DEEP VEIN

DEEP VEIN
THROMBOSIS
THROMBOSIS
OBJECTIVES
At the end of this presentation students should be
able to

Define Deep Vein Thrombosis

State the incidence of Deep Vein Thrombosis

List the aetiology and risk factors of DVT

Describe the pathophysiology of DVT

List the clinical manifestations of DVT

State the diagnostic assessment of DVT

Discuss the medical, surgical and nursing

management
DEFINITION

DVT occurs when a blood clot forms in a

deep vein

!t most commonly happens in the deep

veins of the lower leg "calf#, and can spread
up to the deep veins in the thigh

$arely, it can develop in other deep veins,

for e%ample in the arm

INCIDENCE

DVT occur in about & per &''' persons per

year

Appro%imately ()',''' to *'','''

Americans each year suffer from DVT and &
in every &'' people who develops DVT
dies

+ore common in people over the age of ,'

"up to one in )''#

AETIOLOGY
IMMOBILITY: this causes blood flow in the veins to
be slow Slow flowing blood is more likely to clot
HYPERCOAGULABILITY "coagulation of blood
faster than usual#
TRAUMA to the vein: increases the risk of a blood
clot forming
RISK FACTORS

Sittin !o" #on $e"io%& of time, such as when

driving or flying

P"o#one% 'e% "e&t, during a long hospital stay, or

paralysis "from spinal cord injury#
"causes calf muscles not to contract, slows blood
circulation thus forming clots#

!nheriting a blood-clotting disorder

In()"* o" &)"e"* "can slow blood flow thus

increasing the risk of blood clots#

P"en+n,* "increases the pressure in the veins in

the pelvis and legs#
RISK FACTORS

C+n,e" "some cancers increase clotting factors

along with some forms of cancer treatment
increase the risk of blood clots#

He+"t !+i#)"e "affects the pumping mechanism of

the heart increases the chance that blood will pool
and clot#

S-o.in "affects blood clotting and circulation#

Bi"th ,ont"o# $i##& o" ho"-one "e$#+,e-ent

the"+$* "increase the blood's ability to clot#

A hi&to"* of deep vein thrombosis or pulmonary

embolism
RISK FACTORS

A !+-i#* hi&to"* of DVT or ./

Bein ove"/eiht o" o'e&e "increases the

pressure in the veins in your pelvis and legs#

In,"e+&in +e "people older than 40#

Po#*,*the-i+ "increased number of red blood

cells#
PATHOPHYSIOLOGY
VIRCHO01S TRIAD

Stasis of blood

Vessel damage

!ncreased blood coagulability

Vessel trauma stimulates the clotting cascade

.latelets aggregate at the site particularly when

venous stasis present

.latelets and fibrin form the initial clot

PATHOPHYSIOLOGY ,ont1%

$01 are trapped in the fibrin meshwork

The thrombus propagates in the direction of the

blood flow

!nflammation is triggered, causing tenderness,

swelling, and erythema

.ieces of thrombus may break loose and travel

through circulation- emboli

2ibroblasts eventually invade the thrombus,

scarring vein wall and destroying valves

Although the patency may be restored valve

damage is permanent, affecting directional flow
PATHOPHYSIOLOGY
C#ini,+# M+ni!e&t+tion&

Tenderness in the calf "this is one of the

most important signs#

Swelling of the leg

!ncreased warmth of the leg

$edness in the leg

0luish skin discoloration

Discomfort when the foot is pulled upward

Di+no&ti, A&&e&&-ent

Veno)& %)$#e2 3 ,o#o" %)$#e2 )#t"+&o)n%-

this non-invasive test allows for visuali3ation
of the thrombus +ost effective in the
detection of thrombus in the lower e%tremities

I-$e%+n,e $#eth*&-o"+$h* 4 measures

changes in calf volume corresponding to
changes in blood volume brought about by
temporary venous occlusion with a high-
pneumatic cuff
Di+no&ti, A&&e&&-ent ,ont1%

R+%io+,tive !i'"inoen - is administered

intravenously !mages are taken through
nuclear scanning at &5-56 hours, the
radioactive fibrinogen will be concentrated
at the area of clot formation

Veno"+$h*- intravenous in7ection of a

radiocontrast agent The vascular tree is
visuali3ed and obstruction is identified
Di+no&ti, A&&e&&-ent ,ont1%

Co+)#+tion $"o!i#e&4 partial thrombin time,

international normali3ed ratio, circulating
fibrin, monometer comple%es, fibrinopeptide
A, serum fibrin, D-dimer, antithrombin !!!
levels
MANAGEMENT
The o+#& o! DVT t"e+t-ent +"e:

to stop blood clot from getting any bigger

to prevent the clot from breaking loose

and causing a ./

to prevent DVT from occurring again

Deep vein thrombosis treatment options

include8 B#oo% thinne"&5 C#ot ')&te"&5
Fi#te"& 6 Co-$"e&&ion Sto,.in&
MANAGEMENT

B#oo% thinne"& "anticoagulants# such as

HEPARIN and 0ARFARIN

decrease blood's ability to clot

prevent clots from getting bigger

reduce the risk of additional clots.

Typically, he$+"in in7ections are given for a

few days Treatment may be followed with
/+"!+"in (orally) for ( mths or longer
MEDICATIO
NS
MANAGEMENT

The use of heparin and

warfarin must be closely
monitored as they can
increased risk of bleeding

To monitor the effects of

blood thinners, blood tests
are done to check how long
it takes the blood to clot

.regnant women should

not take warfarin
MANAGEMENT

C#ot')&te"& "thrombolytics# such as tissue

plasminogen activator "t.A# or Steptokinase are
given by !V to break up blood clots
These drugs can cause serious bleeding and are
used only in life-threatening situations

Fi#te"& "umbrellas#are used when medications

cannot be taken to thin the blood, it may be
inserted into the vena cava and $"event& e-'o#i
from lodging in the lungs

MEDICAL MANAGEMENT
MEDICAL MANAGEMENT

$est8 in DVT and limited mobili3ation is

re9uired to prevent dislodgement of clot
leading to pulmonary embolism

/levation of the affected part8 this is to

promote ade9uate venous return and
prevent stasis
MANAGEMENT

Co-$"e&&ion
&to,.in&
helps $"event &/e##in
associated with DVT by
applying pressure thus
reduce the chances that
the blood will pool and
clot
The stockings are worn
on the leg from the foot
to the level of the knee
and should be worn for
at least a year if
possible
SURGICAL MANAGEMENT

Deep vein thrombosis is usually treated with

conservative measures and anticoagulant !n
some cases however surgery may be re9uired
to remove thrombus

enous thrombectomy! done when thrombi

lodge into femoral vein and their removal is
necessary

:hen DVT is recurrent and anticoagulant

therapy is contraindicated a ;reenfield filter or
a venal caval filter may be inserted into the
inferior vena cava to trap the clots
S)"i,+# -+n+e-ent

"igation or e#ternal clips! if filters are not

effective in preventing pulmonary emboli or
becomes blocked ligation is done or an
e%ternal clip "Adam De:eese clip# may be
inserted on the inferior vena cava This can
be done by means of an abdominal
laparatomy
NURSING MANAGEMENT
ASS/SS+/<T
=ealth history8

1>o calf pain, duration characteristics and the effect

of walking on the pain

=% of venous thrombosis or other clotting disorders

1urrent medication
.hysical e%amination8

!nspect affected e%tremity for redness and edema

.alpate for tenderness, warmth and cordlike

structures

0ody temperature
NURSING MANAGEMENT
Re&t ,o-!o"t +n% +,tivit*:
Altered comfort pain8 r>t inflammatory process 5
'
DVT
as evidenced by patients verbali3ation
INTERVENTIONS

Assess pain location, characteristic and level 2or

baseline data and to plan appropriate nursing
interventions

+onitor for increasing pain, location or

characteristics and report to the physician promptly
4 increasing pain may indicate e#tension if
thrombosis sudden chest pain may indicate
pulmonary embolism
NURSING MANAGEMENT

Apply warm moist heat to the affected e%tremity at

least four times daily +oist heat penetrate tissues
to a greater depth. $armth promotes vasodilation
which reduces resistance within the affected
vessels, reducing pain.

/levate the affected limb about &)

'
to 5'
'
above
the level of the heart To promote venous return
which reduces edema thus reducing pain

+aintain bed rest as ordered ?sing muscles

during walking e#acerbate the inflammatory
process and increases edema which increases
venous compression and pain
NURSING MANAGEMENT

Administer <SA!D@s for leg pain as ordered eg

Voltaren %o inhibit prostaglandin synthesis by
decreasing en&yme needed for biosynthesis, thus
decreasing pain.

/ncourage diversional activities such as watching

television or guided imagery To augment
analgesics and improve pain tolerance.
NURSING MANAGEMENT
O2*en
!neffective tissue perfusion8 peripheral r>t obstruction
of blood flow and vessel spasm 5
'
DVT aeb cyanosis
of affected e%tremity

Assess skin of the affected leg which includes skin

integrity and colour $eassess every , hrs To
rapidly detect early signs and plan for appropriate
nursing intervention.

+onitor peripheral pulses and capillary refill time at

least every 6 hrs, and report changes immediately
:eak or absent pulses and impaired capillary refill
may indicate e#tension of the thrombus.
NURSING MANAGEMENT

levate e%tremities at all times, keeping knees

slightly fle%ed and legs above the level of the heart
To promote venous return and reduce peripheral
edema

ncourage patient to wear an antiembolic stocking

To e#ert pressure on the e#tremity and promote
venous return

emove antiembolic stocking for ('-*' mins during

daily hygienic To assess the underlying tissue and
allow for perfusion of the dermis
NURSING MANAGEMENT

nsure ade9uate hydration by increasing oral fluids %o

prevent dehydration as increased blood viscosity and
decreased cardiac output contribute to thrombus formation

se egg crate mattress on the bed as needed %o

distribute weight evenly, preventing e#cess pressure on the
affected tissues

ncourage fre9uent position changes, at least every 5

hrs %his reduce pressure on bony prominences and
edematous tissues, reducing the risk of tissue breakdown.

dminister and monitor heparin therapy To decrease

blood viscosity and platelet adhesiveness
NURSING MANAGEMENT
SA2/TA A<D S/1?$!TA
$isk for 1omplication8 .ulmonary /mbolism r>t
dislodgement of thrombus 5 to DVT

Assess vital signs esp respiration and pulse %o

detect early signs of complication for early
intervention.

.romote bed rest and limited mobili3ation. %o

prevent dislodgement of clots.

/ncourage the use of support stocking %o prevent

stasis of blood, hence reducing clot formation.

Administer thrombolytic agents, eg Streptokinase

%o dissolve clots and decrease the risk of '(
NURSING MANAGEMENT

Administer antispasmodic agents ie

0aclofen To prevent vascular spasm that
may dislodge clot and cause ./

.repare patient for surgical insertion of

filters, if indicated 2ilters are placed in the
inferior vena cava to trap clot so they do not
enter the lungs causing ./
NURSING MANAGEMENT
S+!et* +n% &e,)"it*
$isk for complication8 haemorrhage r>t
anticoagulant therapy

Assess for evidence of bleeding such

as petechiae, bruising, bleeding gums
etc )or baseline and to plan
appropriate nursing interventions
NURSING MANAGEMENT

onitor lab results such as !<$, A.TT, =b and

haematocrit levels $eport values outside the
desired range Value within normal rage
prevent further clot development while a fall
may indicate undetected bleeding.

onitor vital signs 96h $apid weak thready

pulse and low blood pressure may be
indicative of undetected bleeding
NURSING MANAGEMENT

eep .rotamine sulfate available To treat e#cessive

bleeding

ncourage patient to use an electric ra3or for shaving

and a soft tooth brush for brushing teeth To decrease
the risk of bruising and bleeding

void invasive procedures as much as possible such

as rectal temperature, vaginal douches or tampons,
urinary catheteri3ation .arenteral in7ections etc !nvasive
procedure can cause tissue trauma and bleeding

pply pressure to in7ection site for (-) mins and to

arterial puncture for &)-5' mins 'ressure prevents
prolonged bleeding by promoting haemostasis
PREVENTION

%ercise the legs regularly 4 take a brisk ('-minute

walk every day

aintain a weight thatBs appropriate for your height

void sitting or lying in bed for long periods of time

without moving the legs

lthough the added risk of developing a DVT caused

by traveling appears to be low, it can be reduced
even further by e%ercising the legs at least once every
hour during long-distance travel

onBt take sleeping pills These cause immobility,

increasing the risk of DVT

ear loose-fitting clothing

PREVENTION

Ceep the legs uncrossed

Ceep hydrated by drinking normally "urine should

be no darker than a pale yellow# Avoid alcohol to
prevent dehydration

:ear graduated compression stockings This is

particularly important for travelers who have other
risk factors for DVT
COMPLICATIONS
The primary complication to be concerned
with is a P)#-on+"* e-'o#i&-
!t occurs when an artery in your lung becomes
blocked by a blood clot "thrombus# that
travels to your lungs from another part of
your body, usually your leg
COMPLICATIONS
COMPLICATIONS
Po&t$h#e'iti, &*n%"o-e also called post-
thrombotic syndrome

Dccurs in &)E of patients DVT

!t presents with leg edema, pain, nocturnal

cramping, venous claudication, skin
pigmentation, dermatitis and ulceration
"usually on the medial aspect of the lower
leg#
REFERENCE
http8>>wwwwebmdcom>heart-disease>tc>deep-vein-thrombosis-what-
increases-your-risk

http8>>wwwwebmdcom>heart-disease>tc>deep-vein-thrombosis-topic-
overview

http8>>wwwmayocliniccom>health>deep-vein-thrombosis>DS'&'')

http8>>enwikipediaorg>wiki>DeepFveinFthrombosis

http8>>wwwmedicinenetcom>deepFveinFthrombosis>articlehtm