Follow these steps for patients with DVT

Here are the steps taken when a patient with suspected deep venous thrombosis (DVT) presents at Seattle-based Harborview Medical Center’s ED, according to Cynthia Natiello, RNC BSN, CCRC, the facility’s vascular research nurse:

1. ED nurses take a health history and perform a thorough assessment, beginning with the patient’s presenting symptoms. For example, if the patient reports pain and swelling, the ED nurse would ask when the pain and swelling began and would assess the intensity. Because injury is a risk factor for DVT, patients are asked if they recall any precipitating incident prior to the pain and swelling. If patients have chest pain and shortness of breath with unknown etiology, and they don’t have pain or swelling, patients still are asked about DVT risk factors.

2. The ED physician reviews the patient’s health history and does a thorough assessment, including symptoms of chest pain and/or shortness of breath indicative of a pulmonary embolism.

3. If a DVT is suspected, validated diagnosis procedures are done such as duplex ultrasound and a pretest stratification in D-dimer.

4. If a DVT is confirmed and the patient is stable, the physician orders outpatient anticoagulation medications such as enoxaparin to be self-administered every 12 hours for approximately two weeks. In addition, patients will receive oral warfarin. ED nurses teach the patient about anticoagulation medications, including treatment purpose, length of treatment, side effects, and proper technique in self-administration of subcutaneous injections and blood draws.

5. If the patients are determined to be unstable, such as with symptoms of a pulmonary embolism, they may be admitted and administered intravenous unfractionated heparin and warfarin.