DVT/ VTE Update
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DVT/ VTE Update Deep Vein Thrombosis/ Venous Thromboembolism PowerPoint PPT Presentation


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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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DVT/ VTE Update Deep Vein Thrombosis/ Venous Thromboembolism

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Dvt

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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