DVT Flashcards
Most common complication of DVT
PE
What is an embolus
A blood clot transported by the blood stream
what causes hypercoagulation following major surger
interplay between fluid shifts and stress response
3 inter-related factors in formation of DVTs
- venous stasis (when blood flows too slowly clotting factors accumulate locally and cause coagulation)
- injury to blood vessel wall (cause clots to form)
- Altered blood composition (more platelets than normal or higher clotting factors)
** 2 or more factors needed for thrombus to form
VTE ?
DVT and PE so closely related that the term VTE used to cover both condition
Scottish Patient Safety Programme
Reduce SSI
DVT prophylaxis
team culture
continuation of beta blocker treatment
Symptoms of DVT
Non specific signs: DVT can be missed
Swelling, warmth and redness, pain (worse when standing) venous distension, low grade pyrexia
Treatment of DVT
Suspected DVT: LMWH (subcutaneous fondaparinux alternative)
If thrombolyis considered or if risk of bleeding then IV UFH post op
Reversal agent for Unfractionated Heparin
Protamine
Risk factors for DVT
Patient Factors
Age Obesity Varicose Veins Immobility Long distance travel Pregnancy
Risk factors for DVT
Disease/surgical procedure
Trauma or surgery Malignancy Heart Failure Infection Inflammatory bowel disease Lower limb paralysis
Perioperative Prevention
- Risk assessment
- Administration of prophylactic drugs
- Non pharmacological prophylaxis
- Patient teaching (need to get up and get mobilised with support)
Methods of Prophylaxis
Mechanical
Pharmacological
Mechanical Prophylaxis
Intermittent pneumatic compression
Graduated elastic compression stockings
How do flowtron boots prevent DVT
compress calf and stimulate fibrinolysis (disintegration of fibrin to prevent clotting)
Contraindication to flowtron boots
acute thrombophlebitis or dvt
severe arteriosclerosis
skin condition
ischaemic vascular disease
why shouldnt anticoagulant therapy be given to someone having a spinal or epidural
because of risk of haematoma
Examples of Pharmacological Prophylaxis
- 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 - Thrombolytics
* STreptokinase
Complications following DVT
Pulmonary Embolus
Venous ulceration
Venous insufficiency
Post thrombotic syndrome (chronic leg pain, swelling, dermatitis and ulcers)
A Pulmonary Embolus occurs when
a dislodge thrombus travels from the site of the DVT and lodges within the pulmonary arterial circulation
what is the primary complication of DVT
PE (most preventable cause of death in hospitalised patients0
Treatment of DVT
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
Symptoms of PE
Dyspnoea Tachypnoea Sinus tachycardia Haemoptysis (cough up blood) Chest pain Faintness, collapse Sudden death
Investigations for PE
attach monitoring ECG Chest Xray Arterial blood gas Perfusion/ventilation lung scans pulmonary angiography (invasive bur gives definite diagnosis)
Definition of DVT
Thrombus in deep vein. Symptoms pain and swelling but can be painless.
