DEEP VEIN THROMBOSIS (INCLUDING PULMONARY EMBOLI CONSIDERATIONS)
I. Pathophysiology: Related to three factors known as the
Virchow triad—stasis of blood flow, vessel wall injury, and
alterations in the clotting mechanism.
a. Mechanical (e.g., trauma, surgery) or physiological (e.g.,
hypertension, phlebitis) damage to the vessel wall leads to
platelet activation, with platelets adhering to one another
and clumping together forming a thrombus.
b. The thrombus either dissolves over time or grows and
becomes large enough to occlude a vessel, which causes
blood flow to slow, expands the veins to accommodate the
increased volume, and causes more clots to form.
c. Proximal deep vein thrombosis (DVT) (extending to the
popliteal, femoral, or iliofemoral vessels)—more likely to
break away from the vessel and cause pulmonary embolism
d. Approximately 50% of clients with DVT are asymptomatic.
a. Thromboembolism can affect superficial or deep veins
although DVT is more serious in terms of potential complications,
including PE, postphlebotic syndrome, chronic
venous insufficiency, and vein valve destruction.
b. Predisposing and risk factors
i. Major surgery, especially orthopedic; trauma; prolonged
immobilization for any cause; spinal cord injury;
ii. Cardiovascular conditions such as valvular heart disease
with dysrhythmias, myocardial infarction (MI), heart
iii. Cancer; central venous catheter use
iv. Obesity; age greater than 40
v. Pregnancy-related complications
vi. Intravenous (IV) drug users, hormone replacement therapy,
oral estrogen birth control pills
a. Morbidity: Approximately 2.5 million people experience
DVT/PE (Day, 2003) with 600,000 hospitalizations annually
(Schreiber, 2007); risk for hospitalized medical and surgical
clients at 10% to 40% and orthopedic surgery clients
at 40% to 60% (Geerts et al, 2004).
b. Mortality: Initial and recurrent thromboembolic events are
estimated to cause 300,000 deaths annually (Bussey, 2007).
c. Cost: Estimates vary; de Lissovoy (2001) suggests $3 to
$4 billion annually for DVT/PE.
Primarily treated at the community level, with short inpatient
stay generally indicated in the presence of embolization.
Spinal cord injury
Ventilatory assistance (mechanical)
1. Maintain or enhance tissue perfusion and facilitate resolution
2. Promote optimal comfort.
3. Prevent complications.
4. Provide information about disease process, prognosis,
and treatment regimen.
1. Tissue perfusion improved in affected limb.
2. Pain or discomfort relieved.
3. Complications prevented or resolved.
4. Disease process, prognosis, and therapeutic needs
5. Plan in place to meet needs after discharge.