Deep vein thrombosis (DVT) is the formation of a blood clot in a deep vein, often in the legs, influenced by factors outlined in Virchow’s triad: venous stasis, blood coagulability, and vascular wall injury. Key risk factors include recent surgery, immobility, obesity, and advanced age, with common symptoms being leg pain, swelling, and warmth. Diagnosis commonly involves imaging such as Doppler ultrasound, while treatment typically includes anticoagulation and the use of elastic compression stockings.

1. DEEP VENOUS
THROMBOSIS
• Deep-vein thrombosis is the
formation of a blood clot
("thrombus") in a deep vein.
It commonly affects the leg veins,
such as the femoral vein or the
popliteal vein or the deep veins
of the pelvis.

6. Etiology of thrombosis
Virchow's triad is a group of 3 factors
known to affect clot formation:
• rate of flow (venous stasis)
• the consistency (thickness) of the
blood ( altered blood coagulation)
• qualities of the vessel wall ( vessel
wall injury)
 At least two of these factors seem
to be necessary for thrombosis to
occur.

7. • Venous stasis occurs when blood
flow is reduced, as in:
heart failure or shock,
when veins are dilated as with some
medication therapies and
when skeletal muscle contraction is
reduced as in: immobility, paralysis
of the extremities or anesthesia.
(Bed rest reduces blood flow in the
legs by at least 50%)

8. • Damage to the intimal lining of blood
vessels creates a site for clot
formation.
direct trauma to the vessels, for
example with fractures or
dislocation, diseases of the veins
and chemical irritation of the vein
from intravenous medication or
solutions can damage veins.

9. • Increased blood coagulability
occurs most commonly in:
patients who have abruptly
withdrawn from anticoagulant
medications,
oral contraceptives use and
several blood abnormalities.

10. Virchow noted that more deep
venous thrombosis occurred in
the left leg than in the right and
proposed compression of the
left common iliac vein by the
overlying right common iliac
artery as the underlying cause.

11. • Formation of a clot frequently
accompanies thrombophlebitis -
which is an inflammation of the vein
walls.
• When a clot develops initially in the
vein as a result of stasis or
hypercoagulability ,but without
inflammation, the process is referred
to as phlebothrombosis.

12. The most common risk factors are:-
• recent surgery or hospitalization,
40% of these patients did not
receive heparin prophylaxis.
• advanced age,
• obesity,
• infection,
• immobilization,
• use of combined (estrogen-
containing) forms of
hormonal contraception,

13. • tobacco usage
• Thrombophilia (tendency to
develop thrombosis) often
expresses itself with recurrent
thromboses.
• History of varicosities
• Spinal cord injury
• Polycythemia vera
• cancer

15. It is recognized that thrombi
usually develop first in the calf
veins, "growing" in the direction
of flow of the vein.
 DVTs are distinguished as being
above or below the popliteal vein.
 Very extensive DVTs can extend
into the iliac veins or the
inferior vena cava.
The risk of pulmonary embolism is
higher in the presence of more
extensive clots.

16. • The major problem associated
with recognizing DVT is that
signs & symptoms are non
specific.
• The exception to this is
phlegmasia cerulea dolens
(massive iliofemoral venous
thrombosis) in which the
entirely extremity becomes
massively swollen, tense,
painful, and cool to the touch.

19. VTE: Pathophysiology
• Virchow’s Triad
• Alterations in blood flow - Venous
Stasis
• Alterations in blood constituents
• Vascular endothelium damage

20. VTE: Predisposing
Factors
• Principal Risk Factors
• Immobilization
• Trauma
• Surgery
• Infection
• Post-partum period
• Other Factors
• Age
• Obesity
• Malignancy
• Previous VTE
• Varicose Veins
• Dehydration
• Hormonal Therapy

21. tests
The presence of deep venous
thrombosis may be seen on:
• X-rays to show veins (venography)
in the legs
• Doppler ultrasound exam of a limb
• Plethysmography of the legs

22. • Homan's sign is used in clinical
practice to diagnose DVT.
• The gold standard is intravenous
venography, which involves injecting a
peripheral vein of the affected limb
with a contrast agent and taking X-rays
, to reveal whether the venous supply
has been obstructed. Because of its
invasiveness, this test is rarely
performed.
• Impedance plethysmography and
Doppler ultrasonography are non-
invasive alternatives.

23. Imaging the leg veins
• Compression ultrasound
scanning of the leg veins,
combined with duplex
measurements (to determine
blood flow), can reveal a
blood clot and its extent (i.e.
whether it is below or above the
knee).

24. blood tests
• complete blood count
• Primary coagulation studies:
• liver enzymes
• renal function and electrolytes

25. Probability scoring
Scarvelis and Wells overviewed a set of clinical
criteria for DVT, on the heels of a widely
adopted set of clinical criteria for pulmonary
embolism.
Wells score or criteria: (Possible score -2 to 9)
1) Active cancer (treatment within last 6
months or palliative) -- 1 point
2) Calf swelling >3cm compared to other calf
(measured 10cm below tibial tuberosity) -- 1
point
3) Collateral superficial veins (non-varicose) -- 1
point

26. 4) Pitting edema (confined to
symptomatic leg) -- 1 point
5) Swelling of entire leg - 1 point
6) Localized pain along
distribution of deep venous
system -- 1 point
7) Paralysis, paresis, or recent
cast immobilization of lower
extremities

27. 8) Recently bedridden > 3 days, or
major surgery requiring regional
or general anesthetic in past 12
weeks -- 1 point
9) Previously documented DVT -- 1
point
10) Alternative diagnosis at least
as likely -- Subtract 2 points

28. interpretation
• Score of 2 or higher - deep vein
thrombosis is likely. Consider
imaging the leg veins.
• Score of less than 2 - deep vein
thrombosis is unlikely.

29. Two-level DVT Wells score
Clinical feature Points
Active cancer (treatment ongoing, within 6 months, or palliative) 1
Paralysis, paresis or recent plaster immobilisation of the lower
extremities
1
Recently bedridden for 3 days or more or major surgery within
12 weeks requiring general or regional anaesthesia
1
Localised tenderness along the distribution of the deep
venous system
1
Entire leg swollen 1
Calf swelling at least 3 cm larger than asymptomatic side 1
Pitting oedema confined to the symptomatic leg 1
Collateral superficial veins (non-varicose) 1
Previously documented DVT 1
An alternative diagnosis is at least as likely as DVT −2
Clinical probability simplified score
DVT likely 2 points or more
DVT unlikely 1 point or less
a
Adapted with permission from Wells PS et al. (2003) Evaluation of D-dimer in the diagnosis of suspected deep-vein
thrombosis. New England Journal of Medicine 349: 1227–35

30. symptoms
• Leg pain in one leg
• Leg tenderness in one leg
• Swelling (edema) of one leg
• Increased warmth in one leg
• Changes in skin color (redness) in one
leg
• In some cases signs of pulmonary
embolism are the first indication of
DVT e.g. chest pain,dyspnea,
hemoptysis, tachycardia, cyanosis,
shock or sudden collapse.

31. • There may be no symptoms
referrable to the location of the
DVT, but the classical symptoms
of DVT include pain, swelling
and redness of the leg and
dilatation of the surface veins.
In up to 25% of all hospitalized
patients, there may be some
form of DVT.

32. • There are several techniques during
physical examination to increase the
detection of DVT, such as
measuring the circumference of the
affected and the contralateral limb
at a fixed point (to objectivate
edema), and palpating the venous
tract, which is often tender.
Physical examination is unreliable for
excluding the diagnosis of deep vein
thrombosis.

33. THERAPY
• Thrombolytics is generally
reserved for extensive clot, e.g.
an iliofemoral thrombosis. And
there may be an increase in
serious bleeding complications.

34. • Anticoagulation is the usual
treatment for DVT. In general,
patients are initiated on a brief
course (i.e., less than a week) of
heparin treatment while they start
on a 3- to 6-month course of warfarin
.
• In patients who have had recurrent
DVTs (two or more), anticoagulation
is generally "life-long."

35. • Elastic compression stockings
should be routinely applied.
They usually exert a sustained, evenly
distributed pressure over the entire
surface of the calves (leg), thereby
reducing the caliber of the
superficial veins in the legs,
resulting in increased flow in the
deep vein.

36. Surgical magx
Surgery for DVT is necessary only when:-
• Anticoagulant or thrombolytic are
contraindicated.
• Danger of pulmonary embolism is
extreme
• The venous drainage is so severely
compromised that permanent damage
to the extremity will probably result.
Thrombectomy is the surgery of choice

37. • Hospitalization should be considered
in patients with more than two of the
following risk factors as these
patients may have more risk of
complications during treatment.
• bilateral DVT, renal insufficiency, body
weight <70 kg, recent immobility,
chronic heart failure, and cancer

38. Nrsg magx
• If the pt is receiving anticoagulant
therapy, the nurse must monitor the
partial thromboplastin time,
prothrombin time, hemoglobin &
hematocrit values, platelet count &
fibrinogen level.
Close nursing observation is also
required to detect bleeding; if
bleeding occurs it must be reported
immediately & therapy is
discontinued.

39. • Bed rest, elevation of the affected
extremity, elastic stocking and
analgesics for pain relief are added
to therapy. They not only help to
improve circulation but they also
increase comfort.
• Warm moist packs applied to the
affected extremity reduce the
discomfort associated with DVT as
do mild analgesics prescribed for
pain control.

40. • When the pt begins to ambulate,
elastic pressure stockings are used.
Walking is better than standing or
sitting for long periods.
When the stockings are removed the skin
should be inspected for signs of
irritation, and the calves are examined
for possible tenderness. Any skin
changes are reported.
stockings are contraindicated in pts with
pitting edema because they can
produce severe pitting at the ankle.

41. • When the pt is on bed rest , the
foot and the lower legs should
be elevated periodically above
the level of the heart. This
position allows the superficial &
tibial veins to empty rapidly.

42. • Active and passive leg exercises,
particularly those involving calf
muscles should be performed to
increase venous flow.
Early ambulation is most effective in
preventing venous stasis.
Deep breathing exercises are
beneficial because they produce
increased negative pressure in the
thorax, which assists in emptying
the large veins.

43. prevention
• Doctors may prescribe
anticoagulants to help prevent DVT
in high-risk people or those who are
undergoing high-risk surgery.
To help prevent DVT, move your legs
often during long plane trips, car
trips, and other situations in which
you are sitting or lying down for long
periods of time.

44. Potential complications
Chronic venous occlusion
Pulmonary embolism from dislodged
thrombi
Vascular destruction- leading to:-
ochronic venous insufficiency
oIncreased venous pressure
oVaricosities
oVenous ulcers

45. Venous obstruction – resulting
to:-
oIncreased distal pressure
oFluid stasis
oEdema
oVenous gangrene

49. NB//
• Make sure that you formulate,
nursing diagnosis for each and
every conditions that we
discuss.