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Venous Procedure > Venous Week 6 > Flashcards

Venous Week 6 Flashcards

1
Q

What are treatments for a DVT based on?

A

They are based on a patient’s medical conditions and history.

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2
Q

What does anti-coagulation mean?

A

Blood thinners.

“Anti”→ means againts

“Coagulation”→ means blood clot.

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3
Q

What are anti-coagulation medication used for?

A

They are used to prevent the coagulation or clotting of blood by thinning the blood and changing the clotting factors in the blood.

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4
Q

Who are anti-coagulation medication given to?

A
  • Patients has been diagnosed with a DVT/blood clot.
  • Prevenative (prophylactically) care for a patient who is at high risk for a DVT/blood clot.
    • Patients having an orthepedic surgery.
    • Patients who are critically ill or have been hospitilzed for long periods of time.
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5
Q

What are the two most common blood thinners used to treat DVT?

A
  • Heparin
  • Coudamin
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6
Q

How is Heparin administered?

A

Intravenous.

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7
Q

How is coudamin administered?

A

Orally.

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8
Q

What does heraprin do?

A

It prevents extension and embolization of thrombus.

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9
Q

Does herparin dissolve a blood clot?

A

It does not dissolve a blood clot.

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10
Q

Where is heparin administered?

A

It is administered in a hopsital setting only.

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11
Q

When is heparin usually given in the hospital?

A

It is often given at the bedside “prophylactically” to prevent blood clots in sick and bedridden patients.

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12
Q

What are some of the negatives of heparin?

A
  • Wear off quickly and does not last long.
  • Uncomfortable for the patient.
    • Injection.
    • Burns when administered.
    • Bruising.
  • HIT (heparin induced thrombocytopenia)
    • It causes a significant drop in platelet count resulting in hypercoaguability.
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13
Q

What is HIT?

(Heparin Induced Thrombocytopenia)

A
  • Causes platelet drop and results in hypercoagulability.
    • This a paradoxical reaction= opposite affect.
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14
Q

What happens to patients who become HIT positive?

A

They are extremely at risk for clotting.

This can be life and limb threatening.

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15
Q

What medication is a low molecular weight heparin?

A

Lovenox

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16
Q

How can Lovenox be administered?

A

It is administered subcutaneously.

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17
Q

Where can Lovenox be administered?

A

It can be administered at outpatient centers, and be given to themselves in their own home.

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18
Q

Why is the low molecular weight heparin perferred?

A
  • Fewer complications.
  • Effects last longer than heparin.
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19
Q

What are some of the negatives of Lovenox?

A
  • HIT can occur but with much less risk than heparin.
  • Uncomfortable for patient.
    • injection.
    • causes bruising.
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20
Q

What is the most common ORAL anticoagulant?

A

Coumadin AKA warfarin.

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21
Q

What is the difference between coumadin and heparin?

A

Coumadin→orally→.administered in an outpatient setting.

Heparin→intravenous→administred in hospital settings

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22
Q

Is coumadin short term or long term?

A

It is used long term. (can be lifelong)

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23
Q

What is coumadin used for?

A
  • Treatment of DVT & PE
  • Also used to treat arterial thrombosis.
  • Patient with arterial bypass grafts.
  • For patients who have artial fibrilation. (higher risk for forming clots in the heart.)
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24
Q

Does coumadin break up or dissolve a thrombus?

A

no, it does not but it prevents the formation of thrombus or the extension of a thrombus.

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25
Q

What are some of the negatives of coumadin?

A
  • Slow onset.
    • takes approx. 36 hrs to become effective.
  • Slow offset
    • takes approx. 2 days to wear off
  • Vitamin K contraindicates effects (lessens or makes ineffective.)
  • Patients blood needs to be constantly monitored.
  • Dosage often changes due to lab values.
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26
Q

While taking coumadin, the blood needs to be monitored very closely to make sure?

A
  • The anticoagulation is effective & working.
  • The blood is not getting to thin.
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27
Q

How often is blood monitored to make sure there isnt any adverse effects from coumadin?

A

weekly.

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28
Q

What is some of the blood work that is done to check for any adverse affects from coumadin?

A
  • Prothrombrin time (measures how fast blood is clotting)
  • INR/international noromalization ratio (measures how fast blood is clotting)
  • PPT/Partial prothrombin time (detects clotting abnormalities)
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29
Q

What are some of the newly approved oral anticoagulants?

A
  • Xarelto
  • Pradaxa
  • Eliquis
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30
Q

Do the newer approved anticoagulants require extreme montioring like coumadin does?

A

No.

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31
Q

What are 3 treatmeants for a DVT?

A
  • Transcatheter Thrombolysis
  • Venous Thrombectomy
  • IVC filters
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32
Q

What does a transcatheterthrombolysis do?

A
  • “Lyse” means to dissolve or break down.
  • A catheter is inserted within the leg and medication is administered directly into the clot.
  • GOAL: Rapidly dissolve the clot and restore flow.
33
Q

Where are thrombolytics usually used in?

A

Used in larged veins of the iliofemoral level or for extensive occlusion DVT.

34
Q

What is the most common thrombolytic?

A

TPA (tissue plasminogen activator)

35
Q

What is a venous thrombectomy?

A
  • Surgical removal of thrombus.
  • “thromb” means clot or thrombus
  • “ectomy” means to remove
36
Q

What is an IVC filter?

A
  • Metal umbrella-like structure.
  • It is inserted through a peripheral artery.
  • Placed in the inferior vena cava.
  • It acts as a basket case or net that catched emboli coming from the leg.
  • It prevents emboli from traveling to the lungs.(pulmonary embolis)
37
Q

Do IVC filters treat DVT?

A

No, but they prevent the primary complications.

(Pulmonary Embolism)

38
Q

Who usually gets an IVC filter?

A

Patients who…

  • Cannot be anticoagulated.
  • At high risk for DVT and undergoing surgery.
39
Q

How long can permanent IVC filters be left?

A

Can be left for a period of time.

40
Q

Are IVC filters hard to remove?

A

No, they are easily placed and removed.

41
Q

What must a patient undergo before getting their IVC filter replaced/removed?

A

Patients will undergo a venous duplex exam of the legs before their filter gets removed to make sure there are no acute clots in the legs.

42
Q

What are some side effects from a temportary IVC filter?

A

If left too long and/or the struts break or the filter migrates, it can lead to:

  • Puncture
  • Embolism
43
Q

What is a venous disease?

A

Issues and/or conditions with the veins other than DVT.

44
Q

What are some venous disease or conditions that may be results of DVT?

A
  • Phlegmasia Alba Dolens.
  • Phlegmasia Cerulea Dolens
  • Venous Gangrene.
  • Postphlebitic Syndrome (venous insufficiency)
45
Q

Know the abdominal anatomy:

A
46
Q

What is May-Thurner syndrome?

A
  • Left common illac vein is compressed against the L5 vertebrae by the right common illac artery.
    • results in “extrinsic compression”
      • compression can be caused by:
        • enlarged lymph nodes
        • tumor
        • ect.
47
Q

What are the risk factors for May-Thurner syndrome ?

A
  • middle aged.
  • Postpartum
  • Female occurence is greater than in male.
48
Q

What do patients with May-Thurner syndrome present with?

A
  • Unilateral left leg swelling.
  • DVT in left leg.
49
Q

How is May-Thurner diagnosed by?

A
  • Duplex Ultrasound
    • visualize compressions
    • diagnose DVT
    • follow up with patients who have May-Thurner syndrome.
  • CT angiography
  • Venography
50
Q

What are the treatments for May-Thurner syndrome?

A
  • Anticoagulation.
  • Endovascular treatment.
  • Surgery.
51
Q

How is an endovascular treatment done for May-Thurner syndrome?

A
  • It is done with a catheter inserted into the groin vessel.
  • Balloon angioplasty and stenting of the left common illiac vein.
  • Place an IVC filter
52
Q

How is surgery done for the treatment of May-Thurnery syndrome?

A
  • Bypass (from IVC to left common illiac)
  • Transposition of the right common illiac artery (remove or reposition)
53
Q

What is Phlegmasia Alba Dolens?

A
  • It is the decrease of venous drainage as a result of acute illiofemoral DVT.
  • Capillary circulation is obscurred by edema resulting in arterial spasms.
54
Q

What are the causes of Phlegmasia Alba Dolens?

A
  • Hypercoaguability
  • Extensive venous thrombosis
55
Q

What are the risk factors for Phlegmasia Alba Dolens?

A
  • Middle Age
  • Pregnancy
  • Occurs in females more than males.
56
Q

What are the physical characterisitics of Phlegmasia Alba Dolens?

A
  • Swollen
  • Pale “white” discoloration of the leg.
  • Cool to the touch.
  • Pulseless
57
Q

What are the treatments for Phlegmasia Alba Dolens?

A
  • Anticoagulation
  • Compression stockings
  • Thrombolytics
  • Thromboectomy
  • Amputation
58
Q

What is Phlegmasia CURULEA Dolens?

A

It is massively decreased venous return due to extensive DVT at multiple levels.

(illiofemoral, calf and their collaterals)

59
Q

How is the venous flow affected by Phlegmasia Cerulea Dolens?

A

It is vastly obstructed therefore reducing arterial flow.

60
Q

What are the causes of Phlegmasia Cerulea Dolens?

A
  • Hypercoguability
  • Trauma
  • Cancer
61
Q

What are the risk factors for Phlegmasia Cerulea Dolens?

A
  • Middle aged
  • Post-OP
  • Occurs in females more than males
  • May-Thurner syndrome
62
Q

What are the physical characteristics of Phlegmasia Cerulea Dolens?

A
  • Blue discoloration to the leg.
  • Cool to the touch
  • Swollen
  • Absent arterial pulses
63
Q

What are the treatments of Phlegmasia Cerulea Dolens?

A
  • Thromboectomy
  • Amputation
  • Thrombolytics
  • Aggressive anticoagulation
  • Extensive leg elevation.
64
Q

What is venous gangrene?

A

Venous gangrene is the actual necrosis of the tissue due to the massive venous outflow and arterial inflow obstructions.

65
Q

What causes venous gangrene?

A
  • No venous return or blood leaving the leg.
  • No arterial circulation getting to the tissue via capillaries.

This results in tissue death.

66
Q

What can be a result from Phlegmasia Cerulea Dolens?

A

Venous gangrene

67
Q

What is venous insufficiency known as?

A

Postphlebetic Syndrome.

68
Q

When is there venous insufficiency?

A

Occurs when there is poor venous return due to non-functioning valves.

69
Q

What are the mechanisms of venous insufficiency?

A
  • The non-functioning valves results in the inability for the blood to travel proximally to the heart (valvular incompetence)
70
Q

What does valvular incompetence result in?

A

Results in increased ambulatory(standing) venous pressure.

(venous hypertension)

71
Q

What is the path of the blood?

A

Arteries→Arterioles (O2 gets transferred to tissue)→Capillaries→Venules→Veins

72
Q

When venous pressure increases, what happens to the microvasculature (venules and capillaries) pressure?

A

It increases, which results in edema and red blood cells getting released into the tissue.

73
Q

What happens when RBC break down in the tissues?

A

Hyperpigmentation occurs which is called lipodermatosclerosis.

74
Q

What causes ulceration?

A

O2 being absorbed into the tissues.

75
Q

Where does venous insufficiency typically occur?

A

In the gaiter area.

76
Q

What is considered the gaiter area?

A

Between the calf and ankle.

77
Q

Approximately, How many people suffer from venous insufficiency?

A

500,000

78
Q

What are the risk factors for venous insufficiency/postphlebetic syndrome?

A
  • Anything that causes damages to a valve will causes valvular incompetence and subsequent insufficiency.
  • Venous thrombosis (DVT)→80% of patient with DVT will get a CVI
  • Occupations that require long sessions of standing or sitting.
  • Female
  • Genetic/Family history
  • Age
  • Pregnancy
79
Q

What are the treatments of venous insuffiency?

A
  • Compression stockings (decrease venous pressure)
  • Leg elevation
  • Bandaging and proper skin care with ulceration
  • Sclerotherapy
  • Vein stripping (removal of superficial veins)
  • RFA (radiofrequency ablation) of GSV, SSV, or perforaters.

Venous Procedure (5 decks)

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