Thromboembolic Disease- Deep Vein Thrombosis (DVT) for Certified Emergency Nursing (CEN)
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Outline
Thromboembolic Disease- Deep Vein Thrombosis (DVT)
Definition/Etiology:
Thromboembolic disease is the formation of blood clot which blocks a blood vessel. Clots can form due to hereditary or acquired factors. Patients often have multiple causes.
- Veins are a low-pressure system, and any blood that pools or stagnates can clot.
- Long flights or sedentary periods (post-op bedrest) can cause blood to pool in the legs.
- Dehydration, leukemia, and sickle cell disease increase viscosity (thickens the blood) and makes clotting more likely.
- Genetic disorders can make certain people clot more than others: Factor V Leiden, Protein C deficiency, Protein S deficiency, Antiphospholipid Syndrome, Anticardiolipin, etc.
- Hormone supplements such as testosterone and estrogen can increase clotting and should be avoided in smokers and in patients with genetic predisposition.
- Varicose veins can increase stagnation of blood.
- Injury to vessels (IVs, central lines) can precipitate clot.
- Cancers of all types can increase risk of clot formation.
Pathophysiology:
Hereditary vs. acquired
Virchow Triad:
- Alteration in blood flow (stasis, bedrest, flight)
- Vascular injury (central line)
- Inherited or acquired hypercoagulable state (cancer, genetic disorder, dehydration)
Clinical Presentation:
DVT:
- Pain
- Isolated edema in limb
- Erythema
PE:
- Pleuritic chest pain
- Impending doom
- Dyspnea
CVA (FAST mnemonic):
- Face (unequal smile)
- Arm drift
- Speech slurred
- Time (of onset)
Collaborative Management:
Testing:
- PT/INR, PTT, D-dimer
- Ultrasound
- CT angiogram
- VQ scan
- Echocardiogram with bubble study
Interventions:
- Heparin gtt or low molecular weight heparin
- Initiate oral anticoagulation
- IVC filter can be considered
- Interventional radiology for thrombectomy (clot snare), drip thrombolytic (clot buster)
- Compression stockings
Management:
- 3-6 months of anticoagulation vs lifetime
Evaluation | Patient Monitoring | Education:
- Teach patient signs and symptoms of gastrointestinal bleeding.
- Monitor labs (CBC for all, INR if on Warfarin, PTT if on Heparin).
- Teach patient about dietary considerations if on Warfarin (vitamin K foods), and to be aware that certain antibiotics can increase INR if also on Warfarin.
Linchpins: (Key Points)
- Blood clots can cause death if they travel and cause pulmonary embolism or stroke.
- Virchow Triad (spokes):
- Stasis
- Vascular injury
- Hypercoagulable state (Inherited or acquired)
Transcript
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References:
- Bauer, K. A. (2022, August 9). Overview of the causes of venous thrombosis. UpToDate. https://www.uptodate.com/contents/overview-of-the-causes-of-venous-thrombosis
- Lip, G. Y. H. (2022, April 7). Overview of the treatment of lower extremity deep vein thrombosis (DVT). UpToDate. https://www.uptodate.com/contents/overview-of-the-treatment-of-lower-extremity-deep-vein-thrombosis-dvt
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