Cardiovascular 2

• Phlebitis is the inflammation of a superficial vein
• Venous thrombosis involves the formation of a thrombus and inflammation of the vein. It can be deep or superficial
• Venous thromboembolism: spectrum from deep vein thrombosis to pulmonary embolus
• Superficial vein thrombosis is the formation of a thrombus in a superficial vein VS deep vein thrombosis is a thrombus in a deep vein
• Virchow’s triad is a triad of factors that predisposes one to venous thrombosis. They include stasis of blood flood, local trauma to the vessel wall (endothelial injury) and hypercoagulability
• Venous stasis can be caused by bedrest, orthopedic surgery, paralysis, varicose vein, etc. The blood is stagnant and does not circulate
• Endothelial damage can be caused by a direct injury (IV catheter) or an indirect injury (chemotherapy, diabetes). It consists of damage to the lining of the blood vessel
• Hypercoagulability can be caused by malignancy, cigarette smoking, estrogen based oral contraceptives
• Clinical manifestations of superficial thrombosis

  • palpable, firm, subcutaneous cordlike vein with tender, red and warm surrounding area
  • mild systemic temperature elevation and leukocytosis (increased WBC)
  • extremity edema possibility
• Clinical manifestations of DVT:

  • possible unilateral leg edema
  • extremity pain and tenderness with palpation
  • dilated superficial vein
  • sense of fullness in thigh or calf
  • paresthesia (numbness or tingling)
  • warm skin and erythema
  • elevated systemic temperature
• The most serious complication of DVT is a pulmonary embolism (clot in capillaries of lungs)
• Deep vein thrombosis is a clot stuck to the blood vessel VS embolism is a clot that travels through the bloodstream
• Assessment for venous thromboembolism

  • past health history
  • medications
  • clinical manifestations
  • physical examination
• Diagnostic studies for DVT

  • ultrasounds
  • D-dimer: increased values with venous thrombosis and pulmonary embolism (blood test)
• Prevention of DVT

  • early ambulation
  • change positions
  • leg exercises
  • compression stockings or sequential compression devices
  • prophylactic anticoagulants (prevent clot)
• The calf muscle acts as a pump for deep leg veins. Compression stocking can imitate the muscle contraction
• When DVT exists, anticoagulants prevent the extension of the clot as well as the development of new thrombi and embolization. Some patients require surgical therapy like a vena cava filter, which filters out clots as blood returns to the right side of the heart
• WTE health teaching

  • address risk factors
  • use graduated compression stockings
  • information on anticoagulant administration, dosage and adverse effects
  • signs and symptoms of pulmonary embolism