CARDIOVASCULAR MODULE:

DEEP VENOUS THROMBOSIS THROMBOPHLEBITIS

Adult Medical-Surgical Nursing

Deep Venous Thrombosis (DVT): Description

Occlusion of a major deep vein, usually the deep saphenous by a thrombus or clot, obstructing venous return to the heart

Thrombophlebitis: Description

Inflammation of a vein, associated with thrombus formation

DVT/Thrombophlebitis:Pre-disposing

Factors

Stasis in the circulation from immobilityLong-haul flightsPost-operative immobility*↑ blood viscosityOral contraceptionTraumaCongestive heart failure (circulatory stasis)Smoking

DVT/ Thrombophlebitis: Pathophysiology

Stasis within the circulation orTrauma and inflammation of a vein Lead to →

Thrombus formation which may occlude venous blood flow from peripheries

Thrombophlebitis (inflammation/ thrombi)

DVT/ Thrombophlebitis: Complications

Pulmonary embolism: a common cause of post-operative death

Emboli may break off the thrombus and travel through the venous circulation

→ right side of the heart, and then to the lungs where they lodge and obstruct breathing

Clinical Manifestations

Calf painSwelling of affected leg compared with other

limbInability to freely move the affected leg from

painCalf muscle tense and tender to touchPositive Homan’s test

If thrombophlebitis: redness and heat accompanies painful calf muscle

Pulmonary Embolism: Clinical Manifestations

Acute sudden severe chest painSevere dyspnoea and cyanosisShock: hypotension, tachycardia, sweating,

peripheral shut-down: the patient is “cold and clammy”

Often leads to sudden deathOften occurs post-operatively*

DVT/ Thrombophlebitis: Diagnosis

Patient history and clinical picture

Calf measurements

Homan’s sign positive

Doppler will demonstrate venous blood flow

DVT/ Thrombophlebitis: Prevention

Avoid immobility:Frequent leg exercises post-operatively and

early ambulationAnticoagulant cover for surgery (low

molecular weight heparin)Anti-embolic stockings for surgical and

immobile cases (correct measurement; applied pre-op)

Adequate hydration

DVT/ Thrombophlebitis: Management

Elevate the limb: this assists venous return and reduces swelling

Compression bandage: ↓ risk of emboli (anti-embolic stockings later)

Anticoagulation: IV heparin infusion aims to prevent further

extension of the thrombusAspirin/ oral anticoagulants/ anti-platelets

long-term Thrombolytic agent if very recent

Nursing Responsibilities

Keep leg elevated (no exercise now)Monitor degree of leg oedema/ inflammationEnsure the correct elastic bandage or stocking Vital signsHeparin pumpAdequate hydrationInstruct patient about long-term anticoagulant

therapy: Precautions, regular INR check, carry card to

identify on anticoagulants