Deep Vein Thrombosis

By K.Lee Barnes, Amanda Serio, Katelyn Gaffney

Define the Problem

A DVT is a blood clot that forms in veins deep in body,
commonly for in lower extremities as a result of damage
to vein walls, blood stagnation, or hypercoagulation.

http://www.radiologyinfo.ca/utilisateur/images/LargePicture/IR_thrombo_1_a.jpg

Statistics
o 300,000-600,000 people are affected by DVT/PE
per year.
o 60,000-100,000 Americans die as result of DVT/PE.
o 25% of people with PE first symptom is sudden
death.

Risk Factors

Blood clotting disorders

Prolonged bed rest or long sitting periods
Injury/Surgery
Pregnancy
Birth control or hormone replacement therapy
Smoking
Cancer
Heart failure
PE history
Age
Vein Disease

http://all-free-download.com/free-vector/vector-clipart/no_smoking_sign_clip_art_23316.html

Health Implications
For the patient
o
o
o
o
o
o
o
o

Pulmonary Embolism
Chronic Venous Insufficiency
Post-thrombotic syndrome
Ischemia
Stroke/ TIA
Myocardial infarction
Tissue necrosis
Death

For the institution

o
o

Increased health care costs

patient populations in ortho-trauma are at increased risk for developing DVTs

due to trauma, immobility, post-op risk factors

Nursing: Assessment
Assess for Pulses, Pallor,
Swelling, Redness, Warmth
Shortness of Breath, Brusing and
Chronic Pain.

Nursing Role
Diagnose: X-ray, blood test,
venography or ultrasound.
Intervention
o Prophylaxis:
Foot pushes, leg lifts,
elevating the foot of
the bed, active and
passive ankle
movement, SCDs,
compression
stockings, normal
walking and blood
thinners.

Treatment
Angioplasty: A catheter with a
balloon on the end is inserted into
affected vein. Balloon is inflated to
widen vein, then stent may be
placed to keep vein open.
Treatment with clot buster or
warfarin/Lovenox

http://www.singaporemedicalclinic.com/ckfinder/userfiles/images/Arteries%20Veins/Balloon
%20Angioplasty%20Singapore.jpg

Treatment Continued...
Thrombolysis: A
catheter is inserted into
affected vein.
Medication is delivered
to the colt through the
catheter.
Thrombectomy: Clot
broken up into small
pieces with catheter
and suctioned out.

http://cirse.org/files/images/Patients/full%20sized%20images/Thrombectomy(800x534).jpg

Treatment Continued
Inferior Vena Cava Filter: A filter
with anti embolism medication is
placed into vein leading to heart.
Designed to trap embolisms in lower
body (keep from going to brain).
Especially efficient for those with
clotting disorder.

http://www.medicalexhibits.com/obrasky/2009/09111_04X.jpg

Recommendations
Quit smoking
remain active
o normal walking
o leg lifts
o foot pushes/ pulls
dietary advice
medication compliance
follow-up monitoring

http://www.fairview.org/healthlibrary/Article/82954

Spectrum Health Initiatives

VTE/DVT prophylaxis measures apply to all inpatient and observation patients
that are 18yrs of age or older unless contraindicated
Medication prophylaxis
o Low dose unfractionated heparin (subQ)
o LMWH
o Factor Xa inhibitor
o Warfarin
Mechanical
o SCDs/ foot pumps
Discharge instructions for Tx or prophylaxis

References
Krames On-demand. (n.d). Understanding deep vein thrombosis [Health sheet]. Retrieved from www.kramesondemand.com:
https//www.kramesondemand.com/Healthsheet.aspx?id=40199&ContentTypeId=3
American Academy of Otrhopedic Surgeons. (n.d). Deep vein thrombosis. Retrieved from
http://orthoinfo,aaos.org/topic.cfm?topic=A00219
Data & Statistics. (n.d). Retrieved from http://www.cdc.gov/ncbddd/dvt/data.html
Spectrum Health. (2008). Venous thromboemoblism core measures [policy brief]. Retrieved from https://insite.spectrumhealth.org/departments/Quality/Pages/VTE-Core-Measures.aspx