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

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”

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

SMH DVT/VTE Screening Tool Bedrest BMI > 30 Birth Control Pills Central Venous Line Hypercoaguable states Pregnancy Varicose Veins Obesity Orthopedic and Major Surgeries Stroke or hx of CVA COPD Cancer CHF Pneumonia Inflammatory Disorder Nephrotic Syndrome Hx of DVT or P.E. Hx of HITT

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

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

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

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

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

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

Risk Levels for DVT Prophylaxis 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 Requires UFH, or LMWH with SCD and TED hose Requires LMWH with SCD UFH or LMWH with TED hose 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

SMH DVT/VTE Prophylaxis Order Set Obtain 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 No Risk Factors Ambulate in hallways/room QID TED hose or SCD

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