DVT/ VTE Update

1

• 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 gt 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 Virchows 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 Homans sign- calf pain on dorsiflexion
  ( not all patients 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 agelt40 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 gt60, pt age 40-60 with
  additional risk factors
• Highest risk pt with multiple risk factors, hip
  or knee arthroplasty and spinal cord injury

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SMH DVT/VTE Prophylaxis Order SetObtain 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
• SCD at all times except when ambulating
• 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