Never rub area, may dislodge clot Early ambulation or leg exercises best way to prevent clot from forming
DVT cont. Treatment › IV heparin - GO TO TREATMENT › Low molecular weight heparin › IVC filter – used to prevent clots › Streptokinase, urokinase, or alteplase (t-Pa) – THESE DISOLVE THE CLOTS Supremely high risk of bleeding with these › Coumadin (Warfarin) Takes 3 days to build therapeutic level › Xarelto, Eliquis Lixiana, Pradaxa (newer anticoagulants) › Anticoagulants do NOT dissolve the clot!
And more DVT Elastic stocking to prevent recurrence › TED hose or less commonly Jobst hose Apply in AM SCDs Prevention: › Exercise, hydrate, quit smoking, avoid substances that coagulate the blood, and avoid sitting for long periods.
Thrombosis Whenever a pt has a known thrombosis, monitor for pulmonary embolus, if found it is an emergency › Dyspnea › Hemoptysis – COUPHING UP BLOOD › Tachypnea › Chest pain › Feeling of impending doom › cyanosis
Embolism Sudden obstruction of an artery by a mass of foreign material through circulation › Usually a blood clot broken off from a thrombus Effects of an embolism depend on: › Site at which it is lodged › Size compared with the caliber of the blood vessel
Embolism Arterial thrombosis is treated r/t severity Thrombectomy › Catheter threaded into the artery and streptokinase or urokinase may used to dissolve the clot › Usually done over 36-72hr period › IV heparin may also be used to prevent further clotting
Venous Insufficiency and Varicose Veins: Contributing Factors Obesity Family or personal history of atherosclerosis Trauma Hypertension Smoking Pregnancy Long periods of bedrest Standing for long periods of time Varicose veins: enlarged veins that are distorted in shape by accumulations of pooled blood › Leads to incompetent valves that allow reflux of blood from deep veins into superficial veins
Vericose Veins/Venous Insufficiency Signs and symptoms › Dilated, twisted-appearing, superficial vessels › Swelling of foot, leg, and ankle especially at the end of the day › Legs feeling “full” and “heavy” › Include increased pigmentation of the skin, dryness and scaling, and excoriations (scratches) › Progression leads to blood leaking into spaces causing deposits of hemosiderin and discoloration of the skin, starting around ankles and shins
Venous Insufficiency and Varicose Veins: Treatment Elastic support hose Exercise legs and feet periodically throughout the day – walking is ideal exercise Elevate legs whenever possible Weight reduction Behavior modification to reduce risk factors Nonsteroidal anti-inflammatory drugs (NSAIDs), thrombolytics, and anticoagulants Surgery
Venous Disorders: Surgical Interventions Thrombectomy Sclerotherapy Ambulatory phlebectomy Vein stripping and ligation › Veins with multiple, severe varicosities (>4mm) Endoscopic surgery Laser treatment Vena cava filter – KEEP CLOT FROM TRAVELING
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- Fall '19