Respiratory physiotherapy in patients with Cystic Fibrosis and upper
limb deep vein thrombosis
We report physiotherapy management of two patients with severe cystic
fibrosis (CF) lung disease and upper limb deep vein thrombosis (DVT).
These patients were admitted due to a pulmonary exacerbation. Following
peripherally inserted central catheters they were diagnosed with an
upper limb DVT. Due to their underlying lung disease, physiotherapy was
mandatory for improvement. However, the DVT and anticoagulation
treatment raised concerns for pulmonary emboli and hemoptysis. A
framework for physiotherapy management in these patients, using a set of
precautions and restrictions to maintain airway clearance while
minimizing risk for pulmonary emboli and hemoptysis, was established.
Using these set of instructions, the patients experienced no major
adverse event while maintaining sufficient airway clearance to allow
respiratory improvement. These precautions were continued until the
upper limb DVTs resolved. To our knowledge there are currently no
guidelines nor expert opinions available. Therefore, this framework can
help guide physiotherapy management.