraint, the patient was diagnosed with deep venous thrombosis (DVT) and pulmonary embolism (PE).
- No significant hematological risk factors for VTE were identified, apart from borderline PAI-1 and hyperlipidemia.
Findings:
- This report is the first to suggest a potential association between physical restraint and VTE in a psychiatric patient.
- Immobilisation due to restraint is a recognized risk factor for thrombophlebitis.
- The case underscores the need to consider VTE risk in patients undergoing physical restraint.
Implications:
- Psychiatric wards should increase vigilance for VTE in patients subjected to physical restraint.
- Further research is necessary to elucidate the direct link between physical restraint and thrombosis.
- Prophylactic VTE treatment is not yet recommended solely based on restraint use, pending more evidence.