What Nurses Need to Know About Deep Vein Thrombosis (DVT)

• Deep Vein Thrombosis (DVT) is a type of venous thromboembolism that affects deep veins in the lower leg, thigh, pelvis, and other parts of the body.
• How to identify patients who are at a higher risk for DVT, as well as the symptoms and dangers.
• Tips for preventing DVT, including medications and habits to keep at-risk patients safe.

Venous Thromboembolism (VTE) is a term that refers to blood clots in the veins and it occasionally goes underdiagnosed even though it is one of the most fatal medical conditions that can lead to disability and death.

The American Society of Hematology (ASH) recognizes the need for a comprehensive set of guidelines on the treatment of VTE to help the medical community better manage this serious condition.

Deep vein thrombosis (DVT) is a medical condition that occurs when a blood clot forms in a deep vein.  The clots usually develop in the lower leg, thigh, or pelvis, but they can also occur in the arm.

It is important to be aware of the seriousness of DVT and to be cognizant that it can affect anyone.  DVT can cause serious illness, disability, and in some cases, death.  The positive news is that DVT is preventable and treatable if discovered in a timely manner.

Risk Factors for Deep Vein Thrombosis

Anyone can develop a DVT; however, certain factors can increase the chance of having this condition.  The chance increases for someone who has more than one of the following factors present at the same time.

Following is a list of factors that increase the risk of developing a DVT:

Injury to a vein often caused by:

• Fractures
• Severe muscle injury
• Major surgery (particularly involving the abdomen, pelvis, hip, or legs)

Slow blood flow often caused by:

• Confinement to bed (e.g., due to a medical condition or after surgery)
• Limited movement (e.g., a cast on a leg to help heal an injured bone)
• Sitting for a long time, especially with crossed legs
• Paralysis

Increased estrogen often caused by:

• Birth control pills
• Hormone replacement therapy, sometimes used after menopause
• Pregnancy and up to 3 months after giving birth

Certain chronic medical illnesses such as:

• Heart disease
• Lung disease
• Cancer
• Inflammatory bowel disease (Crohn’s disease or ulcerative colitis)

Other factors that increase the risk of DVT include:

• Previous DVT or PE
• Family history of DVT or PE
• Age (risk increases as age increases)
• Obesity
• A catheter located in a central vein
• Inherited clotting disorders

The Danger of Deep Vein Thrombosis

The most serious complication of DVT occurs when a part of the clot breaks off and travels through the bloodstream to the lungs, causing a blockage called pulmonary embolism (PE).

If the clot is small, and with appropriate treatment, most individuals can recover from a pulmonary embolism; however, there could be some damage to the lungs.  If the clot is large, it can stop blood from reaching the lungs and can unfortunately become fatal.

In addition, one-third to one-half of people who have a DVT will have long-term complications caused by the damage the clot does to the valves in the vein called post-thrombotic syndrome (PTS).  People with PTS have symptoms such as swelling, pain, discoloration, and in severe cases, scaling or ulcers in the affected part of the body.  In some cases, these symptoms can become severe and disabling to the individual.

For some individuals, a DVT can become a chronic illness and can make the individual more prone for a future DVT.

Symptoms of Deep Vein Thrombosis

It is important to know the signs and symptoms of DVT, the risks for DVT, and the importance of seeking care immediately if any signs or symptoms of DVT are present.

Almost half of the individuals with DVT have no symptoms at all.  The following are the most common symptoms of DVT that occur in the affected part of the body:

• Swelling
• Pain
• Tenderness
• Redness of the skin

If an individual develops any of these symptoms, the doctor should be contacted as soon as possible.

Diagnosis of Deep Vein Thrombosis

The diagnosis of DVT requires special tests that can only be performed by a doctor. A medical history is performed to collect and review recent medical history, including medications and surgeries.

A physical exam is performed by a healthcare provider to evaluate signs and symptoms, risk factors, and examine the affected area as well as one’s heart rate and overall health. Ultrasound uses a device placed over the part of the body where there is a suspected blood clot and sends sound waves into the area.  A computer transforms the waves into an image that can often show the presence of a clot.

Blood tests look for a substance called D-dimer, which is released when a blood clot dissolves. High levels of D-dimer may indicate the presence of a blood clot.

Treatment of Deep Vein Thrombosis

Medication known as thrombolytic is used to prevent and treat DVT.  Compression stockings (also called graduated compression stockings) are sometimes recommended to prevent DVT and relieve pain and swelling and they may need to be worn for two years or more after having DVT.  In severe cases, the clot may need to be removed surgically.

Prevention of Deep Vein Thrombosis

The following tips are helpful in the prevention of DVT:

• Moving around as soon as possible after having been confined to bed such as after surgery, illness, or injury.
• If an individual is at risk for DVT, discuss the following with the doctor:
• Wearing compressions stockings
• Medication (anticoagulants) to prevent DVT
• When sitting for long periods of time such as when traveling for more than four hours, do the following:
• Get up and walk around every 1 to 2 hours
• Raise and lower one’s heels while keeping toes on the floor
• Raise and lower one’s toes while keeping heels on the floor
• Tighten and release one’s leg muscles
• Wear loose-fitting clothes

One can also reduce his/her risk for developing this condition by maintaining a healthy weight, avoiding a sedentary lifestyle, and following doctor’s recommendations based on individual risk factors.

The Bottom Line

Immediate medical attention is necessary to treat DVT.  In severe cases that are life threatening, medications called thrombolytics can be administered to help dissolve the clot. 

Other medications, called anticoagulants may be used to prevent more clots from forming.  Some people may need to be on medication long-term to prevent future blood clots.  Early detection is the key to avoiding fatal complications.

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