Blood clots formed from any source, lodging in the patient leg or arm, impeding blood flow and causing inflammation. This backup of blood pools in the extremity causing swelling, redness, warmth and pain. These clots can dislodge and become embolic, lodging in the heart, lungs, or brain.
Narrowing or occlusion of the vessels in an extremity. If caused by plaque (cholesterol and other substances) this could be from poor diet, lack of exercise, or genetics. However, blood stasis can cause aggregation of platelets and other blood products forming a clot that travels to the extremity (or heart, lungs or brain!). The most common cause of blood pooling (stasis) is Atrial Fibrillation (AFib). Other major causes are prolonged sitting, pregnancy, smoking, and birth control. Virchow’s triad explains the 3 major contributors to the development of thrombophlebitis: venous stasis, damage to the inner lining of the vessel, and hypercoagulability.
Stabilization of the blood clot or disintegration of the blood clot as well as prophylaxis treatment for future blood clots. Prevention of complications such as embolic strokes, myocardial infarction, or pulmonary embolism.
*Note – the evidence shows that Homan’s Sign is an unreliable and nonspecific finding. It is only present in 33% of those with a DVT and should not be used as standard practice in isolation.
A potential complication of thrombophlebitis and DVT is thrombi can break of and become emboli to other vital organs such as the lungs (PE), heart (MI), or brain (CVA). Monitor for signs of these occurrences.
This is an anticoagulant that prevents worsening of clots or development of new clots. It does not breakdown clots, but allows the body’s natural fibrinolysis to occur without new clots forming.
Monitor aPTT q6h to adjust and maintain therapeutic levels.
Follow your facility protocols for administration of bolus and dosing. Refer to the Pharmacology course for more details of this drug.
Both SubQ and oral anticoagulant therapy are used as prophylactic (prevention) therapy.
Patient will need to have frequent blood draws to monitor their INR if taking Coumadin. Therapeutic range is between 2 and 3.
Follow your facility protocols for administration and dosing. Refer to the Pharmacology course for more details of these drugs.
The sooner you get a patient moving the less likely they are to form anymore blood clots.
Compression socks and SCDs encourage blood flow back to the heart and prevent blood stasis.*Caution – as soon as the patient has a confirmed DVT, ll three of these should be held until an IVC filter can be placed
Vitamin K works to help increase clotting, this is opposite of what we are trying to do for this patient.
The only time Vitamin K is used therapeutically is if the patient is bleeding out, in which case the treatment may be vitamin K with Fresh Frozen Plasma (FFP).
Vitamin K is also the antidote for Coumadin (warfarin)
This monitors for changes in the heart and allows for quick intervention if the clot moves and is stuck in the heart.
This monitors for changes in oxygenation if the clot moves to the lungs.
This isn’t just for in the hospital, it is also for when the patient goes home. The patient is at major risk for bleeding out, thus educating about s/sx of internal bleeding as well as educating about fall precautions is vital.
For more information, visit www.nrsng.com/cornell
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