Download Deep Vein Thrombosis

Deep Vein Thrombosis
Josh Vrona, Hunter Dolan, Erin McCann
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Signs and Symptoms of a DVT
S 50% of patients do not have symptoms
S Swelling in leg; red, discolored, or white skin; tachycardia,
fever, warm skin over affected area; aching, tiredness,
tenderness, and leg pain.
Defining the Problem
S DVTs are caused by damage to the inner lining in the vein
S Examples: surgery, serious injuries, inflammatory responses
S Blood Flow becomes slower and sluggish due to a decrease in
motion, which causes the blood to be thicker than normal and
therefore, more likely to clot.
S Contributing factors: genetics, prolonged bed rest, injury, surgery,
pregnancy, birth control pills, HRT, obesity, smoking, cancer,
heart failure, age (>60), inflammatory bowel disease
Defining the Problem
S Complications: Pulmonary Embolism, Postphlebitic syndrome
S Scope of problem: According to the CDC it is thought that as
many as 900,000 people could be affected each year.
S 60-100,000 Americans die of DVT/PE
S Among people who have had a DVT, 50% will have complications
S Surveillance studies have found that the absolute risk of DVT is
10-20% among general medical patients, and up to 40-60% in
patients having hip surgery, knee surgery, or major trauma.
Implications for Patient
S At an increase risk for developing another blood clot
S Need to be aware of new leg pain, swelling, or redness
S Increased risk for bleeding d/t anticoagulant use
S Need to wear an alert bracelet that says they are on
anticoagulants
S Aim to reduce their risk of bleeding
Implications for Institution
S
“In 2001, the Agency for healthcare research and quality began a
campaign to combat med error in order to improve patient safety. The
use of appropriate VTE prophylaxis was included in this.”
S “The National Voluntary Consensus Standards for Prevention and
Care of Venous Thromboembolism is a policy created by the
National Quality Forum that states “Every healthcare organization
shall have a written policy appropriate for its scope that is evidenced
based and that drives continuous quality improvement related to
venous thromboembolism risk assessment, prophylaxis, diagnosis and
treatment.”
Implications for Institution
S The mean hospital cost per readmission for recurrent DVT
was $11,862
S Medicare will no longer pay hospitals for additional costs
considered to be hospital acquired conditions
S Private health care plans and other health care purchasers
have their own nonpayment policies, but most are the same
as Medicare.
Implications for Healthcare
Resources
S Very expensive to care for these patients
S DVT patients average $16,000 more in medical costs than
patients without a DVT.
S If a DVT is the primary diagnosis the average cost is
$10,800
Recommendations
S For patient care: anticoagulants for at least 3 months,
thrombolytic therapy, vena cava filter
S Prevention/prophylaxis: Anticoagulant medications
(heparin, lovenox, coumadin), moving lower legs, bending
knees frequently, getting up to walk as soon as the patient is
able to, pneumatic compression device, elastic stockings
Nursing Role
S Assessment: look for signs and symptoms of a DVT (leg
pain, ankle engorgement, swelling, differences in leg
circumference, temperature changes, feeling of heaviness in
affected limb, Homan’s sign)
S Planning: Take prophylactic measures, get patient up and
walking as soon as possible
Nursing Role
S Interventions: Prophylactic measures, frequent assessment
for signs of a DVT, monitor anticoagulant therapy, monitor
for and manage potential complications (bleeding, PE),
work with PT to get patient up and moving, provide rest and
comfort (if they have a DVT-bed rest, analgesics, warm
compress, elevation of extremity)
S Evaluation: Pt will not develop a DVT, Pt will not develop a
PE, absence of SOB, monitor patients PT and INR
Spectrum’s Initiatives
Education Materials
S Teach them about their medication regimen
S Example: how to take it, complications, when to see a doctor,
blood tests needed
S Teach them how to prevent DVTs
S Walking/moving whenever possible, wearing PCDs,
continuing medications prescribed
S Teach them risk factors and signs that indicate a DVT
Conclusion
S DVTs are a preventable complication
S They are an extremely expensive medical cost so nurses
should take every precaution possible to prevent them
S The nurses responsibilities include assessing the patient for
signs of a DVT, monitoring therapy initiated to prevent or
treat a DVT, and keep patients as mobile as possible
Sources
S http://www.nhlbi.nih.gov/health/health-topics/topics/dvt/causes
S http://www.mayoclinic.org/diseases-conditions/deep-vein-
thrombosis/basics/complications/con-20031922
S http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4379443/
S http://surgery.med.miami.edu/vascular-and-endovascular/patient-care-
services/dvt
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http://nursingfile.com/nursing-care-plan/nursinginterventions/nursing-management-of-deep-vein-thrombosis.html
Sources
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http://www.mayoclinic.org/diseases-conditions/deep-vein-thrombosis/basics/riskfactors/con-20031922
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http://www.uptodate.com/contents/deep-vein-thrombosis-dvt-beyond-the-basics
S
http://www.cmsa.org/portals/0/pdf/CMAG_DVT.pdf
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http://www.nbch.org/nbch/files/ccLibraryFiles/Filename/000000001630/HAC%20P
ayment%20Policy%20Toolkit%20(final%20version)%20081109.pdf
S
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