CARDIOVASCULAR MODULE: DEEP VENOUS THROMBOSIS THROMBOPHLEBITIS Adult Medical-Surgical Nursing

Deep Venous Thrombosis (DVT): Description Occlusion of a major deep vein, usually the deep saphenous by a thrombus or clot, obstructing venous return to the heart

Thrombophlebitis: Description Inflammation of a vein, associated with thrombus formation

DVT/Thrombophlebitis:Pre-disposing Factors Stasis in the circulation from immobility Long-haul flights Post-operative immobility* ↑ blood viscosity Oral contraception Trauma Congestive heart failure (circulatory stasis) Smoking

DVT/ Thrombophlebitis: Pathophysiology Stasis within the circulation or Trauma and inflammation of a vein Lead to → Thrombus formation which may occlude venous blood flow from peripheries Thrombophlebitis (inflammation/ thrombi)

DVT/ Thrombophlebitis: Complications Pulmonary embolism: a common cause of post- operative death Emboli may break off the thrombus and travel through the venous circulation → right side of the heart, and then to the lungs where they lodge and obstruct breathing

Clinical Manifestations Calf pain Swelling of affected leg compared with other limb Inability to freely move the affected leg from pain Calf muscle tense and tender to touch Positive Homan’s test If thrombophlebitis: redness and heat accompanies painful calf muscle

Pulmonary Embolism: Clinical Manifestations Acute sudden severe chest pain Severe dyspnoea and cyanosis Shock: hypotension, tachycardia, sweating, peripheral shut-down: the patient is “cold and clammy” Often leads to sudden death Often occurs post-operatively*

DVT/ Thrombophlebitis: Diagnosis Patient history and clinical picture Calf measurements Homan’s sign positive Doppler will demonstrate venous blood flow

DVT/ Thrombophlebitis: Prevention Avoid immobility: Frequent leg exercises post-operatively and early ambulation Anticoagulant cover for surgery (low molecular weight heparin) Anti-embolic stockings for surgical and immobile cases (correct measurement; applied pre-op) Adequate hydration

DVT/ Thrombophlebitis: Management Elevate the limb: this assists venous return and reduces swelling Compression bandage: ↓ risk of emboli (anti- embolic stockings later) Anticoagulation: IV heparin infusion aims to prevent further extension of the thrombus Aspirin/ oral anticoagulants/ anti-platelets long- term Thrombolytic agent if very recent

Nursing Responsibilities Keep leg elevated (no exercise now) Monitor degree of leg oedema/ inflammation Ensure the correct elastic bandage or stocking Vital signs Heparin pump Adequate hydration Instruct patient about long-term anticoagulant therapy: Precautions, regular INR check, carry card to identify on anticoagulants