DVT Prevention and Treatment
Patients who are immobile or on bed rest because of surgery, injury, or an illness are at risk for developing a DVT (deep vein thrombosis). DVT results from clot formation in a deep vein, usually in the leg. If the clot breaks loose, it travels through the bloodstream to the lungs, where it gets lodged, resulting in a pulmonary embolism (PE). In the lung, the clot prevents blood flow, causing damage to the lung or leading to death.
To improve patient outcomes, nurses should focus on preventing DVT. Early ambulation is the best preventive strategy, but when this is not an option, sequential compression devices (SCDs) or elastic compression stockings are effective choices.
Mechanical devices, such as SCDs, are the first choice for DVT prevention, because they are as efficient as pharmacologic methods without causing bleeding complications. SCDs inflate and deflate air-filled sleeves on the legs to mimic muscle activity during ambulation. As the sleeves inflate and deflate, the muscle tightens and relaxes, pushing blood upward to prevent slow blood flow and keeping the valves in the veins functioning normally. Note that SCDs cannot be used on an extremity with a DVT or area with compartment syndrome, a deformity, or an open infected wound.
SCDs are ordered by the physician or nurse practitioner based on a risk assessment done on admission. A baseline skin assessment and neurovascular assessment must be done before SCDs are placed on the patient’s legs and every 8 hours thereafter. Assessments should include pain, pallor, pulses, “pins and needles” sensation, paralysis, skin abnormalities, edema, and signs or symptoms of possible blood clots, such as swelling, redness, or pain.
When applying SCDs:
- Make sure the sleeve is the correct size by measuring the patient’s leg.
- Wrap the sleeve around the patient’s leg, lining up the ankle with the ankle indication on the sleeve.
- Secure the sleeve, ensuring a correct fit by placing two fingers between the patient’s leg and the sleeve.
- Attach the sleeve to the mechanical pump unit, checking the connections of the hose between the pump and the sleeves.
- Turn the pump on and assess sleeve inflation and deflation.
- Remove the sleeve every 8 hours when the patient ambulates or bathes to assess the skin.
The nurse should educate the patient on how the SCDs prevent DVTs and the importance of notifying the nurse if they need to be removed. The patient should also report any “pins and needles” sensation or pain to the nurse. Inform the patient that once they are ambulating most of the day, the doctor may discontinue the SCD therapy.
T.E.D. anti-embolism stockings, also known as thromboembolic-deterrent hose, provide continuous pressure to the lower extremities to keep blood from pooling and blood clots from developing in the deep veins of the lower extremities.
T.E.D. hoses are available in knee-length or thigh-length in various sizes. Refer to the package for proper sizing information. The graduated pressure pattern starts at 18 mmHg at the ankle and gradually decreases to 8 mmHg at the popliteal in knee-length or the upper thigh in thigh-length.
It is important to use the appropriate size and apply the stockings correctly to ensure the patient receives the maximum benefit.
The hose can be difficult to put on a patient because of the firmness and lack of stretch. When applying, make sure the patient is in a comfortable, supine or semi-Fowler’s position and their feet are dry. Begin by gathering the stocking fabric in your hands and apply stocking on the patient’s toes, stretching down to the heel. Make sure the inspection toe hole falls under the toes (the toes should not be sticking out).
Another option is to turn the stocking inside out to the heel area, position the stocking over the foot and heel, then pull the stocking up around the ankle and calf. As you gently inch the stocking upwards, smooth out any creases, until the upper edge is about 1 to 2 inches below the knee cap for knee length and to the gluteal fold for thigh length. As the thigh portion of stocking is applied, rotate the stocking inward so the panel is toward the inside of the leg, over the femoral artery.
Compression stockings are not recommended for patients with:
- Leg conditions such as dermatitis, vein ligation, gangrene, or a recent skin graft
- Severe arteriosclerosis or other ischemic vascular disease
- Large edema of the legs or pulmonary edema from congestive heart failure
- Extreme deformity of the leg
There are a few things you need to remember to write in the chart:
- The size of the stockings and the date they were applied
- When the stocking is removed
- Skin appearance
- The absence or presence of tenderness in calves, thighs, or toes
- Inspection of stockings for each shift
- Change in patient’s weight or size
- The patient’s report of pain or discomfort
That’s all for now! Thanks for watching and happy studying.