Deep Vein Thrombosis

Definition:
Deep vein thrombosis or DVT is a blood clot that forms in a deep vein
inside the body. DVT usually occurs in a deep leg vein that runs
through the muscle of the calf and the thigh. Blood clots form when
blood thickness and clumps together.

Deep vein thrombosis

Sign and Symptoms of Deep-Vein Thrombosis:

There are different sign and symptoms of deep-vein thrombosis, those

are in the following:

1. Edema,
2. Swelling of the leg,
 3. Distension of surface vein,
4. Pain or tenderness,
5. Warmth in the skin,
6. Redness or discoloration,
7. Leg fatigue,
8. Calf pain on dorsiflexion of the foot (Homans sign).

Causes of Deep Vein Thrombosis:

Various causes of deep-vein thrombosis are mentioned in the below:

1. Immobility:

 Bed Ridden or Paralysis,

 Prolonged travel or sitting,
 Hospitalization,
 Fracture of legs or pelvis,
 Recent pelvic or knee surgery

2. Venous stasis,
3. Hypercoagulability
4. Birth control pill or hormone replacement therapy,
5. Smoking,
6. Genetic predisposition (Family history),
7. Cancer,
8. Congestive Heart Failure,
9. Coronary heart disease,
10. Age more than 60 years,
11. Pace maker catheter,
12. Rheumatoid arthritis.

Patho Physiology:
Blood cells contain platelets and protein known as clotting factors.
When a blood vessel is cut and damaged, the platelets and clotting
factors protein form a solid clot that acts as a plug to stop the wound
bleeding. These are normal processes for blood clotting when blood
vessel bleeds or damaged. But the blood clots form when blood vessel
not damaged and restricts the blood flow, it’s called Deep-vein
thrombosis and can lead a life threatening condition.

Diagnosis and Test for Deep Vein Thrombosis:

Various diagnosis and test for deep-vein thrombosis are in mentioned
in the following:

1. USG,
2. Blood Test- D-Dimer, CBC,
3. Venography,
4. CT or MRI Scans.

Deep Vein Thrombosis Treatment:

There are different treatments for deep-vein thrombosis; which are in
the below:

1. Anticoagulant:

 Warfarin,
 Heparin.

Heparin:

 Standard (Heparin- can be given as Intravenous injection),

 Low molecular weight Heparin (LMWH) -can be given as
subcutaneous.

2. Clot blusters- (Streptokinase, Urokinase),

3. Direct Xa inhibitors –Apixaban(Eliquis), Edoxaban (Savaysa)
Rivaroxaban (Xarelto),
4. Direct Thrombin Inhibitor-Dabigatran (Pradaxa),
5. Filters (Inferior venacava filters),
6. Compress stockings,
7. Thrombectomy,
8. Exercise.

Complications of Deep Vein Thrombosis:

There is various complication of deep-vein thrombosis, those are
mentioned in the below:

1. Pulmonary embolism,
2. Postphlebitic syndrome.

Nursing Intervention for Deep Vein Thrombosis:

Various nursing intervention for deep-vein thrombosis are in the
following:

1. Assess for and reports sign and symptoms of Deep Vein

Thrombosis.
2. Keep the affected leg elevated and comfortable position.
3. Keep the head up of bed.
4. Immobilize the patient and initiate bed rest to reduce risk of clot
mobilization.
5. Administer anticoagulants as ordered to reduce the risk of
additional clotting.
6. Carefully calculate heparin dose.
7. Use infusion pump to administer intravenous heparin.
8. Do not mix the heparinized solution with other medications.
9. Discourage positions that compromise blood flow.
10. Administer analgesics (Morphine) as ordered to manage pain.
11. Apply warm compress to affected leg using a 2-hour-on, 2-hour-
off schedule around the clock.
12. Provide elastic compression stocking.
13. Administer oxygen as ordered in order to maintain tissue
perfusion.
14. Check and monitor any sign of bleeding.
15. Check any sign of complication (Pulmonary embolism).
16. Obtain lab orders to monitor APTT, PT and INR.
17. Ensure intake of vitamin-k rich food including green, leafy
vegetable.
18. Instruct patient to carefully brushing teeth to avoid bleeding.
19. Instruct patient to keep nasal mucosa hydrate and moist.
20. Ensure a minimum intravenous fluid intake of 2500ml per day for
proper hydration unless contraindicated to prevent increase blood
viscosity.
21. Provide adequate knowledge to patient pertaining to warfarin
therapy.
22. Check any sign of excessive bleeding complication of warfarin
therapy.
23. Be aware of the signs of signs of excessive bleeding, such as
frequent and bilateral epitasis, hematuria (blood in the urine) and
deep tissue bruising (purpura).
24. Advise the patient to take care when brushing teeth in order to
reduce risk of bleeding gums.
25. Discuss with patient the need to change method of contraception,
if applicable (as oral contraceptives increase DVT .