COMPILED BY : KUSUM

MS.c Nursing ,2 nd year.

Defination : Thrombus formation in deep veins of

legs or thighs
Tibial veins, soleal/gastrocnemius veins, popliteal vein
femoral vein, deep femoral vein,
common femoral vein, iliac veins.

15%
Death
Approximately one-third develop pulmonary embolism

Untreated Proximal
DVT
30-50% risk PE
12-15% mortality

Treated DVT
<8% risk PE
Mortality <2%

Incidence
DVT: 160 per 100,000
Symptomatic non-fatal PE: 20 per 100,000
Fatal PE: 50 per 100,000

Virchows Triad
Alterations in blood flow - Venous Stasis
Alterations in blood constituents
Vascular endothelium damage

Principal Risk Factors

Immobilization
Trauma
Surgery
Infection
Post-partum period

Other Factors

Age
Obesity
Malignancy
Previous VTE
Varicose Veins
Dehydration
Hormonal Therapy

DVT
Asymptomatic
Pain/tenderness
Erythema
Acute swelling
Pallor- Phlegmasia
Alba
CyanosisPhlegmasia

Cerulea

PE
Dyspnea &
Tachypnea
Diaphoresis
Hemoptysis
Low-grade
fever
Pleuritic CP
Cough
Hypotension
Coma
CXR
EKG

Venography ex-gold standard

Duplex Ultrasound
Comfortable
Inexpensive
No risk
Good sensitivity and specificity for distal
Less sensitive for proximal DVT

The term superficial femoral

vein
should never be used, because
the femoral vein is in fact a deep
vein and is not part of the
superficial venous system.
Confusion arising from use of
the inappropriate name has
been responsible for many
cases of clinical
mismanagement and death

Management of superficial
femoral vein thrombosis should
be the same as any DVT

Patient with suspect symptomatic

Acute lower extremity DVT

Venous duplex scan

negative

Low clinical probability

High clinical probability

positive

observe
negative

Evaluate coagulogram /thrombophilia/ malignancy

Repeat scan /
Venography
Anticoagulant therapy
contraindication

IVC filter

yes

No

pregnancy
OPD
hospitalisation

LMWH
LMWH
UFH

warfarin

Compression treatment

Idiopathic DVT < 50 years

Family history of DVT
Thrombosis in an unusual site
Recurrent DVT

3-6 months first DVT with reversible risk

factors
At least 6 months for first idiopathic DVT
12 months to lifelong for recurrent DVT or
first DVT with irreversible risk factors
malignancy or thrombophilic state

Diagram 6

Consider in: Acute< 10 days iliofemoral

DVT.

Long-term benefit in preventing

post-phebitic syndrome is unknown.

Impaired tissue perfusion secondary to DVT.

Risk for infection related to prolonged
hospital stay or blood pooling associated
with venous stasis.
Ineffective therapeutic management
related to postoperative recovery treatment
regimen.
Knowledge deficit related to hemodynamic
stability and vascular status, as evidenced
by prolonged levels of immobility.