deep venous thrombosis/ thrombophlebitis by dr. hanan said ali

Deep Venous Thrombosis/Thrombophlebitis

ByDr. Hanan Said Ali

Learning Objectives

Define deep venous thrombosis. Mention aetiology of deep venous

thrombosis. Identify Pathophysiology of deep venous

thrombosis. Enumerates clinical manifestations of deep

venous thrombosis. List Complication. Describe the treatment & nursing care for

client with deep venous thrombosis.


The most common venous disorder, results from incompetent valves in the veins and obstruction of venous return to the heart usually results in a thrombus.

The formation of thrombus(clot) in association with inflammation of the veins is called “Thrombophlebitis”


AetiologyVenous thrombosis typically results from at

least one element of Virchow triad: Venous stasis Damage to the endothelial lining of the vein Hypercoagulopathy.

Risk factors for deep vein thrombosis Advanced age-the elderly typically have a

number of risk factors.


Risk factors for deep vein thrombosis Cont. Gender-DVT occurs more often in women.

Positive history of thromboses.

Immobility/ stasis Surgery, bed rest, paralysis, fractured hip. Prolonged sitting. Obesity and pregnancy.


Risk factors for deep vein thrombosis Cont. Increased viscosity

Dehydration, fever and malnutrition. Sever anaemia

Intimal damage. Central and peripheral IV catheter, pacemaker IV drug abuse.

Trauma Fractures (pelvis and long bones) Burns


Risk factors for deep vein thrombosis Cont. Associated conditions/ disorders.

Malignancy. Varicose veins. Inherited coagulation disorder. Haemolytic anaemia

Use of oral contraceptives (oestrogen content) Chronic lung and heart disease (CHF, cereb.vascu.) Cigarette smoking. Venous cannulation or catheterization


Pathophysiology Thrombi develop from platelets, fibrin, and

both red and white cells.

They typically form in areas where the blood flow is slow or turbulent.

Muscle spasm and changes in the intravascular pressure can cause the developing thrombus to dislodge and move towards the heart and lung.


Pathophysiology The lungs are rich in heparin and plasmin

activators and can effectively dissolve some thrombi.

However, if the thrombus is not successfully dissolved, it can lodge in an artery and obstruct perfusion to the lung segment causing problems.


Clinical ManifestationIt varies according to the size and location of

the thrombus and adequacy of collateral circulation.

Superficial Thrombophlebitis A palpable firm, subcutaneous cord-like

vein. The area surrounding the vein may be

tender to the touch, reddened, and warm. Temperature elevation, oedema


Clinical ManifestationDeep ThrombophlebitisMay have no symptoms or have : Unilateral leg oedema, pain, warm skin and

temperature greater than 38c .

Homan's sign, pain on dorsiflexon of the foot when the leg is raised is a classic but unreliable sign because it is not specific for DVT.


Clinical ManifestationDeep Thrombophlebitis If the inferior vena cava involved, the lower

extremities may be oedematous and cyanotic.

If the superior vena cava involved, the upper extremities, neck, back and face may be oedematous and cyanotic.

If the calf is involved, tenderness present.


Complication Pulmonary embolism Chronic venous insufficiency and phlegmasia

ceruleadolens.ManagementDiagnosis Chest x-ray APTT(activated partial thromboplastin time) PT(prothrombin time) Venogram , lung scan and pulmonary

angiogram.


Treatment Complete bed rest for 5 to 7 days.

Local heat to extremity when inflammation is acute.

Fit the client carefully for graduated compression stockings and teach correct use.

Taught the client the action, dosage and side effects of anticoagulant.


Eat dark green and yellow leafy vegetables moderately because these are rich in vitamin K which can counteract the effect of Coumadin (warfran)

Advice the client to bleeding precaution and need for ongoing laboratory follow-up.


Treatment Cont.The conservative treatment includes: Continuous IV heparin. Bed rest with bathroom privileges. Elevation of legs above the heart level. Anticoagulant therapy and heparin,

warfarin. Elastic compression stockings.


Treatment Cont.The conservative treatment includes Cont.: Measurement and charting of size of

both thighs and calves every morning Mild oral analgesics such as aspirin and

codiene. NSAIDS


Surgical Procedure if indicated include: Intracaval filter insertion. Venous Thrombectomy.

The primary option is transvenous filtrationDevice placed in the vena cava to trap

emboli before they reach the heart and pulmonary vessels.


Nursing care of the client with a venacaval filter Assess venipuncture site for signs of bleeding

or infection.

Immobilize the extremity after the procedure.

Assess peripheral pulses, temperature, colour and sensation in affected extremity.

Assess for pain and presence of positive Homan's sign.


Nursing care of the client with a venacaval filter Assess respiratory status and monitor pulse

oximetry or blood gases.

Position in partial or high- fowler's position.

Implement bleeding precaution and associated safety measures if systemic anticoagulation is to be continued.


Nursing care of the client with a venacaval filter Teach the client to monitor for signs of

infection at insertion site.

Signs of systemic bleeding (e.g. Blood in stool, urine, gums, nosebleed easy bruises.

Pulmonary embolism- swelling and warmth in extremity, sudden chest pain, dyspnea, tachypnoea, restlessness.

Thank You

deep venous thrombosis/ thrombophlebitis by dr. hanan said ali

Documents

venous cannulation

venous stasisdamage

deep vein thrombosis

common venous disorder

obstruction of venous

number of risk factors

developing thrombus

lung segment