DVT

Question 1

Most common complication of DVT

Answer 1

PE

Question 2

What is an embolus

Answer 2

A blood clot transported by the blood stream

Question 3

what causes hypercoagulation following major surger

Answer 3

interplay between fluid shifts and stress response

Question 4

3 inter-related factors in formation of DVTs

Answer 4

1. venous stasis (when blood flows too slowly clotting factors accumulate locally and cause coagulation)
2. injury to blood vessel wall (cause clots to form)
3. Altered blood composition (more platelets than normal or higher clotting factors)

** 2 or more factors needed for thrombus to form

Question 5

VTE ?

Answer 5

DVT and PE so closely related that the term VTE used to cover both condition

Question 6

Scottish Patient Safety Programme

Answer 6

Reduce SSI
DVT prophylaxis
team culture
continuation of beta blocker treatment

Question 7

Symptoms of DVT

Answer 7

Non specific signs: DVT can be missed

Swelling, warmth and redness, pain (worse when standing) venous distension, low grade pyrexia

Question 8

Treatment of DVT

Answer 8

Suspected DVT: LMWH (subcutaneous fondaparinux alternative)

If thrombolyis considered or if risk of bleeding then IV UFH post op

Question 9

Reversal agent for Unfractionated Heparin

Answer 9

Protamine

Question 10

Risk factors for DVT

Patient Factors

Answer 10

Age
Obesity
Varicose Veins
Immobility
Long distance travel
Pregnancy

Question 11

Risk factors for DVT

Disease/surgical procedure

Answer 11

Trauma or surgery
Malignancy
Heart Failure
Infection
Inflammatory bowel disease
Lower limb paralysis

Question 12

Perioperative Prevention

Answer 12

1. Risk assessment
2. Administration of prophylactic drugs
3. Non pharmacological prophylaxis
4. Patient teaching (need to get up and get mobilised with support)

Question 13

Methods of Prophylaxis

Answer 13

Mechanical

Pharmacological

Question 14

Mechanical Prophylaxis

Answer 14

Intermittent pneumatic compression

Graduated elastic compression stockings

Question 15

How do flowtron boots prevent DVT

Answer 15

compress calf and stimulate fibrinolysis (disintegration of fibrin to prevent clotting)

Question 16

Contraindication to flowtron boots

Answer 16

acute thrombophlebitis or dvt
severe arteriosclerosis
skin condition
ischaemic vascular disease

Question 17

why shouldnt anticoagulant therapy be given to someone having a spinal or epidural

Answer 17

because of risk of haematoma

Question 18

Examples of Pharmacological Prophylaxis

Answer 18

1. Anticoagulants (delays, suppresses/prevents blood clotting)
   * Standard Unfractionated Heparin (UFH) - protamine reversal*
   * Low molecular weight heparin (LMWH) - most common effects last longer than unfractionated heparin - cant be reversed
   * Warfarin (oral)
   * Fondaparinux
   * Dextrans 40 and 70
   * Aspirin
2. Thrombolytics
   * STreptokinase

Question 19

Complications following DVT

Answer 19

Pulmonary Embolus
Venous ulceration
Venous insufficiency
Post thrombotic syndrome (chronic leg pain, swelling, dermatitis and ulcers)

Question 20

A Pulmonary Embolus occurs when

Answer 20

a dislodge thrombus travels from the site of the DVT and lodges within the pulmonary arterial circulation

Question 21

what is the primary complication of DVT

Answer 21

PE (most preventable cause of death in hospitalised patients0

Question 22

Treatment of DVT

Answer 22

IV loading dose of Heparin, followed by continuous infusion or intermittent sub cut injection. Continue heparin for 5 days and until INR in therapeutic range for 2 consecutive days. Lab monitoring on daily basis essential. INR should be less than 1.2

Question 23

Symptoms of PE

Answer 23

Dyspnoea
Tachypnoea
Sinus tachycardia
Haemoptysis (cough up blood)
Chest pain
Faintness, collapse
Sudden death

Question 24

Investigations for PE

Answer 24

attach monitoring
ECG
Chest Xray
Arterial blood gas
Perfusion/ventilation lung scans
pulmonary angiography (invasive bur gives definite diagnosis)

Question 25

Definition of DVT

Answer 25

Thrombus in deep vein. Symptoms pain and swelling but can be painless.