1. Venous Thromboembolism
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. 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

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. 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)

12. 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 with additional risk factors
Highest risk – pt with multiple risk factors, hip or knee arthroplasty and spinal cord injury

13. 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

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