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DVT/ VTE Update Deep Vein Thrombosis/ Venous Thromboembolism

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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. Incidence.

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slide1
DVT/ VTE Update

Deep Vein Thrombosis/

Venous Thromboembolism

what is dvt vte
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
Incidence

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
Stroke or hx of CVA

COPD

Cancer

CHF

Pneumonia

Inflammatory Disorder

Nephrotic Syndrome

Hx of DVT or P.E.

Hx of HITT

Bedrest

BMI > 30

Birth Control Pills

Central Venous Line

Hypercoaguable states

Pregnancy

Varicose Veins

Obesity

Orthopedic and Major Surgeries

SMH DVT/VTE Screening Tool
new dvt score
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
Causes of DVT/VTE

Venous Thrombus are triggered by Virchow’s triad which are:

  • Venous stasis or sluggish blood flow
  • Endothelial damage
  • Primary or acquired hypercoagulability
signs and symptoms of dvt
Signs and Symptoms Of DVT
  • 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
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 PE- SOB, tachycardia, pleuritic chest pain, tachypnea, anxiety, and hemoptysis
diagnosing dvt
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
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 prophylaxis
Low risk- pt age<40 minor surgery

Moderate risk– pt age 40-60, minor surgery with additional risk factor

Early mobilization

SCD mechanical device and TED

May need unfractionated heparin(UFH) or low molecular weight heparin (LMWH)

Risk Levels for DVT Prophylaxis
risk levels for dvt prophylaxis1
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

Requires UFH, or LMWH with SCD and TED hose

Requires LMWH with SCD

UFH or LMWH with TED hose

Risk Levels for DVT Prophylaxis
smh dvt vte prophylaxis order set obtain baseline cbc w platelet prior to initiation of medications
SMH DVT/VTE Prophylaxis Order SetObtain 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
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
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