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.
1
 Approximately 600,000 experience pulmonary
embolism (PE).
1
 Venous Thromboembolism (VTE) is the term
commonly used to describe both DVT and PE.

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

 Did You Know?

For up to 200,000 of those 200000

with PE, the blood clot in 150000

the lung proves fatal – 100000 Annual

Number of
killing more people than 50000 Deaths

AIDS and breast cancer 0

combined. PE AIDS Breast
Cancer

2-6

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.
 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
 Risk Factors for DVT
7,8

 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. 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.
 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.
 Could Mrs. Smith’s DVT
have been prevented?
 Evidenced based CHEST Guidelines
recommend:
– Identifying hospitalized patients that are at high
risk for developing DVT

 Implementing interventions to prevent DVT

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.
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
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
Physician Order (continued)

If DVT prophylaxis is NOT indicated….

the reason must be identified.
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)