Venous Thromboembolism: Symptoms, Treatment & Prevention

It starts off as something simple. Your patient is complaining of leg pain. Their right calf is swollen to twice the size of the left, and it is bright red. Whether your patient has had surgery, suffered trauma, or even has just come off of a long trip in the car, they may be at risk of venous thromboembolism, also known as deep vein thrombosis. It is important to constantly monitor the patient for signs and symptoms of venous thromboembolism and to know about measures for prevention. The prophylaxis for VTE has come a long way in recent years. Hospitals now have dedicated assessments in place to help prevent this sometimes silent condition from taking lives.

Symptoms of Venous Thromboembolism

Although most nurses are trained to look for swelling in one arm or leg over the other, as much as 80 per cent of VTE cases do not present this way. Another sign of venous thromboembolism is pain upon quick dorsiflexion of the foot. This is known as the Homan's sign, and can sometimes tip off a nurse to a possible VTE. The Homan's sign is absent in half of all VTE cases and can sometimes indicate other conditions. Sometimes the only way to know the patient has had a deep vein thrombosis is that they start showing signs of a pulmonary embolism. A pulmonary embolism is a clot that travels from the calf or arm and goes into the lungs. Some signs of the PE include shortness of breath, pleuritic chest pain, an increased breathing rate, and coughing up blood. However, a PE may have no signs or symptoms either, and the patient can just go into cardiac arrest. This is why prevention is the most important step in treating VTE.

Treatment of Venous Thromboembolism

The treatment for venous thromboembolism is aggressive anticoagulation therapy. This usually necessitates a hospital stay for intravenous heparin infusion. A patient would usually need this continuous infusion until their oral warfarin levels became therapeutic enough to prevent clots. New studies show that patients with or without a PE can be started on Lovenox, which is a once or twice daily subcutaneous, injectable heparin. The benefits of this is that this therapy can be done on an outpatient basis. However, the gold standard treatment for VTE is continuous infusion therapy with heparin with conversion to warfarin.

Prevention Measures for VTE

It is important to recognise the patients that are at higher risk for VTE. These patients include surgical patients, trauma patients, those with IVs, those who need injections of irritating substances, history of IV drug abuse, history of prior VTE, immobilisation for more than three days, compression of the iliac or femoral veins, history of congestive heart failure, pregnancy, hormone therapy, malignancy, coagulation issues, and dehydration. Prevention measures can include such things as continuous heparin IVs, subcutaneous Lovenox injections once or twice daily, and even short courses of warfarin. However, there are many nursing interventions that can be performed to prevent VTE. Early ambulation following surgery is absolutely vital to assist in the mobilisation of blood in the legs to prevent clots. Turning and positioning immobilised patients every two hours on schedule can also help prevent clots. Elastic compression hose and sequential stockings are important for those who are bed-bound. These help massage the legs and keep blood flowing to prevent VTE's from forming. The important point to remember with these interventions is that all staff must be trained in how to use them and are instructed to put them on the patient's when they are laying in bed. Using a combination of nursing interventions and pharmacological aids is your best chance of stopping VTE's before they harm your patient.

References

Nursing; Recognizing and Managing: DVT – Deep Vein Thrombosis; Michael W Day; May 2003
http://findarticles.com/p/articles/mi_qa3689/is_200305/ai_n9237660/

RN; DVT: What Every Nurse Should Know; Paula Breen, RN, CRRN; April 2000
http://www.modernmedicine.com/modernmedicine/data/articlestandard/rnweb/342004/114305/article.pdf