DVT/ VTE Update Deep Vein Thrombosis/ Venous Thromboembolism

1. DVT/ VTE Update Deep Vein Thrombosis/ Venous Thromboembolism

2. 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”

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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