DEEP VEIN THROMBOSIS (DVT)

WHAT IS DEEP VEIN THROMBOSIS?

It is the development of great in the deep veins of or pelvis. DVT is potentially because it may lead embolism. thrombi in the the extremities life-threatening to pulmonary

PATHOPHYSIOLOGY
Virchows Triad Stasis of blood Vessel damage Increased blood coagulability Endothelial injury due to central venous catheters, pacemakers, or injection drug use. Hypercoagulable state or subclavian vein compression at the thoracic outlet.

Vessel trauma stimulates the clotting cascade Platelets aggregate at the site particularly when venous stasis present

PATHOPHYSIOLOGY
Platelets and fibrin form the initial clot Inflammation is triggered , FIBROSIS Tendernes s Swelling Erythema RBC are trapped in the fibrin meshwork

The thrombus propagates in the direction of the blood flow

Enlarging clot may occlude the vessel lumen partially or totally and may detach and lodge elsewhere in the systemic circulation

Pulmonary Embolism

Chronic venous insufficiency

Postphlebitic syndrome

CAUSES
It is caused by Virchows triad
Vessel wall injury (e.g. cigarette smoking) Venous stasis (e.g. prolonged bed rest) hypercoagulability of the blood (e.g. use of contraceptive pills, dehydration, hyperglycemia) * note: For a DVT to occur, at least two among the triad should be presented by the patient. (Nursing Crib)

Clinical Manifestations of DVT

Usually non specific. The exception is Phlegmasia cerula dolens. Deep Veins With obstruction of the deep vein comes edema and swelling of the extremity because the outflow of venous blood is inhibited. signs and symptoms of a pulmonary embolus are the first indication of DVT. Superficial Veins Thrombosis of superficial veins produces pain or tenderness, redness and warmth in the involved area. The risk of the superficial venous thrombi becoming dislodged or fragmenting into emboli is very low because most of them dissolve spontaneously

Clinical Manifestations of DVT

Calf pain (+ Homans sign)

* Response: Pain in the calf with this maneuver may be consistent with the diagnosis of deep venous thrombosis.

Clinical Manifestations of DVT

Tenderness Palpable induration (redness) along the course of vein Edema

DIAGNOSIS
possibly a positive Homans sign ( Duplex Doppler Ultrasonography and impedance plethysmography Plethysmography and/or Phlebography

COLLABORATIVE MANAGEMENT
Medical Management
Pharmacologic Treatment
Anticoagulants - Used in clients with venous and arterial disorders that put them at high risk for clot formation
Heparin it inhibits the action of thrombin; conversion of fibrinogen to fibrin does not occur and the formation of a fibrin clot is prevented. Coumadin inhibits hepatic synthesis of Vitamin K, thus affecting the clotting factors II, VII, IX and X.

COLLABORATIVE MANAGEMENT
Medical Management
Pharmacologic Treatment
Thrombolytics - It disintegrates blood clot (thrombus)
Unlike heparins, catheter directed thrombolytic therapy lyses and dissolves thrombi in atleast 50 % of cases. Advantage: It includes less long-term damage to the venous valves and a reduced incidence of postthrombic syndrome and chronic venous insufficiency. Disadvantage: Thrombolytic therapy results in a threefold greater incidence of bleeding than heparin. If bleeding occurs and cannot be stopped, the thrombolytic agent is discontinued.

COLLABORATIVE MANAGEMENT
Surgical Management
Thromboembolectomy Greenfield vena cave filter and umbrella filter

NURSING MANAGEMENT
MANAGEMENT (for patients taking up anticoagulants) Assess and Monitor anticoagulant therapy Monitor and manage potential Bleeding Since the principal complications such as Bleeding, complication of anticoagulant therapy is Thrombocytopenia and Drug interactions spontaneous bleeding. Thrombocytopenia Monitor platelet count because a complication of heparin therapy may include Heparin induce Thrombocytopenia. Drug Interaction Oral anticoagulants interact with many other medications and herbal and nutritional supplements, close monitoring of the patients medication schedule is necessary RATIONALE

NURSING MANAGEMENT
MANAGEMENT Maintain tissue perfusion. *Check pulse distal to the site of the To assess for circulatory blockage thrombosis. RATIONALE

*Elevate legs

To promote venous return and to prevent edema To prevent venous stasis.

*The nurse should also instruct the client that walking is better than standing or sitting for long periods.

*Monitor calf pain.

Presence of calf thrombophlebitis.

pain

indicates

NURSING MANAGEMENT
MANAGEMENT RATIONALE

Provide comfort.
Apply warm, moist packs to the To reduce the discomfort associated with DVT. affected extremity. To prevent venous stasis. Encourage the client to walk once anticoagulation therapy has been

initiated.

For pain relief

Administration of analgesic agents.