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DVT & PE Cindy Fehr Malaspina University-College BSN Nursing Program

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Presentation on theme: "DVT & PE Cindy Fehr Malaspina University-College BSN Nursing Program"— Presentation transcript:

1 DVT & PE Cindy Fehr Malaspina University-College BSN Nursing Program
Nursing 335 – Fall 2005

2 FACTS Orthopedic injuries place at  risk
DVT – formation of thrombus in deep vein, typically in lower extremity PE – thrombus that travels into the pulmonary circulation

3 Pathophysiology of DVT
Prevention is key Identify those at high risk Virchow’s triad  changes in blood coagulability, changes in vessel wall, changes in blood flow Prophylactic tx with oral anticoagulant or LMW heparin Intermittent pneumatic compression devices (calf compressors) or elastic stockings (TEDS) Early ambulation Early identification & treatment of DVTs treat with vena cava filters Virchow’s triad: 1. venous stasis or obstruction 2. overt vessel injury 3. intravascular conditions such as intimal irritation; roughening, inflammation, infection, and abnormalities of coagulation or fibrinolysis

4 Coagulation Pathways Extrinsic Pathway - activated when tissue trauma occurs Intrinsic Pathway - activated under conditions such as stress, anxiety, or fear, and in the absence of external tissue injury stage one cascade - either the intrinsic or extrinsic pathway ends with the formation of prothrombin-converting factor stage two prothrombin-converting factor begins series of chemical interactions  slowly converts prothrombin to thrombin. Stage three fibrinogen interacts with thrombin to form fibrin. erythrocytes, phagocytes, and microorganisms, also collect at the site to complete thrombosis development

5 predisposing factors of DVT
* advanced age * trauma * spinal cord injury * immobilization * myocardial infarction * heart failure * stroke * previous thromboembolic disease * thrombotic abnormalities * obesity * pregnancy * constricted clothing * homocystinuria * systemic lupus erythematosus * inflammatory bowel disease * central venous catheter use * oral estrogen use

6 Pulmonary Embolism About 10% of PEs result in immediate death
a futher 20% kill later if they're untreated Once treated, the mortality rate drops to 3%.

7 Source: Nucleus Medical Art Online

8 Venous thromboembolism (PE)
a serious and common problem that can and should be prevented A serious problem: 80% of PE occur without signs 2/3 of deaths occur within 30 minutes A common problem: One in 100 hospitalized patients dies of PE Can & should be prevented

9 These pulmonary emboli removed at autopsy look like casts
of the deep veins of the leg where they originated. Source:

10 What increases the chances of having a pulmonary embolism?
Older adults, especially those who are bedridden People who have or have had cancer Anyone who has recently undergone surgery, especially in the abdomen Family history of pulmonary embolism Obesity Recent fracture of the pelvis or legs Pregnant women and women who have recently given birth Oral contraceptive use

11 The main symptoms of a Pulmonary Embolus are:
Chest pain Typically under the breastbone or to one side Typically a sharp stabbing pain Typically made worse when breathing in Shortness of breath A mild temperature (typically 38°C), with sweating Rapid pulse A dry cough, sometimes with blood (usually small amounts, sometimes more) A feeling of anxiety

12 There are three main tests which can be performed:
D-dimer: represents fibrin split products that are released into the blood stream when there are clots in the blood stream Chest X-ray: helpful to eliminate other possibilities, but 25% of PEs don't show up on an ordinary x-ray Ventilation Perfusion scan (V/Q scan): good initial screening test, but notoriously difficult to analyse CT scan: the definitive diagnostic tool Source: American Family Physician Journal Sept. 2001

13 Treatment to thin the blood using anti-coagulants.
initial injection (bolus) of heparin, followed by a heparin infusion for several days although heparin provides immediate protection, it has an extremely low half-life, so it only protects you while you're being infused with it a longer-lasting anti-coagulant is used for ongoing protection. (warfarin) on heparin until blood tests (INR test) confirms that warfarin is keeping your blood two or three times thinner than usual

14 Treatment cont. Less common treatments include
These options are used when anti-coagulation is proving ineffective or where the clot is so severe that it is too dangerous to wait for the clots to dissolve in the thinned blood clot-filters clot-busting drugs surgery

15 Prevention To help prevent development of blood clots in the venous system Pressure stockings early ambulation low dose heparin use of sequential compression

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