It starts off as something simple. Your patient is complaining of leg pain. One leg is swollen to twice the size of the other and 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 (VTE), also known as deep vein thrombosis (DVT).
It is important to constantly monitor the patient for signs and symptoms of venous thromboembolism (VTE) 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.
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 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 (PE). A PE is a clot that travels from another part of the body to the lungs. Some signs of a 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.
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. 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 can also help prevent clots. Compression 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 VTEs before they harm your patient.
Lynda is a registered nurse with three years experience on a busy surgical floor in a city hospital. She graduated with an Associates degree in Nursing from Mercyhurst College Northeast in 2007 and lives in Erie, Pennsylvania in the United States. In her work, she took care of patients post operatively from open heart surgery, immediately post-operatively from gastric bypass, gastric banding surgery and post abdominal surgery. She also dealt with patient populations that experienced active chest pain, congestive heart failure, end stage renal disease, uncontrolled diabetes and a variety of other chronic, mental and surgical conditions. Her Website.