 Deep Vein Thrombosis Josh Vrona, Hunter Dolan, Erin McCann

Signs and Symptoms of a DVT  50% of patients do not have symptoms  Swelling in leg; red, discolored, or white skin; tachycardia, fever, warm skin over affected area; aching, tiredness, tenderness, and leg pain.

Defining the Problem  DVTs are caused by damage to the inner lining in the vein  Examples: surgery, serious injuries, inflammatory responses  Blood Flow becomes slower and sluggish due to a decrease in motion, which causes the blood to be thicker than normal and therefore, more likely to clot.  Contributing factors: genetics, prolonged bed rest, injury, surgery, pregnancy, birth control pills, HRT, obesity, smoking, cancer, heart failure, age (>60), inflammatory bowel disease

Defining the Problem  Complications: Pulmonary Embolism, Postphlebitic syndrome  Scope of problem: According to the CDC it is thought that as many as 900,000 people could be affected each year.  ,000 Americans die of DVT/PE  Among people who have had a DVT, 50% will have complications  Surveillance studies have found that the absolute risk of DVT is 10-20% among general medical patients, and up to 40-60% in patients having hip surgery, knee surgery, or major trauma.

Implications for Patient  At an increase risk for developing another blood clot  Need to be aware of new leg pain, swelling, or redness  Increased risk for bleeding d/t anticoagulant use  Need to wear an alert bracelet that says they are on anticoagulants  Aim to reduce their risk of bleeding

Implications for Institution  “In 2001, the Agency for healthcare research and quality began a campaign to combat med error in order to improve patient safety. The use of appropriate VTE prophylaxis was included in this.”  “The National Voluntary Consensus Standards for Prevention and Care of Venous Thromboembolism is a policy created by the National Quality Forum that states “Every healthcare organization shall have a written policy appropriate for its scope that is evidenced based and that drives continuous quality improvement related to venous thromboembolism risk assessment, prophylaxis, diagnosis and treatment.”

Implications for Institution  The mean hospital cost per readmission for recurrent DVT was $11,862  Medicare will no longer pay hospitals for additional costs considered to be hospital acquired conditions  Private health care plans and other health care purchasers have their own nonpayment policies, but most are the same as Medicare.

Implications for Healthcare Resources  Very expensive to care for these patients  DVT patients average $16,000 more in medical costs than patients without a DVT.  If a DVT is the primary diagnosis the average cost is $10,800

Recommendations  For patient care: anticoagulants for at least 3 months, thrombolytic therapy, vena cava filter  Prevention/prophylaxis: Anticoagulant medications (heparin, lovenox, coumadin), moving lower legs, bending knees frequently, getting up to walk as soon as the patient is able to, pneumatic compression device, elastic stockings

Nursing Role  Assessment: look for signs and symptoms of a DVT (leg pain, ankle engorgement, swelling, differences in leg circumference, temperature changes, feeling of heaviness in affected limb, Homan’s sign)  Planning: Take prophylactic measures, get patient up and walking as soon as possible

Nursing Role  Interventions: Prophylactic measures, frequent assessment for signs of a DVT, monitor anticoagulant therapy, monitor for and manage potential complications (bleeding, PE), work with PT to get patient up and moving, provide rest and comfort (if they have a DVT-bed rest, analgesics, warm compress, elevation of extremity)  Evaluation: Pt will not develop a DVT, Pt will not develop a PE, absence of SOB, monitor patients PT and INR

Spectrum’s Initiatives

Education Materials  Teach them about their medication regimen  Example: how to take it, complications, when to see a doctor, blood tests needed  Teach them how to prevent DVTs  Walking/moving whenever possible, wearing PCDs, continuing medications prescribed  Teach them risk factors and signs that indicate a DVT

Conclusion  DVTs are a preventable complication  They are an extremely expensive medical cost so nurses should take every precaution possible to prevent them  The nurses responsibilities include assessing the patient for signs of a DVT, monitoring therapy initiated to prevent or treat a DVT, and keep patients as mobile as possible

Sources   thrombosis/basics/complications/con thrombosis/basics/complications/con   services/dvt services/dvt  interventions/nursing-management-of-deep-vein-thrombosis.htmlhttp://nursingfile.com/nursing-care-plan/nursing- interventions/nursing-management-of-deep-vein-thrombosis.html

Sources  factors/con factors/con    ayment%20Policy%20Toolkit%20(final%20version)% pdf ayment%20Policy%20Toolkit%20(final%20version)% pdf  5q3nv7yWtood7cmOQz6vGNiI7CIU6a6e5JVJ-NnMiQ2zOjATODaIuoTHwdvK7cWrGuOdnzLm62XrDSh=s0-d-e1- ft# 5q3nv7yWtood7cmOQz6vGNiI7CIU6a6e5JVJ-NnMiQ2zOjATODaIuoTHwdvK7cWrGuOdnzLm62XrDSh=s0-d-e1- ft#