How many patients elect to have the "umbrella filter?"

JLaskowicz · 01-23-2002, 08:46 PM

Hi this is Jan again. First, I want to thank everyone for their time and thoughtfulness in replying to my questions. We are so appreciative of this forum to help us through this difficult time.

This is my 4th post regarding questions we have for my stepson, Todd, and his C5 SCI he incurred 2 weeks ago.

My husband, Jim, wanted me to post a question about the umbrella filter. He wants to know if most SCI patients decide to have the umbrella filter surgically implanted. Jim tells me this filter's purpose is to protect against blood clots flowing to the heart. Todd elected NOT to have this protection. Has anyone else done the same? If so, do you feel this was a good decision? Have you had any blood clot problems in your legs? I believe Jim is concerned if this was the correct decision. Any feedback positive or negative would be helpful to him.

Jim says Todd seems to be doing better and has been able to do breathing on his own today. He is still assisted with the ventilator if he should need it. He still has a feeding tube. He says he is very hungry ... a good sign. He seems to be getting stronger. They are going to sit him more upright tomorrow. Jim plans on finding out if Todd can distinguish hot from cold with his sensory feelings under his injury. I will keep you posted. Thank you to the individual who recommended that Todd have shoes on part of each day. My husband, went out today and got him a pair of high top shoes and Todd had them on for several hours. The nurse said that was a good idea, but they never told Jim to do this. This is why all your comments and suggestions are so helpful to us --- you all are our lifeline. Thank you so much.

Jan

rtr · 01-23-2002, 09:58 PM

I have a filter. About a year ago, I had a serious blood clot. Because of the filter, the clot stayed in my leg. These sites have more information.

This PDF file has a lot of information about the filters.
web page

This website has information about deep vein thrombosis (DVT)

web page

Wise Young · 01-24-2002, 03:03 AM

JLaskowicz,

The umbrella filter is intended to prevent pulmonary emboli (clots going to the lung) rather than clots to the heart. People with spinal cord injury are at a relatively high risk for such emboli. If it occurs, it damages the lung.

Not all people with spinal cord injury get an umbrella filter but the fact that Todd's doctors are recommending it suggests that they are worried about the possibility. The procedure for implanting the filter does not require open surgery. The filter is inserted with a catheter through a vein in the leg. Your stepson should ask his doctors whether they recommend this for every one of their patients. His decision should not be based on fear of the procedure.

Perhaps one of our SCI-Nurses can comment on the policies at their institutions but I don't think that a Greenfield umbrella is recommended for all people with spinal cord injury. The incidence of pulmonary emboli varies from institution to institution, depending in part on other practices that they have, including the use of anticoagulation, active air boots, and nursing care.

Wise.

Joe B · 01-24-2002, 04:55 AM

I did not have the filter but the staff did put me in these active air leggings. They are filled by a small air pump and have passages in them that alternately flex to provide pressure to different parts of the leg. I believe the idea is to force the blood to circulate even though your stepson isn't moving his legs. You could ask about the leggings rather than the filter.

Todd doesn't sound like he has additional problems like poor circulation. You said he was active, does not smoke, was not diabetic,had normal blood pressure and circulation before the injury. He should be prepared for orthostatic hypotension when they start sitting him up. The body no longer sends the signals to the veins to compress and keep blood from collecting in the low part of the body. You get very lightheaded and almost pass out. Someone should be holding you when you sit up until the body adjusts which it will eventually.

After release from ICU and going into rehab one of the first things that he will be taught is to do stretching and range of motion ROM on his legs. This helps circulation, keeps the legs flexible, and reduces spasticity in the legs.

I didn't have shoes until I got into rehab but my wife, a nurse, insisted on this box being placed at the foot of the bed that supported my feet into a vertical position. It was to prevent foot drop same as wearing high top shoes I guess but allows the staff access to the feet to check color of the nails (a tell tale sign of poor circulation if dark).

I went to the Dallas/FW area after 3 mos in Michigan and spent some time at TIRR. It was okay back then (1988) but is supposed to be better now. I liked the DFW area because the design of most homes and restaurants are accessible. They use a lot of ranch style buildings there. Also the hot dry climate seemed better than the cold humid one Michigan had.

Whether Todd gets significant recovery or not, whoever provides care for him the first year needs to be prepared to commit a lot of time and effort. They will need to do many personal activities that he will not be able to do for himself at first and they will spend a significant amount of time just getting him to medical care. They also may have a financial strain because of suppying things that insurance does. Whoever cares for him should be prepared for this.

You said he does not have personal insurance right now. Perhaps you should ask some of those that post here about getting personal care attendants through medicare. I dont know about that.

Joe B
C6-7
1988

The Human Cannonball · 01-24-2002, 06:59 AM

I had a greenfield filter put in 12/28/91, one day after neck decompression, code blue, pulimonary emboli. Unlike the football player Derrick Thomas(god rest his soul) my embolism was caught in the intense care unit and immediately was treated and filter put in. Those professionals saved my life!! I had blood clots for many months and had to go through prothombin times and blood check for 2 years. Luckily all the edema and clots cleared up in my legs.

quick question, is there any reason ever to take a greenfield filter out??

thanks
John/Chicago

KLD · 01-24-2002, 06:14 PM

Since deep vein thrombosis leading to pulmonary embolus is the leading cause of death in people with SCI during weeks 2-4 after injury, aggressive measures to prevent this. While Greenfields are often used with the thought that this could prevent the patient from needing prophylactic anticoagulation, our recommendation (and that of the Consortium for Spinal Cord Medicine Clinical Practice Guidelines) is to use a combination of low dose heparin or low molecular weight heparin, early mobilization, compression stockings and intermittent compression stockings (combination).

Prevention of Thrombophlebitis CPG

If a Greenfield is used without anticoagulation the person can still get clots in their legs. Although a Greenfield can prevent major emboli, it cannot prevent microemboli, and clots in the legs can cause long term phlebotic syndrome with chronic edema and skin problems. The procedure does make a lot of money for vascular surgeons, and is relatively easily done, but is not without risks. We had a patient develop a significant abdominal hematoma (clot) when his Greenfield penetrated the wall of the vena cava, probably associated with aggressive "quad coughing". He also had a DVT that later led to phlebotic syndrome.

Chris Chappell · 01-26-2002, 02:30 PM

Not to change the subject but just so you're aware that there are some experimental spinal cord injury therapies being offered. Even though your son is C5, which may preclude participation, you and your family may want to check out www.proneuron.com If you have any questions come back and post.

FYI, I do have a filter. I was never really asked whether I wanted it or not. Essentially it was considered standard protocol. I have never had a clot problem. Also, Tet(sp)hose, like stockings, also help with circulation during the first few weeks.

Good luck.

gpbullock · 02-04-2002, 03:58 PM

Dr's suggested that I get a filter following a bout with PE. I denied it though because the Dr's couldn't describe the potential problems in the future other than to tell me they could lead to kidney complications in the future, or get clogged requiring surgery, and couldn't be taken out, etc. I decided that I would take my chances with the cumadin and potential internal bleeding. I felt that when a cure is available, and I am walking around at 50, I don't want to die because of complication from a greenfield filter which was installed 20 years earlier as a result of SCI.

smokey · 02-04-2002, 05:09 PM

http://chorus.rad.mcw.edu/doc/02067.html
This web address can give you a little more info on IVC filters. I had one put placed in my inferior vena cava in 1977 because I coded twice due to pulmonary embolii a couple weeks after being paralyzed. I do not recall which type was used. I had no choice at the time because I was in rough shape, but I have had no problems because of it. Frankly, it saved my life back then. I haven't been on any blood thinners and have somewhat impaired circulation in my legs like many quads (pitting edema, dependant rubor, etc.) I wear the knee high compression stockings (very sexy) and all is well.

lindahalifax · 03-03-2009, 04:39 PM

Regarding question about reasons to remove a Greenfield Filter: any filter can clog or infection can occur.

01-23-2002, 08:46 PM	#1
JLaskowicz Junior Member Join Date: Jan 2002 Location: Chicago suburbs Posts: 17	How many patients elect to have the "umbrella filter?" Hi this is Jan again. First, I want to thank everyone for their time and thoughtfulness in replying to my questions. We are so appreciative of this forum to help us through this difficult time. This is my 4th post regarding questions we have for my stepson, Todd, and his C5 SCI he incurred 2 weeks ago. My husband, Jim, wanted me to post a question about the umbrella filter. He wants to know if most SCI patients decide to have the umbrella filter surgically implanted. Jim tells me this filter's purpose is to protect against blood clots flowing to the heart. Todd elected NOT to have this protection. Has anyone else done the same? If so, do you feel this was a good decision? Have you had any blood clot problems in your legs? I believe Jim is concerned if this was the correct decision. Any feedback positive or negative would be helpful to him. Jim says Todd seems to be doing better and has been able to do breathing on his own today. He is still assisted with the ventilator if he should need it. He still has a feeding tube. He says he is very hungry ... a good sign. He seems to be getting stronger. They are going to sit him more upright tomorrow. Jim plans on finding out if Todd can distinguish hot from cold with his sensory feelings under his injury. I will keep you posted. Thank you to the individual who recommended that Todd have shoes on part of each day. My husband, went out today and got him a pair of high top shoes and Todd had them on for several hours. The nurse said that was a good idea, but they never told Jim to do this. This is why all your comments and suggestions are so helpful to us --- you all are our lifeline. Thank you so much. Jan

01-23-2002, 09:58 PM	#2
rtr Senior Member Join Date: Aug 2001 Posts: 319	umbrella filter I have a filter. About a year ago, I had a serious blood clot. Because of the filter, the clot stayed in my leg. These sites have more information. This PDF file has a lot of information about the filters. web page This website has information about deep vein thrombosis (DVT) web page

01-24-2002, 06:59 AM	#5
The Human Cannonball Senior Member Join Date: Jul 2001 Location: Chicagoland area Posts: 110	The human cannonball I had a greenfield filter put in 12/28/91, one day after neck decompression, code blue, pulimonary emboli. Unlike the football player Derrick Thomas(god rest his soul) my embolism was caught in the intense care unit and immediately was treated and filter put in. Those professionals saved my life!! I had blood clots for many months and had to go through prothombin times and blood check for 2 years. Luckily all the edema and clots cleared up in my legs. quick question, is there any reason ever to take a greenfield filter out?? thanks John/Chicago

01-24-2002, 06:14 PM	#6
KLD Senior Member Join Date: Jul 2001 Location: California Posts: 866	Suggestion Since deep vein thrombosis leading to pulmonary embolus is the leading cause of death in people with SCI during weeks 2-4 after injury, aggressive measures to prevent this. While Greenfields are often used with the thought that this could prevent the patient from needing prophylactic anticoagulation, our recommendation (and that of the Consortium for Spinal Cord Medicine Clinical Practice Guidelines) is to use a combination of low dose heparin or low molecular weight heparin, early mobilization, compression stockings and intermittent compression stockings (combination). Prevention of Thrombophlebitis CPG If a Greenfield is used without anticoagulation the person can still get clots in their legs. Although a Greenfield can prevent major emboli, it cannot prevent microemboli, and clots in the legs can cause long term phlebotic syndrome with chronic edema and skin problems. The procedure does make a lot of money for vascular surgeons, and is relatively easily done, but is not without risks. We had a patient develop a significant abdominal hematoma (clot) when his Greenfield penetrated the wall of the vena cava, probably associated with aggressive "quad coughing". He also had a DVT that later led to phlebotic syndrome.

01-26-2002, 02:30 PM	#7
Chris Chappell Senior Member Join Date: Jul 2001 Location: Denver, CO Posts: 7,035	Jan Not to change the subject but just so you're aware that there are some experimental spinal cord injury therapies being offered. Even though your son is C5, which may preclude participation, you and your family may want to check out www.proneuron.com If you have any questions come back and post. FYI, I do have a filter. I was never really asked whether I wanted it or not. Essentially it was considered standard protocol. I have never had a clot problem. Also, Tet(sp)hose, like stockings, also help with circulation during the first few weeks. Good luck.

01-24-2002, 03:03 AM	#3
Wise Young Administrator Join Date: Jul 2001 Location: New Brunswick, NJ, USA Posts: 37,975	JLaskowicz, The umbrella filter is intended to prevent pulmonary emboli (clots going to the lung) rather than clots to the heart. People with spinal cord injury are at a relatively high risk for such emboli. If it occurs, it damages the lung. Not all people with spinal cord injury get an umbrella filter but the fact that Todd's doctors are recommending it suggests that they are worried about the possibility. The procedure for implanting the filter does not require open surgery. The filter is inserted with a catheter through a vein in the leg. Your stepson should ask his doctors whether they recommend this for every one of their patients. His decision should not be based on fear of the procedure. Perhaps one of our SCI-Nurses can comment on the policies at their institutions but I don't think that a Greenfield umbrella is recommended for all people with spinal cord injury. The incidence of pulmonary emboli varies from institution to institution, depending in part on other practices that they have, including the use of anticoagulation, active air boots, and nursing care. Wise.

01-24-2002, 04:55 AM	#4
Joe B Senior Member Join Date: Jul 2001 Location: 16052 E Andrew Fountain Hills, AZ Posts: 163	I did not have the filter but the staff did put me in these active air leggings. They are filled by a small air pump and have passages in them that alternately flex to provide pressure to different parts of the leg. I believe the idea is to force the blood to circulate even though your stepson isn't moving his legs. You could ask about the leggings rather than the filter. Todd doesn't sound like he has additional problems like poor circulation. You said he was active, does not smoke, was not diabetic,had normal blood pressure and circulation before the injury. He should be prepared for orthostatic hypotension when they start sitting him up. The body no longer sends the signals to the veins to compress and keep blood from collecting in the low part of the body. You get very lightheaded and almost pass out. Someone should be holding you when you sit up until the body adjusts which it will eventually. After release from ICU and going into rehab one of the first things that he will be taught is to do stretching and range of motion ROM on his legs. This helps circulation, keeps the legs flexible, and reduces spasticity in the legs. I didn't have shoes until I got into rehab but my wife, a nurse, insisted on this box being placed at the foot of the bed that supported my feet into a vertical position. It was to prevent foot drop same as wearing high top shoes I guess but allows the staff access to the feet to check color of the nails (a tell tale sign of poor circulation if dark). I went to the Dallas/FW area after 3 mos in Michigan and spent some time at TIRR. It was okay back then (1988) but is supposed to be better now. I liked the DFW area because the design of most homes and restaurants are accessible. They use a lot of ranch style buildings there. Also the hot dry climate seemed better than the cold humid one Michigan had. Whether Todd gets significant recovery or not, whoever provides care for him the first year needs to be prepared to commit a lot of time and effort. They will need to do many personal activities that he will not be able to do for himself at first and they will spend a significant amount of time just getting him to medical care. They also may have a financial strain because of suppying things that insurance does. Whoever cares for him should be prepared for this. You said he does not have personal insurance right now. Perhaps you should ask some of those that post here about getting personal care attendants through medicare. I dont know about that. Joe B C6-7 1988

02-04-2002, 03:58 PM	#8
gpbullock Senior Member Join Date: Jul 2001 Location: Ridgecrest,CA.USA Posts: 1,537	Dr's suggested that I get a filter following a bout with PE. I denied it though because the Dr's couldn't describe the potential problems in the future other than to tell me they could lead to kidney complications in the future, or get clogged requiring surgery, and couldn't be taken out, etc. I decided that I would take my chances with the cumadin and potential internal bleeding. I felt that when a cure is available, and I am walking around at 50, I don't want to die because of complication from a greenfield filter which was installed 20 years earlier as a result of SCI.

02-04-2002, 05:09 PM	#9
smokey Senior Member Join Date: Jul 2001 Location: Massachusetts, USA Posts: 1,865	IVC Filters http://chorus.rad.mcw.edu/doc/02067.html This web address can give you a little more info on IVC filters. I had one put placed in my inferior vena cava in 1977 because I coded twice due to pulmonary embolii a couple weeks after being paralyzed. I do not recall which type was used. I had no choice at the time because I was in rough shape, but I have had no problems because of it. Frankly, it saved my life back then. I haven't been on any blood thinners and have somewhat impaired circulation in my legs like many quads (pitting edema, dependant rubor, etc.) I wear the knee high compression stockings (very sexy) and all is well.

03-03-2009, 04:39 PM	#10
lindahalifax Junior Member Join Date: Mar 2009 Posts: 1	Regarding question about reasons to remove a Greenfield Filter: any filter can clog or infection can occur.

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