Deep Vein Thrombosis (DVT)
Deep Vein Thrombosis (DVT)
A disorder involving a thrombus in a deep vein, most commonly the ileac and femoral veins. It occurs in at least 5% of all surgical patients. More serious than superficial thrombophlebitis because of the risk for pulmonary embolism.
Signs and symptoms
May be asymptomatic
Possible unilateral edema, pain, warm skin, and erythema
If calf involve, tenderness is present
Interventions
Provide bed rest
Elevate extremity above the level of the heart as prescribed
Administer intermittent or continuous warm moist compress
Assess neurovascular signs of the affected limb
Apply anti-embolic stockings (thigh-high or knee-high) as prescribed, usually applied when edema subsides, this will help reduce venous stasis and assist in the venous return of blood to the heart
Avoid putting pillows under the knee
Monitor for sudden shortness of breath and chest pain for possible pulmonary embolism
Advise patient not to massage the extremity
Medical interventions:
Thrombolytic therapy (t-PA), initiated within 5 days after the onset of symptoms
Heparin therapy, prevents enlargement of the existing clot and formation of a new clot
Warfarin therapy, prescribed following heparin therapy when symptoms of DVT have resolved
Administer analgesics for pain
Administer diuretics to reduce lower extremity edema (measure circumference of thighs and calves)
Main causes “VIRchow’s Triad”
Vascular trauma:
Abdominal and pelvic surgery (e.g., gynecological or urological)
Venipuncture
Fracture of pelvis, hip or leg
Trauma
In-dwelling femoral vein catheter
History of previous DVT
Increase coagulation:
Cigarette smoking
Dehydration or malnutrition
Oral contraceptives (common in women > 35-years-old who smoke cigarette)
High dose estrogen therapy
Polycythemia Vera
Reduce blood flow:
Pregnancy and postpartum period
Prolonged immobility (bed rest, fractured leg or hip, long trip without exercise, spinal cord injury, stroke, advanced age, orthopedic sugery)
Obesity
Varicose veins
Atrial fibrillation, congestive heart failure
Potential complications
Pulmonary embolism
Laboratory assessments/Diagnostic Test
Venous doppler evaluation – determine venous flow in deep femoral, popliteal, and posterior tibial veins
Duplex scanning – determine location and extent of thrombus within veins “ultrasound imaging + Doppler” (most common test used to diagnose DVT)
Venogram (phlebogram) – determine the location and extent of clot using a contrast media
Spiral CT scan – obtains continuous slices allowing visualization of entire anatomic areas such as the lungs
D-dimer – elevation may suggest pulmonary embolus but is not diagnostic
Platelet count, bleeding time, INR, aPTT – possible alteration due to drug therapy
Education
Instruct the patient concerning the hazards of anticoagulation therapy “BBRANDDIM”
Bleeding signs and symptoms (e.g., ecchymosis, gum & nose bleeding, hematuria, etc.)
Blood test monitoring (e.g., PT, aPTT, INR)
Razor electric and soft-bristled toothbrush must be used
Avoid ASA, NSAID, and other herbs (e.g., garlic, ginseng, ginkgo biloba, st. John’s wort etc.)
No contact sports (e.g., basketball, football, boxing etc.)
Diet must have regular intake of foods rich in vitamin K (e.g., broccoli, cabbage, brussels sprouts, green leafy vegetables), avoid grapefruit may increase bleeding risk
Dentist and other health care provider should know that the patient is on anticoagulant
Intramuscular injections must be avoided if possible
Medical alert bracelet must be worn at all times
Avoid prolonged sitting or standing, crossing legs when seated and wearing constrictive clothing
Elevate the legs for at least 10 to 20 minutes every few hours each day
Plan a progressive walking program
Check the legs for edema, and measure the leg circumference
Wear antiembolism stockings as prescribed
Avoid smoking
