 Hi, welcome to Nursing School Explained and this video on venous thrombosis. As a quick review, a thrombus or a blood clot occurs when there is some sort of damage to the vascular endothelium and platelets start to aggregate and then fibrin also adheres to these platelets and that clot is formed. Now in general, that's a good thing when it comes to like wound healing and any kind of cuts that we need to stop the bleeding but when it comes to the inside of a vein it can lead to thrombosis and then the blood flow is obstructed. So let's go ahead and take a look at this. Risk factors for developing venous thrombosis. Number one risk factor is atrial fibrillation which is a very common arrhythmia and I have a separate video that goes into the details on atrial fibrillation in itself. And then bed rest. So anybody think about who has a prolonged hospitalization for whatever reason. Anybody in the post op period who is not maybe as ambulatory as they previously were. So any kind of stagnation not being able to move as usual puts the patient at higher risk because it interrupts their inner fears with that venous return and the blood flow in the lower extremities. And then also prolonged periods of sitting. So think about somebody who is traveling on a long plane flight or car ride somewhere there at risk for developing venous thrombosis as well as trauma. So any traumatic injury to the lower extremities can cause the damage to the vascular endothelium and then the platelets and the fibrin will start to aggregate and maybe form a thrombus. Heart failure patients are at a higher risk as well as pregnant patients and in the postpartum period. And that is mostly because the blood volume increases during pregnancy and just the sheer fact of that plus maybe decreased ambulation and movement as the fetus grows also leads to a higher risk of developing thrombi. And then IV drug abuse as well as hypercoagulation disorder. So those would be genetic disorders. And then also birth control pills especially if the woman is older than 35 years old and the smoker in addition. So that's a higher risk for blood clots also. And then for signs and symptoms we have to distinguish between whether superficial veins or deep veins are affected and that's just like the term suggests superficial more towards the surface that you can easily palpate and then the deeper veins are the ones that we typically just can, signs and symptoms that we typically just can distinguish by the patient's complaints or whatever their subjective data is. So for superficial veins it might be palpable because it is so close to the surface it might be fur or cord-like. And the patient might say that the area feels a little bit itchy, tended to palpation. It might also have signs of inflammation that are red and warm. But the cord-like kind of a strand that you can feel right underneath the skin and sometimes you can even see it along the superficial vein is pretty tell-tale. And then deep veins. So deep vein thrombosis DVT is sometimes also referred to as VTE which is venous thromboembolism and that is mostly used in terminology when we talk about core measures and the reduction of venous thrombosis in these high-risk patients especially in the hospital setting. And the E here stands for embolus and then just recall that a thrombus is a blood clot that is stagnant stationary in the body part but an embolus is a blood clot that has dislodged from the original location and is now on the move in the bloodstream. And the reason that we worry about embolize so much is because as they make their way through the venous system they get caught as they come back through the right side of the heart they can get caught in the lungs leading to pulmonary emboli or if they come from the heart itself such as in patients with atrial fibrillation from the heart itself they go out through the left side of the heart and then they can break off into carotid arteries causing thrombi or blood clots in the brain which leads to a stroke. Okay so signs of deep vein thrombosis are unilateral edema it typically only occurs on one side and the patient might say that the calf feels kind of full and then there are those signs of inflammation that we always look for tenderness to palpation red warmth and then the patient might even have a temperature because of this inflammation that's greater than 100.4. Diagnostic tests Doppler ultrasound are usually telltale or the standard if we suspect that there's a thrombus going on the lower extremities we certainly also want to check the patient's coagulation time so their PT, INR and then also their fibrin levels because we know fibrin causes the clot in the first place. D dimer is a very good test to see if there's any clotting going on in the body just keep in mind that a D dimer is very nonspecific so it might be elevated for a lot of different reasons and thrombosis is just one of them so it's a good indicator that will let us know that we need to look deeper into this to determine if it's a thrombus or not but there might be other reasons why the D dimer is elevated and we also want to look at their blood count to look at their HNH and platelet levels because again these platelets aggregate and a lot of these tests are also in anticipation that we might have to put the patients on anticoagulants eventually and we'll look at that here. So then complications like I already mentioned number one is a pulmonary embolism because it comes from the lower extremities and the only way it's going to come up is through that inferior and superior vena cava into the right side of the heart and then from there it can go to the lungs and get clogged in one of the pulmonary blood vessels causing a pulmonary embolism. Now if a main blood vessel in the lungs is obstructed for a long time it can lead to backup of the other blood vessels and then we can the patient can develop pulmonary hypertension which is clearly also a major complication. Treatment for superficial veins superficial vein thrombosis is typically nothing needs to be done because it's superficial and it usually goes away with ambulation maybe a little bit of warm compresses and the body will just dissolve it but if it's in the deep veins these clots have a higher risk for breaking off and causing a PE an embolus so treatment here is so treatment here is early infrequent ambulation and position changes so if the patient is not able to move themselves let's say they had some orthopedic spinal surgery we need to be sure that we reposition them and also compression that can be compressional stockings or a ted hose or maybe those inflation devices that we adhere to the lower extremities that kind of inflate and deflate to the lower extremities that will help with that venous return and keep the blood from being so stagnant in those lower extremities and these three very simple measures are usually enough if the patient has low risk factors so if they're generally healthy and now they're having let's say a broken femur from an accident typically these measures will be enough however if the patient has any of these risk factors or maybe a history of blood clotting then many times they're started on the medication and there are many different anticoagulants that the provider might put the patient on and it just depends on the patient's risk factors and lifestyle to determine what kind of anticoagulant the patient will be on and so number one scumadin also referred to as warfarin a very kind of old school medication anticoagulant as well as lobinox which is a low molecular weight heparin and then there's also a category of anticoagulants called factor 10a inhibitors and examples are serralto and eliquids and these medications just work a little bit in different ways on that coagulation cascade from thrombi to form and again it depends on the provider's preference and the patient's preference as well as the patient's risk factors to determine which one the patient is going to be put on if all fails or if it's really serious the patient might need surgical treatment which can be a thrombectomy so ectomy removing the thrombus by doing surgery cutting that vein open removing the clot and then also an IVC filter that's sometimes also called a greenfield filter and that just means that a filter is installed in the inferior vena cava in the patient's abdomen just in case that blood clot breaks off from the legs and it makes its way up to the heart which then can get into the lungs causing a pulmonary embolism so that filter will catch that blood clot so that would be more high risk factor of patients as for nursing care we always want to educate our patients because we know that these three measures are typically enough to prevent blood clotting and many times if we just educate our patients and tell them why it is so important to ambulate to get up all day there and pay although they might be in pain they might not want to they have no appetite all these things we want to encourage them to do these things so that we can prevent this complication of thrombosis and maybe even a PE and then current ambulation and position changes as well as review their medications and supplements because especially kumand in here and some of these other anticoagulants have severe side effects with other medications or interactions with other medications as well as supplements what in terms of what pertains to the coagulation cascade so we want to make sure we review all their medications and supplements and then we also have to administer these anticoagulants and whenever we do that we have to be aware of bleeding because now we're making the patient's blood more viscous and so we have to check their labs that pertain to that PT INR as well as APTT if this was patient was on heparin and then certainly check them for bleeding and all the common sites to make sure that we're not over anticoagulant this patient and then causing some bleeding in turn thanks for watching this video on venous thrombosis I also have a video like I mentioned on atrial fibrillation as well as on peripheral artery disease so this is the venous side and then the artery disease is it's very different so check the video out in my playlist and I hope to see you soon right back here on nursing school explained thanks for watching