Transcript DVT - Smh.com

DVT/ VTE Update
Deep Vein Thrombosis/
Venous Thromboembolism
What is DVT/VTE
• Is a condition where a blood clot forms
inside the deep vein usually occurs in
the lower leg
• SMH calls DVT/VTE= the “killer legs”
Incidence
• The clot travels and block a blood
vessel in the lungs resulting in
Pulmonary Embolism (PE) which is the
most common complications of DVT
• It affects 300,000 deaths every year
which is more than AIDS and breast
cancer combined
SMH DVT/VTE Screening Tool
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Stroke or hx of CVA
COPD
Cancer
CHF
Pneumonia
Inflammatory
Disorder
• Nephrotic Syndrome
• Hx of DVT or P.E.
• Hx of HITT
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Bedrest
BMI > 30
Birth Control Pills
Central Venous Line
Hypercoaguable
states
Pregnancy
Varicose Veins
Obesity
Orthopedic and
Major Surgeries
New DVT Score
• DVT screening tool will be integrated in
the patient medical history
• All questions must be answered in order
to derive a DVT score
• DVT score will fan to the clinical
summary tab and will be use as a tool to
communicate to the MD
Causes of DVT/VTE
Venous Thrombus are triggered by
Virchow’s triad which are:
1. Venous stasis or sluggish blood flow
2. Endothelial damage
3. Primary or acquired hypercoagulability
Signs and Symptoms Of DVT
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Sudden swelling in the lower leg
Pain and tenderness in the calf
Discoloration or visibly large veins
Skin is warm to touch
Legs may feel tight and heavy
Some DVT are “silent’’ and maybe
present with minimal symptoms
Assessment of DVT
• Positive Homan’s sign- calf pain on
dorsiflexion ( not all patient’s have it)
• Red, swollen, warm, and tender to
touch in the affected leg
• Patient may show the signs of PESOB, tachycardia, pleuritic chest pain,
tachypnea, anxiety, and hemoptysis
Diagnosing DVT
• Low risk use the D-dimer test to rule out
DVT or PE
• Contrast venography, gold standard for
diagnosing DVT and pulmonary
angiography for diagnosing PE
• Other testing: ultrasound, doppler flow
studies, duplex scanning
New Recommendation for the
Prevention of DVT
• The American College of Chest
Physician (AACP) revised the
guidelines in 2004
• The following risk levels and
recommended prophylaxis are evidence
based prevention guidelines
Risk Levels for DVT
Low risk- pt age<40
minor surgery
Moderate risk– pt age
40-60, minor
surgery with
additional risk factor
Prophylaxis
• Early mobilization
• SCD mechanical
device and TED
• May need
unfractionated
heparin(UFH) or low
molecular weight
heparin (LMWH)
Risk Levels for DVT
High risk- pt age >60,
pt age 40-60 with
additional risk
factors
Highest risk – pt with
multiple risk factors,
hip or knee
arthroplasty and
spinal cord injury
Prophylaxis
• Requires UFH, or
LMWH with SCD
and TED hose
• Requires LMWH
with SCD
• UFH or LMWH with
TED hose
SMH DVT/VTE Prophylaxis Order Set
Obtain baseline CBC w/ platelet prior to initiation of medications
Moderate to High Risk (more than 2 risk factors)
– Lovenox 30mg SQ q 12 hours or
– Lovenox 40mg SQ q day
– SCD at all times except when ambulating
Low to Modearate Risk (1 risk factor)
– Lovenox 40mg SQ q day or
– SCD at all times except when ambulating
No Risk Factors
– Ambulate in hallways/room QID
– TED hose or SCD
Nurses Role
• Obtain a complete history and physical
• Identify patient risk factors
• Notify the doctor for 2 or more risk
factors
• Implement DVT/VTE prophylaxis order
set as ordered
• Educate patient in preventing, detecting,
and treating DVT/VTE