Presentation on theme: "Wendy Ebner and Nora Gray"— Presentation transcript:
1 Wendy Ebner and Nora Gray DVT ProtocolWendy Ebner and Nora Gray
2 DefinitionA DVT is the formation of a blood clot that does not break down in a deep vein of the body.Because the clot does not bread down, it can become large and obstruct the normal flow of blood in the vein.
3 ConsiderationsDeep veins of the lower extremities are the most common sites for a DVT.If the clot breaks into smaller pieces, it becomes an embolus which can travel to vital organs and cause life-threatening conditions such as a heart attack, stroke, or pulmonary embolism.
5 Risk Assessment Patients at highest risk for DVT are those who; Have undergone major surgery including that of the hip or kneeSuffered traumaAre olderHave a history of having a DVT
6 Prevention/Interventions Mobility-foot pumps, exerciseCompression stockingsEarly ambulation following surgeryClose management of CHF, HTN and/or DiabetesSmoking cessationWeight managementPrevent dehydrationPharmacologic interventions (see below)Herbal remedies (see below)Elastic compression stockingsFoot pumps when immobilized in bed or chairMonitor anticoagulant therapyMonitor Vit K intake (green leafy vegetables, soybean oil, and canola oil)Increase fluids and avoid alcohol
7 Signs and Symptoms of DVT’s Recognize and report signs/symptoms of a DVT including:Unilateral edemaPain in extremityErythemaCalf tendernessPale leg & cool with diminished arterial pulse+ Homan’s sign (discomfort in the calf muscles on forced foot dorsiflexion w/ knee straight; NOTE: Homan’s sign is neither sensitive nor specific; Present in <1/3 of patients with confirmed DVT; Found in >50% of patients without DVT) (Schreiber, 2009)
8 SBAR-CUS Situation Background Assessment Recommendation Concerned and Uncomfortable about this patients’Situation or safety
9 Signs/Symptoms of PERecognize and report (call 911) for signs/symptoms of a pulmonary emboli (PE) including:Unexplained sudden onset of shortness of breathChest pain or discomfort that worsens with deep breath or coughLightheadedness or dizzinessHemoptysisAnxiety
10 Goals of Pharmacologic Intervention Prevent clot formationStop clot from getting biggerPrevent clot from breaking loose and resulting in an embolusPrevent DVT from re-occurring.
11 Herbal Remedy Considerations Herbal products may include ingredients that contain coumarin, inhibit platelet activity, or inhibit platelet aggregation – check with physician before use of these agents alone or in combination with anticoagulants, antiplatelets, or vitamin K antagonists
12 Patient/Family Education Basic disease instruction including S/S of DVT extension & pulmonary embolism; complicationsLifestyle modification related to smoking and weight managementIndications & actions of medications/herbals; dose & schedule; target INR & lab work; missed dose strategy)Medication interactions (that increase or decrease INR); diet (foods to avoid, limit, & eat)Self-care (i.e., leg elevation, avoid crossing legs & standing for long periods); anticoagulant safety issues (avoid sharp objects & injury; monitor common bleeding sites – gums, nose, GI, GU, skin; actions to take if bleeding)Dental considerations (soft bristle toothbrush; notifying dentist)Cultural considerations of animal derived products (heparin) and alternative synthetic options for whom animal derived products are objectionable
13 Nursing Diagnosis/Problems Need for assessment of circulatory system (A963)Need for skilled teaching related to circulatory system (A964)Need for skilled teaching related to prescribed medications (A460)Need for Coumadin (warfarin) therapy (A946)Need for other anticoagulant therapy (excluding coumadin) (A948)Need for skilled teaching related to injection therapy (A631)Need for skilled administration of injection (A632)Need for venipuncture (A800)
14 References References: Agency for Healthcare Research and Quality. (January 2003). Diagnosis and Treatment of Deep Venous Thrombosis andPulmonary Embolism. Evidence Report/Technology Assessment, 1-6.Esmon, C. (2009). Basic mechanisms and pathogenesis of venous thrombosis. Blood Reviews, 23(5), DOI: /j.blreMayo Clinic (2009). Deep vein thrombosis (DVT). Retrieved May 27, 2010, fromvein-thrombosis/DS01005NICE clinical guideline 92. (2008). Reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in patients admitted to hospital. Retrieved July 8, 2010, fromSchreiber, D. (2009). Deep venous thrombosis and thrombophlebitis. Retrieved May 27, 2010, fromSelby, R., & Geerts, W. (2009) Prevention of venous thromboembolism: consensus, controversies, and challenges.Hematology Accessed July 8, 2010, fromSkinner, N., & Moran, R. (2008). Case Management Adherence Guidelines Version 1.0 Deep Vein Thrombosis (DVT). Case Management Society of American: Aston, PA. Retrieved July 12, 1010 fromThe Surgeon General’s Call to Action to Prevent Deep Vein Thrombosis and Pulmonary Embolism. (2008). Retrieved July 8, 2010, fromVan Wicklin, S., Ward, K., & Cantrell, S. (2006). Home study program. Implementing a research utilization plan for prevention of deep vein thrombosis. AORN Journal, 83(6), Retrieved from CINAHL with Full Text databaseSummary of the Seventh ACCP Conference on Antithrombotic and Thrombolytic TherapyCHEST 2004; 126:163S-696S. Retrieved July 12, 2010 from