Deep Vein Thrombosis (DVT)

Education for Nurses

Objectives

Identify risk factors for the development of

Deep Vein Thrombosis (DVT)

Describe the nurse’s role in DVT prevention

Discuss the process for DVT prophylaxis at LVH

Did You Know?

Up to 2 million people in the United States suffer

from DVT every year. Approximately 600,000 experience pulmonary

embolism (PE). Venous Thromboembolism (VTE) is the term

commonly used to describe both DVT and PE.

1

1

1. Hirsh, Hoak. Circulation. 1996;93:2212-2245.

Did You Know?

For up to 200,000 of those with PE, the blood clot in the lung proves fatal – killing more people than AIDS and breast cancer combined.

2. Bick. Drugs. 2000;60:575-595. 3. Kim, Spandorfer. Emerg Med Clin North Am. 2001;19:839-859. 4. Anderson et al. Arch Intern Med. 1991;151:933-938. 5. Centers for Disease Control. Available at: http://www.cdc.gov. 6. American Cancer Society. Available at: http://www.cancer.org.

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50000

100000

150000

200000

PE AIDS BreastCancer

AnnualNumber ofDeaths

2-6

Oh, I just saw Mrs. Smith in the ER last week with the flu. I

wonder why she was admitted with

DVT!!

Risk Factors for DVT

Medical conditions, such as: Coronary Artery Disease • Heart Failure • Exacerbation of COPD or other severe respiratory

disease • Acute MI • Trauma/Burns • Sepsis • Inflammatory bowel disease • Lupus • Stroke

Illness or injury that causes prolonged immobility Age > 40 Pregnancy, birth control pills and hormone replacement therapy Cancer and its treatment Major surgery (ex: abdomen, pelvis, hip facture, knee fracture, hip or

knee replacement) Surgery time > 30 minutes Obesity Indwelling vascular devices Previous DVT or PE

7,8

7. Geerts et al. Chest. 2001;119(suppl):132S-175S. 8. National Experts’ Consensus Panel for Clinical Excellence in Thrombosis Management.

Available at: http://www.thrombosis-consult.com.

Risk Factors for DVT

I wonder if Mrs. Smith was at risk for

DVT?

Was Mrs. Smith at Risk for DVT?

47 years old She is recuperating from surgery

(abdominal hysterectomy) one month ago.

She was just in the emergency dept. with flu-like symptoms; has spent the last 3 days in bed.

She has a history of Lupus.

Yes! She certainly had several risk factors.The more risk factors a patient has, the greater the risk for DVT.

Evidenced based CHEST Guidelines recommend:

– Identifying hospitalized patients that are at high risk for developing DVT

Implementing interventions to prevent DVT

Could Mrs. Smith’s DVT have been prevented?

Let’s review the important interventions for the prevention of DVT:

Ambulation early and often (simplest and most cost

effective means to reduce risk of DVT) Intermittent External Compression Devices:

Also called sequential compression devices or SCDs They increase rate/velocity of venous blood and

reduce pooling in the peripheral veins Compression should begin pre-operatively and be

continued until the patient is fully ambulatory

Anticoagulant Medication Therapy

Medication for DVT Prevention

Chest Guidelines recommend Enoxaparin for the prevention of DVT.

Enoxaparin:

– Also known by the trade name Lovenox Always administered subcutaneously Usual dose is 40mg per day for medically

ill patients If Creatinine Clearance is <30ml/min,

adjusted dose is 30mg per day

Medication for DVT Prevention

Medication for DVT Prevention

Enoxaparin:

– Also known by the trade name Lovenox Always administered subcutaneously Usual dose is 40mg per day for medically

ill patients If Creatinine Clearance is <30ml/min,

adjusted dose is 30mg per day

What’s happening at Lehigh Valley Hospital?

We are focusing on DVT prophylaxis for all

in-patient admissions. The following screen will be attached to all admission

order screens in Last Word. Requires the physician to place the order for the

appropriate DVT prophylaxis

Physician Order

If DVT prophylaxis is NOT indicated….

the reason must be identified.

Physician Order (continued)

Physician Order (continued)

Reasons why prophylaxis may not be indicated include:

• Patient is fully ambulatory and is expected

to be hospitalized for less than 24 hours • The patient declines DVT prophylaxis • The patient is fully anticoagulated

Physician Order (continued)

• The following screens show: • How the order will appear on the

patient’s active order list• The detail screen for the order

Physician Order (continued)

Physician Order (continued)

Diagnosing DVT

Clinical diagnosis of DVT is unreliable because classic symptoms (pain, swelling, tenderness, and warmth) may not be present.

Therefore it is important for ALL healthcare

professionals to collaborate in the identification of high risk patients and implement prophylaxis.

Patient Education

It is important that our patients are included in the plan for prevention of DVT.

Patient Education

Education material available to our patients includes:

Patient education video “DVT Prevention” available on CCTV

Written material: Learn More About Deep Vein Thrombosis Learn More About Pulmonary Emboli

Remember

Major risk factors for DVT include: heart failure, severe respiratory disease and sepsis.

All patients’ DVT risk factors are identified on admission.

If an acutely ill hospitalized patient has a major risk factor for DVT or is confined to bed and has one or more additional risk factors, then prophylaxis is recommended.

Congratulations

You have completed the DVT learning module.

If you need more information:

Contact your unit Patient Care Specialist (PCS)