1. Deep Vein Thrombosis
Presented By
Monika Devi
Msc.(N)
HCN, SRHU

2. Deep vein thrombosis is a part of a condition called venous
thromboembolism. Deep vein thrombosis occurs when a blood clot
(thrombus) forms in one or more of the deep veins in the body, usually in
the legs. Deep vein thrombosis can cause leg pain or swelling, but may
occur without any symptoms. Deep vein thrombosis is a serious condition
because blood clots in the veins can break loose, travel through the
bloodstream, and obstruct the lungs, blocking blood flow.
Introduction

3. Clinical Manifestations

4. Clinical Manifestations
Edema. With obstruction of the
deep veins comes edema and
swelling of the extremity
because the out flow of venous
blood is inhibited

5. Clinical Manifestations
Tenderness. Tenderness, which
usually occurs later, is produced
by inflammation of the vein wall
and can be detected by gently
palpating the affected extremity.

6. • Pulmonary embolus. In
some cases, signs and
symptoms of a
pulmonary embolus are
the first indication of
DVT.
Clinical Manifestations

7. Clinical Manifestations
Phlegmasia cerulea dolens. Also called massive iliofemoral venous
thrombosis, the entire extremity becomes massively swollen, tense,
painful , and cool to the touch.

8. Pathophysiology
Reduced blood flow
Venous stasis occurs when blood flow is reduced, when veins are dilated,
and when skeletal muscle contraction is reduced.
Damage
Damage to the intimal lining of blood vessels creates a site for clot
formation.
Phlebitis
Formation of a thrombus frequently accompanies phlebitis, which is an
inflammation of the vein walls.

9. Platelet aggregates
Venous thrombi are aggregates of platelets attached to the vein wall that
have a tail-like Appendage containing fibrin, white blood cells, and many
red blood cells.
Tail
The “tail” can grow or can propagate in the direction of the blood flow as
successive layers of the thrombus form
CONT…

10. CONT…..
Fragmentation
Fragmentation of the thrombus can occur spontaneously as it dissolves
naturally, or it can occur with an elevated venous pressure.
Recanalization
After an acute episode of DVT, Recanalization or reestablishment of the
lumen of the vessel typically occurs.

11. Assessment and Diagnostic Findings
Detecting early signs of venous disorders of the lower extremities may be
possible through:
• Doppler ultrasound. The tip of the Doppler transducer is positioned at a
45- to 60-degree angle over the expected location of the artery and angled
slowly to identify arterial blood flow.
• Computed tomography. Computed tomography provides cross-sectional
images of soft tissue and visualizes the area of volume changes to an
extremity and the compartment where changes take place.

12. Prevention
Deep vein thrombosis can be prevented, especially if patients who are considered
high risk are identified and preventive measures are instituted without delay.
• Graduated compression stockings. Compression stockings prevent
dislodgement of the thrombus.
• Pneumatic compression device. Intermittent pneumatic compression devices
increase blood velocity beyond that produced by the stockings.
• Leg exercises. Encourage early mobilization and leg exercises to keep the
blood circulating adequately

13. Complications
The following complications should be monitored and managed:
• Bleeding. The principal complication of anticoagulant therapy is spontaneous
bleeding, and it can be detected by microscopic examination of urine.
• Thrombocytopenia. A complication of heparin therapy may be heparin-
induced thrombocytopenia, which is defined as a sudden decrease in platelet
count by at least 30% of baseline levels.
• Drug interactions. Because oral anticoagulants interact with many other
medications and herbal and nutritional supplements, close monitoring of the
patient’s medication schedule is necessary.

14. The objectives for treatment of DVT are to prevent thrombus from growing and
fragmenting,
• Recurrent thromboemboli, and post thrombotic syndrome.
• Endovascular management. Endovascular management is necessary for dvt
when anticoagulant or thrombolytic therapy is contraindicated, the danger of
pulmonary Embolism is extreme, or venous drainage is so severely
compromised that permanent damage to the extremity is likely.
• Vena cava filter. A vena cava filter may be placed at the time of
thromboectomy; this filter traps late emboli and prevents pulmonary emboli.
Medical Management

15. Pharmacologic Therapy
Measures for preventing or reducing blood clotting within the vascular system are
indicated in patients with deep vein thrombosis.
• Unfractionated heparin. Unfractionated heparin is administered
subcutaneously to prevent development of DVT, or by intermittent or
continuous IV infusion for 5 days to prevent the extension of a thrombus and the
development of new thrombi.
• Low-molecular-weight heparin (LMWHs). Subcutaneous LMWHs that may
include medications such as dalteparin and enoxaparin are effective treatments
for some cases of DVT; they prevent the extension of a thrombus and
development of new thrombi.

16. Cont…
• Oral anticoagulants. Warfarin is a vitamin K antagonist that is indicated
for extended coagulant therapy.
• Factor Xa inhibitor. Fondaparinux selectively inhibits factor Xa.
• Thrombolytic therapy. Unlike heparins, catheter-directed thrombolytic
therapy lyses and dissolves thrombi in at least 50% of patients.

17. Nursing Assessment
Assessment of a patient with deep vein thrombosis includes:
• physical examination
• Well’s diagnostic algorithm. Because of the unreliability of clinical
features, Well’s diagnostic algorithm has been validated whereby patients
are classified as having a high, intermediate, or low probability of
developing DVT.

18. Well’s diagnostic algorithm

19. Nursing Diagnosis
Based on the assessment data, the major nursing diagnoses are:
1. Ineffective tissue perfusion related to interruption of venous blood
flow.
2. Impaired comfort related to vascular inflammation and irritation.
3. Risk for impaired physical mobility related to discomfort and safety
precautions.
4. Deficient knowledge regarding Pathophysiology of condition related to
lack of information and misinterpretation.

20. Nursing Interventions
The major nursing interventions that the nurse should observe are:
• Provide comfort. Elevation of the affected extremity, graduated compression
stockings, warm application, and ambulation are adjuncts to the therapy that can
remove or reduce discomfort.
• Compression therapy. Graduated compression stockings reduce the caliber of
the superficial veins in the leg and increase flow in the deep veins; external
compression devices and wraps are short stretch elastic wraps that are applied
from the toes to the knees in a 50% spiral overlap; intermittent pneumatic
compression devices increase blood velocity beyond that produced by the
stockings.

21. Nursing Interventions
• Positioning and exercise. When patient is on bed rest, the feet and
lower legs should be elevated periodically above the level of the heart
and active and passive leg exercises should be performed to increase
venous flow.

22. Discharge and Home Care Guidelines
The nurse must also promote discharge and home care to the patient.
• Drug education. The nurse should teach about the prescribed anticoagulant, its
purpose, and the need to take the correct amount at the specific times prescribed.
• Blood tests. The patient should be aware that periodic blood tests are necessary to
determine if a change in medication or dosage is required.
• Avoid alcohol. A person who refuses to discontinue the use of alcohol should not
receive anticoagulants because chronic alcohol intake decreases their
effectiveness.
• Activity. Explain the importance of elevating the legs and exercising adequately

23. Summary
In this topic we discussed about the deep vein thrombosis its
Pathophysiology, causes, clinical manifestations,
prevention, diagnostics findings, , medical management,
surgical management and nursing management prevention
and home care guidelines.

24. References
• Deep vein thrombosis (pe) oxford handbook of cardiology second edition
2012 page no. 738 , 740.
• Deep vein thrombosis, textbook of cardiovascular & thoracic nursing p
Hariprasath first edition 2016. Page no. 366.
• Deep vein thrombosis, cardiac surgery kirklin/barratt-boyes fourth edition
2013, page no. 1028, 1034, 1038.
• Deep vein thrombosis, cardiology emergencies brown, jay mazel oxford
copyright 2011 page no. 162 – 165.
• Deep vein thrombosis adult cardiac surgery nursing care and
management, whurr publishers ltd first published 2002 page no.
Pulmonary embolism, 176.

25. THANK YOU