9 Deep Vein Thrombosis Nursing Care Plans

Deep vein thrombosis (DVT) is a common and potentially life-threatening condition that requires prompt medical attention. As a nurse, understanding the nursing care plans and nursing diagnosis for DVT is essential to providing the best care for clients. This guide provides a comprehensive overview of DVT nursing care plans and nursing diagnoses, including common symptoms, nursing interventions, nursing management, and treatment options.

What is Deep Vein Thrombosis?

Thrombophlebitis is the inflammation of the vein wall resulting in the formation of a thrombosis (blood clot) that may interfere with the normal blood flow through the vessel.

Typically, venous thrombophlebitis occurs in the lower extremities. It may also occur in superficial veins such as cephalic, basilic, and greater saphenous veins, which usually is not life-threatening and does not necessitate hospitalization, or it may happen in a deep vein, which can be life-threatening because clots may travel to the bloodstream and cause a pulmonary embolism.

Three contributing factors (known as Virchow’s triad) can lead to the development of deep vein thrombosis (DVT), which includes venous stasis, hypercoagulability, and vessel wall injury.

Venous stasis occurs when blood flow is decreased, as in immobility, medication therapies, and in heart failure. Hypercoagulability occurs most commonly in clients with deficient fluid volume, pregnancy, oral contraceptive use, smoking, and some blood dyscrasias. Venous wall damage may occur secondary to venipuncture, certain medications, trauma, and surgery. The objective of treatment of DVT involves preventing the clot from dislodgement (risking pulmonary embolism) and reducing the risk of post-thrombotic syndrome.

DVT is a common venous thromboembolic (VTE) disorder with an incidence of 1.6 per 1000 annually. Even in clients who do not get pulmonary emboli, recurrent thrombosis and “post-thrombotic syndrome” are major causes of morbidity. DVT is a major medical problem accounting for most cases of pulmonary embolism. Only through early diagnosis and treatment can the morbidity be reduced (Schick, 2023).

Nursing Care Plans and Management

Nursing care management for patients with deep vein thrombosis (DVT) involves thorough assessment of the patient’s history and symptoms, administering anticoagulant medications, managing pain, promoting circulation through compression therapy and activity, educating the patient about DVT and self-care measures, providing psychosocial support, collaborating with the healthcare team, and closely monitoring the patient’s condition.

Nursing Problem Priorities

The following are the nursing priorities for patients with deep vein thrombosis:

1. Preventing pulmonary embolism.
2. Management of pain.
3. Promotion of circulation and prevention of complications.
4. Patient education and health teachings.
5. Anticoagulant therapy.

Nursing Assessment

Assess for the following subjective and objective data:

• Apprehension
• Cyanosis
• Dyspnea
• Hypercapnia
• Hypoxemia
• Restlessness
• Somnolence
• Usually involves changes in femoral, popliteal, or small calf veins:
  • Asymptomatic
  • Increased leg warmth
  • Edema (Unilateral)
  • Pain during palpation of a calf muscle
  • Tenderness

Nursing Diagnosis

Following a thorough assessment, a nursing diagnosis is formulated to specifically address the challenges associated with deep vein thrombosis based on the nurse’s clinical judgement and understanding of the patient’s unique health condition. While nursing diagnoses serve as a framework for organizing care, their usefulness may vary in different clinical situations. In real-life clinical settings, it is important to note that the use of specific nursing diagnostic labels may not be as prominent or commonly utilized as other components of the care plan. It is ultimately the nurse’s clinical expertise and judgment that shape the care plan to meet the unique needs of each patient, prioritizing their health concerns and priorities.

Nursing Goals

Goals and expected outcomes may include:

• The client will demonstrate adequate ventilation and oxygenation, as evidenced by ABGs within the normal range.
• The client will report or display resolution or absence of symptoms of respiratory distress.
• The client will maintain optimal peripheral tissue perfusion in the affected extremity, as evidenced by strong palpable pulses, reduction in and/or absence of pain, warm and dry extremities, and adequate capillary refill.
• The client will not experience pulmonary embolism, as evidenced by normal breathing, heart rate, and absence of dyspnea and chest pain.
• The client will report that pain or discomfort is alleviated or controlled, and verbalize methods that provide relief.
• The client will display a relaxed manner, be able to sleep or rest, and engage in desired activities.

Nursing Interventions and Actions

Therapeutic interventions and nursing actions for patients with deep vein thrombosis may include:

1. Promoting Effective Gas Exchange

Clients with deep vein thrombosis (DVT) can experience impaired gas exchange due to altered blood flow to the alveoli and changes in the alveolar-capillary membrane. DVT can obstruct blood flow to the lungs, reducing the amount of blood that reaches the alveoli, where gas exchange takes place. Additionally, changes in the alveolar-capillary membrane, such as inflammation and increased permeability, can further impair gas exchange by reducing the diffusion of oxygen and carbon dioxide between the lungs and the bloodstream. To ensure optimal gas exchange, healthcare providers focus on interventions to improve lung function. Regular monitoring of respiratory status allows for early detection of complications.

1. Assess the level of consciousness and changes in mentation.
Initial signs of systemic hypoxemia include restlessness and irritability, followed by progressively decreased mentation. Reduced oxygenation is a risk factor for thrombosis since the incidence of thrombosis is increased under systemic or local hypoxia. Hypoxia occurs when oxygen demand is greater than oxygen supply, for example, when blood flow is reduced by immobility or reduced by trauma (Gupta et al., 2019).

2. Auscultate lungs for areas of decreased and absent breath sounds and the presence of adventitious sounds (crackles).
Non-ventilated areas may be identified by the absence of breath sounds. Crackles may be seen in fluid-filled tissues and the airway or may indicate cardiac decompensation. A client with a developing pulmonary embolism (PE) may exhibit dyspnea. Dyspnea may be acute and severe in central PE, whereas it is often mild and transient in small peripheral PE (Vyas & Goyal, 2022).

3. Monitor vital signs. Observe changes in cardiac rhythm.
Tachycardia, tachypnea, and BP changes are associated with progressing hypoxemia and acidosis. Alterations in heart rhythm and extra heart sounds may indicate increased cardiac workload related to worsening ventilation imbalance. PE may become apparent when the client exhibits hypotension (systolic blood pressure less than 90 mm Hg or a drop in SBP of 40 mm Hg or more from baseline) (Vyas & Goyal, 2022).

4. Assess respiratory rate and rhythm. Observe for use of accessory muscles, nasal flaring, and pursed lip breathing.
Tachypnea and dyspnea are indicative of pulmonary obstruction. Dyspnea and increased work of breathing may be the first or only signs of subacute pulmonary embolism. Severe respiratory distress and failure accompany moderate to a severe loss of functional lung units. Shock and right ventricular dysfunction confer a poor prognosis and predict mortality. Clients with PE and a coexisting DVT are also at an increased risk for death (Vyas & Goyal, 2022).

5. Observe for generalized duskiness and cyanosis in the earlobes, lips, tongue, and buccal membranes.
This is suggestive of systemic hypoxemia. Late signs of hypoxia include bluish discoloration of the skin and mucous membranes, where vasoconstriction of the peripheral vessels causes cyanosis. Cyanosis is most easily seen around the lips and in the oral mucosa. However, the nurse should never assume the absence of cyanosis means adequate oxygenation (Doyle & McCutcheon, 2015).

6. Assess activity tolerance, such as reports of weakness and fatigue, vital sign changes, or increased dyspnea during exertion. Encourage rest periods, and limit activities to client tolerance.
These guidelines help in determining the response of the client to resume activities and the ability to engage in self-care. The nurse may use the six-minute walk test to assess the response of oxyhemoglobin saturation to exercise or activities, as well as the total distance the client can walk in six minutes on a ground level (Bhutta et al., 2022).

7. Monitor ABGs or pulse oximetry.
Hypoxemia is present in varying degrees, depending on the degree of airway obstruction, cardiopulmonary status, and presence and degree of shock. Respiratory alkalosis and metabolic acidosis may also be present. Arterial oxygen saturation refers to the amount of oxygen bound to hemoglobin in arterial blood. ABGs are useful tools to evaluate hypoxia because they can also shed light on the etiology of the disease process (Bhutta et al., 2022).

8. Evaluate sleep patterns, noting reports of difficulties and whether the client feels well-rested.
The client may have difficulty sleeping due to the feeling of dyspnea. Nocturnal trend oximetry provides information about oxyhemoglobin saturation over a period (usually overnight). This test is primarily used to assess the adequacy or need for oxygen supplementation at night. The use of overnight trend oximetry as a surrogate for a diagnostic sleep study is possible, however, a formal sleep study should be used whenever possible (Bhutta et al., 2022).

9. Check the client frequently and arrange for someone to stay with the client, as indicated.
This assures that changes in condition will be noted and that assistance is readily available. The client may manifest neurological symptoms such as restlessness, headache, and confusion with moderate hypoxia, therefore, the client must be assessed and checked as frequently as possible to avoid further deterioration of the client’s condition (Bhutta et al., 2022).

10. Assist with frequent changes of position, and encourage ambulation as tolerated.
Turning and ambulation enhance the aeration of different lung segments, thereby improving oxygenation. The ACCP Consensus Conference on Antithrombotic and Thrombolytic Therapy for venous thromboembolism recommended ambulation as tolerated for clients with DVT. Therefore, early ambulation on day 2 after initiation of outpatient anticoagulant therapy, in addition to effective compression, is strongly recommended. Early ambulation without ECS is not recommended (Patel, 2019).

11. Encourage coughing, deep breathing exercises, and suctioning as indicated.
Increases oxygen delivery to the lungs by mobilizing secretions and enhancing ventilation. Deep breathing exercises are used to decrease the incidence and severity of pulmonary complications such as pneumonia, atelectasis, and hypoxemia. During exercise education, the nurse explains and demonstrates how to take a deep, slow breath, and how to exhale slowly, three to five times every one to two hours. Clients who performed deep breathing exercises had better pulmonary function compared to the performing no exercise group (Unver et al., 2018).

12. Keep the head of the bed elevated.
This promotes maximal chest expansion, making it easier to breathe and enhancing physiological and psychological comfort. A prone position should be avoided. In COVID-19 acute respiratory distress syndrome (ARDS), a prone position is frequently applied. During prone ventilation, the client’s position remains nearly unchanged, with minimal movements limited to the head and limbs. Therefore, the prone position can be a potential contributor to blood flow changes in these clients (Gebhard et al., 2021).

See also: Patient Positioning: Complete Guide and Cheat Sheet for Nurses

13. Assist with chest physiotherapies, such as postural drainage and percussion of the non-affected area, and with an incentive spirometer.
This facilitates deeper respiratory effort and promotes drainage of secretions from lung segments into bronchi, where they may more readily be removed by coughing or suctioning. Pulmonary rehabilitation can significantly improve dyspnea, overall health, and exercise endurance in clients with PE. The existing evidence suggests that pulmonary rehabilitation is a potential treatment for alleviating post-PE syndrome, which improves the quality of life and prognosis of clients with PE (Yu et al., 2022).

14. Provide supplemental humidification, such as ultrasonic nebulizers.
Nebulization gives moisture to mucous membranes and helps liquefy secretions to facilitate airway clearance. Dry nasal mucosa occurs when the flow is greater than or equal to 4 L/minute, therefore humidification is necessary for clients using low-flow oxygen devices (Bhutta et al., 2022).

15. Provide oxygen therapy with an appropriate method as ordered.
Oxygen therapy can help increase oxygen levels and enhance tissue perfusion, decreasing the risk of hypoxia and other related complications. Oxygen therapy may be indicated for clients with low PaO2 that is less than 60 or SaO2 less than 90, and this can be achieved by increasing the percentage of oxygen in the inspired air that reaches the alveoli (Bhutta et al., 2022).

16. Provide adequate hydration, either oral (PO) or IV, as indicated.
Increased fluids may be given to decrease the hyperviscosity of blood, which can potentiate thrombus formation, or support circulating volume and tissue perfusion. A low fluid volume state can lead to hemoconcentration and low venous flow. Clients who experienced a VTE were found to have elevated biochemical indices of dehydration, in comparison to clients who had not (Keiter et al., 2015).

17. Administer medications, as indicated.
See Pharmacologic Management

18. Prepare the client for a lung scan.
This may reveal the pattern of abnormal perfusion in areas of ventilation, reflecting ventilation and perfusion mismatch, confirming the diagnosis of pulmonary embolism and the degree of obstruction. The absence of both ventilation and perfusion reflects alveolar congestion or airway obstruction. The planar ventilation/perfusion scan is an established diagnostic test for suspected PE. V/Q scanning is mostly performed for clients in whom computed tomographic pulmonary angiography (CTPA) is contraindicated or inconclusive, or when additional testing is needed (Vyas & Goyal, 2022).

19. Prepare for and assist with bronchoscopy.
The purpose of this procedure is to remove blood clots and clear the airway. During flexible bronchoscopy, clots can be removed piecemeal by biopsy forceps, dislodged using a Fogarty catheter, or removed en bloc using either suctioning or a cryoprobe (Sehgal et al., 2017).

20. Prepare for surgical intervention, if indicated.
Vena caval ligation or insertion of an intracaval umbrella is intended for clients with recurrent emboli despite adequate anticoagulation, when anticoagulation is contraindicated, or when septic emboli arising from below the renal veins unresponsive to treatment; Pulmonary embolectomy is often done as a last resort treatment of PE. Traditional venous thrombectomy is performed by surgically exposing the common femoral vein and saphenofemoral junction through a longitudinal skin incision. Care must be taken to avoid dislodging the clot or breaking it into small fragments because pulmonary embolus will result (Patel, 2019).

21. Assist the client to deal with fear and anxiety that may be present.
Feelings of fear and severe anxiety are associated with the inability to breathe and may actually increase oxygen consumption and demand. Encourage the client to express their feelings so that the client may regain some sense of control over emotions. Provide the client with brief explanations of what is happening and the expected effects of outcomes. This may allay anxiety related to the unknown and help reduce fears concerning personal safety.

2. Enhancing Peripheral Tissue Perfusion

Deep vein thrombosis (DVT) can lead to ineffective tissue perfusion due to several factors. The increased blood coagulability makes it more likely for a blood clot to form in the deep veins, leading to restricted blood flow. Venous stasis, caused by reduced blood flow and muscle contractions, can also contribute to DVT, while vessel wall injury can cause inflammation and clot formation, further impeding blood flow. All these factors combined can result in ineffective tissue perfusion, which can lead to a range of complications. Healthcare providers employ various interventions to improve tissue perfusion in these patients.

1. Assess for contributing factors such as a family history of blood clots or inherited blood clotting disorders, prolonged immobility, trauma to the veins, such as from surgery, injury, or infection, use of hormonal birth control or hormone replacement therapy, obesity, sedentary lifestyle, smoking, and alcohol consumption.
Most clients with DVT are asymptomatic. Knowledge of high-risk situations helps in early detection. Genetic mutations within the blood’s coagulation cascade represent those at the highest risk for the development of venous thrombosis. Genetic thrombophilia is identified in 30% of clients with idiopathic venous thrombosis. Immobility can be as transient as that occurring during a transcontinental airplane flight or an operation under general anesthesia (Patel, 2019).

2. Assess for the signs and symptoms of deep vein thrombosis (DVT).
The signs and symptoms that occur in the leg affected by the deep vein clot include swelling, pain or tenderness, increased warmth, and changes in skin color (redness). Edema is the most specific symptom of DVT. Thrombus that involves the iliac bifurcation, the pelvic veins, or the vena cava produces leg edema that is usually bilateral rather than unilateral. Superficial thrombophlebitis is characterized by the finding of a palpable, indurated, cordlike, tender, subcutaneous venous segment (Patel, 2019).

3. Measure the circumference of the affected leg with a tape measure.
Unilateral leg and thigh swelling can be assessed by measuring the circumference of the affected leg 10 cm below the tibial tuberosity and 10 cm to 15 cm above the upper edge of the patella. Deep vein thrombosis is suspected if there is a difference of >3 cm between the extremities. High partial obstruction often produces mild bilateral edema that is mistaken for the dependent edema of right-sided heart failure, fluid overload, or hepatic or renal insufficiency (Patel, 2019).

4. Monitor the results of diagnostic tests.
See Laboratory and Diagnostic Procedures

5. Monitor the following coagulation profile: international normalized ratio (INR), prothrombin time (PT), and partial thromboplastin time (PTT) results.
These are used to measure the effectiveness of anticoagulant therapy. The PT/INR is used for clients receiving warfarin. Baseline values are obtained before the first dose of anticoagulant is administered. Repeated tests are done at prescribed intervals to adjust drug dosages to achieve desired changes in coagulation. A prolonged prothrombin time or activated partial thromboplastin time does not imply a lower risk of new thrombosis. Progression of DVT and PE can occur despite full therapeutic anticoagulation in 13% of clients (Patel, 2019).

6. Assess the client’s level of pain.
Leg pain occurs in 50% of clients, but this is entirely nonspecific. Pain can occur on dorsiflexion of the foot (Homan sign). Tenderness occurs in 75% of clients but is also found in 50% of clients without objectively confirmed DVT. When tenderness is present, it is usually confined to the calf muscles or along the course of the deep veins in the medial thigh (Patel, 2019).

7. Maintain adequate hydration.
Hydration prevents an increased viscosity of blood, which contributes to venous stasis and clotting. A low fluid volume state can lead to hemoconcentration and low venous flow. In a prospective study, dehydration was independently linked to VTE in those clients who had previously had an acute ischemic stroke (Keiter et al., 2015).

8. Encourage bed rest and keep the affected leg elevated (depending on the size and location of the clot) as indicated.
Clients usually require bed rest until symptoms are relieved. The affected leg should be elevated to a position above the heart to decrease swelling. Leg elevation is a simple intraoperative and postoperative technique for improving venous drainage from the lower extremities, which minimizes venous stasis (Keiter et al., 2015).

9. Provide warm, moist heat to the affected site.
Heat promotes comfort and reduces inflammation. Vascular boot warming, also known as Rooke boot warming, helps to vasodilate the distal arterial bed, improves perfusion, raises tissue pressure, and increases venous blood return from the lower extremities, thus improving clinical outcomes for DVT. Compared to other mechanical methods, such as intermittent compression stockings, the vascular boot is relatively more comfortable to wear as it has less pressure on the heel and other bony areas (Zhang et al., 2021).

10. Apply below-knee compression stockings as prescribed. Ensure that the stockings are the correct size and are applied correctly.
Compression stockings enhance circulation by providing graduated pressure on the affected leg to help return the venous blood to the heart. Inaccurately applied stockings can serve as a tourniquet and can promote clot formation. Below-the-knee elastic compression stockings (ECS) assist the calf muscle pump and reduce venous hypertension and venous valvular reflux. This reduces leg edema, aids in microcirculation, and prevents venous ischemia. Graduated compression stockings, on the other hand, with ankle pressures of 30 to 40 mm Hg reduced the incidence of PTS by 50% (Patel, 2019).

11. Administer analgesics as prescribed.
Analgesics relieve pain and promote comfort. Acetaminophen is the safest pain reliever while taking an anticoagulant, but the daily dose recommended must not be exceeded. NSAIDs should be avoided for clients taking anticoagulants because they are associated with an increased risk of bleeding (The North American Thrombosis Forum, 2022).

12. Administer anticoagulants (heparin/warfarin) as prescribed.
Treatment with anticoagulant is used primarily to prevent the formation of new clots by decreasing the normal activity of the clotting mechanism. Heparin IV or subcutaneous low-molecular-weight heparin is started initially. Oral anticoagulant therapy (warfarin) will be initiated while the client is still receiving heparin because the onset of action for warfarin can be up to 72 hours. Heparin will be discontinued once the warfarin reaches therapeutic levels.

13. With a massive DVT severely comprising tissue perfusion, anticipate thrombolytic therapy.
Thrombolytic therapy is used only in severe embolism that significantly comprises blood flow to the tissues since they can cause sudden bleeding. For maximum effectiveness, therapy must be started soon after the onset of symptoms (within 5 days). Accordingly, careful assessment of the indications for lysis against the possibility of bleeding must be carried out before pharmacologic thrombolysis is attempted (Patel, 2019).

14. For clients who are unresponsive to anticoagulant therapy, anticipate the following surgical treatment.
See Preoperative Care

15. Encourage the client to ambulate as tolerated.
In Europe, early ambulation and compression have been the mainstay of adjunctive therapy for DVT. In North America, the unsubstantiated fear of dislodging clots by ambulation led clinicians to recommend bed rest and leg elevation to their clients. The authors explained that bed rest promotes venous stasis, which is a major risk factor for DVT, and therefore, may actually enhance thrombus propagation and the risk of subsequent PE (Patel, 2019).

3. Managing Acute Pain

Clients with deep vein thrombosis (DVT) can experience acute pain due to several factors. The presence of a blood clot in the affected vein can lead to diminished arterial circulation and oxygenation of tissues, causing the accumulation of lactic acid and triggering pain receptors. Additionally, the inflammation response in the affected vein can further exacerbate pain by sensitizing pain receptors and causing tissue damage. Healthcare providers employ various strategies to manage acute pain in these patients.

1. Assess the degree and characteristics of discomfort and pain.
The degree of pain depends on the extent of circulatory deficit, the inflammatory process, the degree of tissue ischemia, and the extent of edema associated with thrombus development. Changes in the characteristics of pain may indicate the development of complications. Leg pain can occur in 50% of clients, but it can be entirely unspecific. Pain can occur on dorsiflexion of the foot (Homan sign) (Patel, 2019).

2. Investigate reports of sudden or sharp chest pain, accompanied by dyspnea, tachycardia, and apprehension, or the development of new pain with signs of another site of vascular involvement.
These signs and symptoms suggest the presence of pulmonary embolism as a complication of DVT or peripheral arterial occlusion associated with heparin‐induced thrombocytopenia with thrombosis syndrome (HITT). Both conditions require immediate medical treatment. Pleuritic chest pain without other symptoms or risk factors may be a presentation of pulmonary embolism. Pleuritic or respirophasic chest pain is a particularly worrisome symptom. Its presence suggests that the embolus is located more peripherally and thus may be smaller (Ouellette & Mosenifar, 2020).

3. Monitor vital signs, noting increased temperature.
Elevations in heart rate may indicate increased discomfort or may occur in response to fever and inflammatory processes. Fever can also increase the client’s discomfort. Fever of less than 39℃ (102.2℉) may be present in 14% of clients; however, a temperature higher than 39.5℃ (103.1℉) is not from pulmonary embolism (Ouellette & Mosenifar, 2020).

4. Maintain bed rest during the acute phase, then start early ambulation gradually as tolerated.
This decreases discomfort associated with muscle contraction and movement. However, the concept of immobilizing DVT clients is outdated, since early mobilization has been demonstrated not to increase the risk of embolization, and large cohort studies have clearly proven that outpatient DVT treatment is feasible and safe for the majority of clients being diagnosed with DVT outside of hospitals. Admitted clients with DVT may be safely mobilized, provided that adequate anticoagulation is immediately initiated (Endig et al., 2016).

5. Encourage the client to change position frequently.
This reduces muscle fatigue, helps minimize muscle spasms, and maximizes circulation to tissues. Position changes can help reduce pain in DVT by improving blood flow and reducing pressure on the affected vein. When the client changes their position, this helps prevent blood from pooling in the affected area and decreases the risk of further developing blood clots.

6. Provide a foot cradle.
The cradle keeps the pressure of bedclothes off the affected leg, thereby reducing pressure discomfort. Additionally, a foot cradle supports the foot and the ankle in a neutral position, which can help improve blood flow and reduce the risk of further blood clots. However, this measure should be used in conjunction with other strategies to prevent DVT, such as regular exercise, position changes, and the use of compression stockings.

7. Elevate affected extremity.
This encourages a venous return to facilitate circulation, reducing stasis and edema formation. Virchow’s triad states that venous stasis is a predisposing factor for DVT. Leg elevation is a simple intraoperative and postoperative technique for improving venous drainage from the lower extremities, which minimizes venous stasis (Keiter et al., 2015).

8. Apply a warm compress to the affected leg using a 2-hour-on, 2-hour-off schedule around the clock.
Moist heat may be applied to the affected region to relieve pain and improve circulation through vasodilation. Heat therapy produces increased collagen extensibility, increased blood flow, metabolic rate, and inflammation resolution. Decreased joint stiffness, muscle spasm, and pain are also positive effects of heat therapy. Heat raises the pain threshold and acts directly on the muscle spindle, decreasing spindle excitability (El-Tallawy et al., 2021).

9. Teach the client non-pharmacological pain management techniques, such as deep breathing exercises, guided imagery, or relaxation techniques.
These techniques can help alleviate pain and decrease the need for opioids or other pain medications, which may have adverse effects. These therapies may also help clients to feel more in control of pain management, improve overall well-being, and promote better compliance with the prescribed treatment plan.

10. Administer medications, as indicated.
See Pharmacologic Management

11. Recommend the use of a vascular warming boot or Rooke boot.
A study evaluated the safety, efficacy, and impact of vascular boot warming on post-thrombotic syndrome in DVT. Pain and swelling are two critical concerns for clients and are closely correlated to their quality of life. Results suggest that vascular boot warming can reduce pain and swell much faster than the standard of care, and it does not increase bleeding (Zhang et al., 2021). 

12. Encourage therapeutic exercise as tolerated.
When the pain decreases, mobilization should be regained gradually. The best treatment in such cases is combined gradual stretching and strengthening exercises. Client education is mandatory about a therapeutic exercise regimen at home once therapeutic sessions have ceased. Therapeutic exercise consists of passive movements, active-assistive exercises, active exercises, stretching, and relaxation exercises (El-Tallawy et al., 2021).

13. Ensure proper wearing of compression stockings.
The more a DVT client is affected by pain and leg swelling, the more likely they will benefit from compression therapy (stockings or bandages), provided that the compression device is fitted correctly. Clients receiving compression therapy need to be educated on proper use and the risk of developing pressure injuries, which is a significant risk. Daily skin inspections are necessary during compression therapy (Endig et al., 2016).

4. Preventing Bleeding Risk and Injury

Clients with deep vein thrombosis (DVT) are at risk for bleeding due to several factors. Abnormal blood profile, such as low platelet counts or coagulopathy, can increase the risk of bleeding. Additionally, anticoagulation therapy, which is commonly used to prevent new blood clots in DVT, can also increase the risk of bleeding by reducing the blood’s ability to clot. This can result in bleeding or hemorrhage, especially in patients who are also taking other medications that can further increase the risk of bleeding, such as aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs). Healthcare providers utilize several strategies to prevent bleeding and injury in these patients.

1. Assess for the signs and symptoms of bleeding.
Bruises, epistaxis, and gum bleeding are early signs of spontaneous bleeding. Significant bleeding, such as hematemesis, hematuria, or GI hemorrhage should be thoroughly investigated because anticoagulant therapy may unmask a pre-existing disease like cancer, peptic ulcer disease, or an arteriovenous malformation (Patel, 2019).

2. Monitor platelet counts and coagulation test results (INR, PT, PTT).
The effects of anticoagulation therapy must be closely monitored to reduce the risk of bleeding. The clotting time is the time it takes for plasma to clot after the addition of different substrates in vitro under standard conditions using the capillary method. PT/INR is the initial test used to identify defects in secondary hemostasis. It is the time taken for blood to clot and generates thrombin. A delay in the PT or aPTT indicates the presence of either a deficiency or inhibitor of the clotting factor (Umerah & Momodu, 2022).

3. Monitor platelets and the heparin-induced platelet aggregation (HIPA) status.
A sudden decrease in the platelet count can occur with heparin use and is known as heparin-induced thrombocytopenia (HIT). HIT is less commonly seen with the use of low-molecular-weight heparin. HIT typically presents as a steady drop in platelet counts (no fluctuations), while hemoglobin and hematocrit counts remain relatively stable. The most common symptom of HIT is the enlargement or extension of a blood clot or the development of a new blood clot. In clients receiving IV heparin, they may experience chills, fever, hypertension, tachycardia, shortness of breath, and chest pain (Nicolas et al., 2023).

4. Administer anticoagulant therapy as prescribed (continuous IV heparin/subcutaneous low-molecular-weight heparin; oral warfarin).
Anticoagulants are given to prevent further clot formation. The type of medication varies per protocol and severity of the clot. First-line therapy for non-high-risk VTE or PE consists of direct oral anticoagulants over vitamin K antagonists. There are also possibilities for advances in anticoagulant delivery systems including the expansion of new oral agents and their antidotes, reducing the size of heparins, developing oral or topical heparins, and modifying physical or chemical formulations. Ita suggests that transdermal delivery may potentially bypass known issues with heparin use (Patel, 2019).

5. If bleeding occurs while on IV heparin: terminate the infusion then recheck the PTT level stat, and reevaluate the dose of heparin based on the PTT result.
Laboratory data guide further treatment. The guide for the PTT level is 1.5 to 2 times normal. Anticoagulation-related major bleeding is associated with an increased risk of death and thrombotic events, independent of the class of anticoagulant used. With the increasing use of non-vitamin K antagonists or oral anticoagulants, the number of clients who require reversal of their anticoagulant effects can be expected to rise (Patel, 2019).

6. Avoid the use of invasive procedures, such as injections or venipuncture, if possible, and use caution during any necessary procedures to minimize the risk of bleeding.
If an invasive procedure is necessary, nurses should take appropriate precautions, such as using a smaller gauge needle or applying pressure to the puncture site, to reduce the risk of bleeding. The management of anticoagulation in clients undergoing surgical procedures is challenging since interrupting anticoagulation for a procedure transiently increases the risk of thromboembolism. At the same time, surgery and invasive procedures have associated bleeding risks that are increased by anticoagulants. A balance between reducing the risk of thromboembolism and preventing excessive bleeding must be reached for each client (Douketis, 2023).

7. Teach the client the importance of complying with the prescribed medication regimen and report any signs of bleeding, such as unusual bruising, nosebleeds, or blood in the stool or urine.
Adhering to the medication regimen prevents the formation of new blood clots and decreases the risk of serious complications, such as pulmonary embolism. Anticoagulants need to be taken regularly and as prescribed by the physician to ensure that the blood’s clotting parameters are within the therapeutic range. Long-term anticoagulation is necessary to prevent the high frequency of recurrent venous thrombosis or thromboembolic events. Interruption of anticoagulation within the first 12 weeks of therapy appears to result in a 25% incidence of recurrent thrombosis (Schreiber & Brenner, 2020).

8. Convert from IV anticoagulation to oral anticoagulation after the appropriate length of therapy. Monitor INR, PT, and PTT levels.
PT or INR levels should be in a therapeutic range for anticoagulation before discontinuing heparin. Oral vitamin K antagonists (VKAs) remain the preferred approach for long-term treatment, which allows for single-dosing oral therapy that can be continued on an outpatient basis. The American College of Chest Physicians (ACCP) recommends cessation of anticoagulant therapy after 3 months of treatment in those with surgery-associated acute proximal DVT, an acute proximal DVT or PE provoked by a nonsurgical transient risk factor, and a first unprovoked VTE and a high risk of bleeding (Schreiber & Brenner, 2020).

9. If HIPA is positive, stop all heparin products and anticipate a hematology consult.
The continuation of heparin products further complicates the situation. Specialty expertise is needed. Laboratory confirmation of HIT is of crucial importance and remains challenging and relies on platelet functional assays highlighting the presence of heparin-dependent platelet-activating antibodies in the client’s serum or plasma. Platelet functional assays using washed platelets include the C-serotonin release assay (SRA), usually described as the gold standard, and HIPA (Gonthier et al., 2021).

10. Keep reversal agents for different anticoagulants within easy access.
The initial step for any condition requiring urgent reversal of anticoagulation is always to discontinue the anticoagulant. Protamine sulfate counteracts the activity of unfractionated heparin. It is also indicated for bleeding in clients on LMWH, although it is not as effective as with bleeding associated with UFH. Idarucizumab is an anti-dabigatran monoclonal antibody fragment used in clients treated with dabigatran presenting with life-threatening bleeding. Andexanet alfa can be given to clients receiving apixaban, betrixaban, edoxaban, and rivaroxaban (Umerah & Momodu, 2022).

11. Avoid administering platelet transfusions to clients with confirmed HIT in the acute phase.
Platelet transfusions are contraindicated during the acute phase, as transfused platelets can bind to IgG and become activated and release PF4, thus worsening the hypercoagulable state. Activated platelets release prothrombotic substances and PF4, creating a continuous cycle that can only be broken when heparin is discontinued and appropriate treatment is initiated (Nicolas et al., 2023).

5. Initiating Health Teaching and Patient Education

Lack of knowledge can be a common issue for clients with deep vein thrombosis (DVT) due to unfamiliarity with the disease and its management. This can result in a lack of understanding about the importance of adherence to treatment and lifestyle modifications that can help prevent future occurrences of DVT. Initiating health teaching and patient education is an essential component of caring for patients with deep vein thrombosis (DVT). Education plays a vital role in empowering patients to actively participate in their own care and make informed decisions regarding their health. Healthcare providers provide comprehensive information to patients about DVT, its risk factors, signs and symptoms, and the importance of adherence to the prescribed treatment plan. Patients are educated about the rationale and potential side effects of anticoagulant medications, as well as the importance of regular monitoring and follow-up appointments.

1. Assess the client’s understanding of the causes, treatment, and prevention plan for deep vein thrombosis.
This information gives an important starting point in education. DVT requires preventive effort to reduce the risk of reoccurrence. DVT is one of the most prevalent medical problems today, with an annual incidence of 80 cases per 100,000. Early recognition and appropriate treatment of DVT and its complications can save many lives (Patel, 2019).

2. Assess the following signs of pulmonary embolus such as shortness of breath, chest pain that worsens with deep breathing or coughing, palpitations, clammy skin, lightheadedness, and cough.
These symptoms can be caused by a blood clot that breaks off from the original clot in the leg and travels to the lung. The challenge in dealing with pulmonary embolism is that clients rarely display the classic presentation of this problem, that is, the abrupt onset of pleuritic chest pain, shortness of breath, and hypoxia. The presentation of PE may vary from sudden catastrophic hemodynamic collapse to gradually progressive dyspnea (Ouellette & Mosenifar, 2020).

3. Instruct the client to take medications as indicated, explaining their actions, dosages, and side effects.
Correct knowledge decreases future complications. Analgesics and anti-inflammatory medications are indicated for short-term symptom relief. Clients may require anticoagulation for weeks or long term, depending on the risks. The immediate symptoms of DVT often resolve with anticoagulation alone, and the rationale for intervention is often the reduction of the 75% long-term risk of PTS. Systemic IV thrombolysis is no longer recommended because of an elevated incidence of bleeding complications, a slightly increased risk of death, and insignificant improvement in PTS (Patel, 2019).

4. Inform the client of the need for regular laboratory testing while on oral anticoagulation.
Routine coagulation monitoring is necessary to ensure that a therapeutic response is obtained and prevent reoccurrences of clots. For admitted clients with unfractionated heparin (UFH), the aPTT or heparin activity level must be monitored every six hours while the client is taking IV heparin until the dose is stabilized in the therapeutic range. Clients treated with LMWH or fondaparinux do not require monitoring of the aPTT (Patel, 2019).

5. Discuss and give the client a list of signs and symptoms of excessive anticoagulation.
Clients need to self-manage their condition. The early assessment facilitates prompt treatment. Hemorrhagic complications are the most common adverse effects of anticoagulant therapy. Anticoagulation therapy for three to six months results in major bleeding complications. Significant bleeding, such as hematemesis, hematuria, or GI hemorrhage, should be thoroughly investigated because anticoagulant therapy may unmask a preexisting disease (Patel, 2019).

6. Provide teaching regarding the safety measures while on anticoagulant therapy such as the use of an electric razor, and the use of a soft toothbrush.
These precautionary measures help reduce the risk of bleeding. The use of a soft-bristled toothbrush prevents trauma to the oral mucous membranes and the risk of bleeding from the gums. Toothpicks and dental floss should also be avoided, as they can injure the gums when used vigorously (Wayne, 2023).

7. Instruct the client to avoid rubbing or massaging the calf.
This will prevent breaking off the clot, which may travel into the circulation as an embolus. Massaging lower extremities using forceful techniques and for prolonged periods where a client has been diagnosed with DVT in the leg veins is associated with complications. Massage can dislodge an already established thrombus, embolus, or blood clot and predispose the client to develop PE and cause sudden death (Behera et al., 2017).

8. Instruct the client on the correct application of compression stockings.
Stockings applied inaccurately can serve as a tourniquet and promote clot formation. The incorrect use of compression stockings can be unsafe; thigh-length stockings that are fitted incorrectly or that roll down the leg can create a tourniquet effect, which can potentially damage the skin and reduce venous outflow. Additionally, one length of stocking may be more appropriate than the other in certain clients; knee-length stockings may be more likely to induce wound complications in clients undergoing knee replacement surgery as the elastic support lies over the wound, creating unwanted localized pressure (Wade et al., 2016).

9. Educate the client about the following measures to prevent reoccurrence:

• 9.1. Avoid constricting garters or socks with tight bands
  Wearing constricting clothing decreases normal blood flow and promotes clotting. Constricting socks or garters work by applying pressure to the lower extremities which helps to improve blood flow and prevent blood clots from forming. However, if the pressure is too high or the socks are too tight, it can restrict blood flow, increasing the risk of blood clots.
  
• 9.2. Avoid staying in one position for long periods; get up and move around every hour or so on a long flight.
  This will avoid the occurrence of venous stasis. The concept of immobilizing DVT clients is outdated, since early mobilization has been demonstrated not to increase the risk of embolization, and large cohort studies have proven that outpatient DVT treatment is feasible and safe for the majority of clients being diagnosed with DVT outside of hospitals (Endig et al., 2016).
  
• 9.3. Maintain adequate hydration.
  Sufficient hydration prevents hypercoagulability. A low-volume state can lead to hemoconcentration and low venous flow. A study found that clients who experienced VTE have elevated biochemical indices of dehydration, in comparison to clients who had not (Keiter et al., 2015).
  
• 9.4. Maintaining a healthy body weight
  Obesity contributes to venous insufficiency and venous hypertension through the compression of the main veins in the pelvic region. It has been shown that the risk of VTE increases with increasing BMI. the risk is higher when obesity interacts with other thrombotic risk factors (Hotoleanu, 2020).
  
• 9.5. Not sitting with the legs crossed
  The client should refrain from any position that promotes vein compression. When the client crosses their legs or thighs, they obstruct some of the veins in the legs, slowing down blood flow. As a result, blood can pool in the veins, which may slightly increase the risk of blood clots in the legs (Triffin & Ketchum, 2020).
  
• 9.6. Participating in an exercise program
  Walking, swimming, and cycling help promote venous return through the contraction of the calf and thigh muscles. These muscles act as a pump to compress veins and support the column of blood returning to the heart. A narrative summary of the included studies related to DVT shows that exercise sessions with a target intensity of 70% peak heart rate significantly improved cardiorespiratory fitness. Additionally, exercise training also improved leg strength and flexibility, as well as calf pump function (Xu et al., 2021).
  
• 9.7. Quitting smoking
  Cigarettes contain nicotine which is a vasoconstrictor that affects blood clotting and circulation. Researchers described through their research that the mechanism of smoking impacts on blood is very dangerous because in smokers the activities of platelet predispose them to blood clots. Platelets regulate clot formation, which is a primary cause of heart attacks (Aslam et al., 2017).
  
• 9.8. Wearing properly sized, correctly applied compression stockings as indicated.
  Clients with DVT are at high risk for redevelopment and may need to wear stockings over the long term. The regular use of graduated elastic compression stockings reduced the incidence of PTS by 50%. Authors strongly recommend the early use and widespread implementation of graduated elastic stockings with adequate anticoagulant therapy for symptomatic proximal DVT to prevent the development of PTS (Patel, 2019).

10. Explain the purpose of activity restrictions and the need for balance between activity and rest.
Rest reduces the oxygen and nutrient needs of compromised tissues and decreases the risk of fragmentation of thrombosis. Balancing rest with activity prevents exhaustion and further impairment of cellular perfusion. A systematic review found that in clients with acute DVT, early walking exercise is safe and may help to reduce acute symptoms and that in clients with previous DVT, exercise training does not increase leg symptoms acutely and may help to prevent or improve the postthrombotic syndrome (Patel, 2019).

11. Educate women about the possible effect of hormonal contraceptives on the risk of developing DVT.
Hormonal contraceptives are widely used throughout the world and have been associated with blood clots in the legs and lungs. Users of hormonal contraceptives have a significantly increased risk of DVT compared to non-users. Women should be informed of these risks and offered education in fertility-awareness-based methods with comparable efficacy for family planning (Keenan et al., 2019).

12. Instruct in meticulous skin care of the lower extremities.
Instruct the client to prevent or promptly treat breaks in the skin and report the development of ulcers or changes in skin color. Chronic venous congestion and post-phlebitis syndrome may develop, especially in the presence of severe vascular involvement and recurrent DVT, potentiating the risk of stasis ulcers.

13. Review the client’s usual medications and foods when on oral anticoagulant therapy.
Warfarin interacts with many foods and drugs either increasing or decreasing the anticoagulant effect. Salicylates and excess alcohol decrease prothrombin activity, whereas vitamin K (multivitamins, bananas, leafy green vegetables) increases prothrombin activity and can cause a higher or lower INR, possibly outside the therapeutic range. Barbiturates increase the metabolism of coumadin drugs; antibiotics alter intestinal flora and may interfere with vitamin K synthesis.

6. Assessing and Monitoring for Potential Complications

Assessing and monitoring for potential complications is an integral part of the care provided to patients with deep vein thrombosis (DVT). Healthcare providers play a crucial role in assessing and monitoring patients for these potential complications to ensure timely intervention and optimal outcomes. Through vigilant assessment, including regular evaluation of vital signs, monitoring of coagulation profiles, and examination for signs and symptoms of complications such as pulmonary embolism or post-thrombotic syndrome, healthcare providers can identify any changes or developments that may require immediate attention.

1. Assess vital signs frequently.
Vital signs provide baseline data and can indicate changes in the patient’s condition. Elevated temperature, increased heart rate, and decreased blood pressure may suggest infection or other complications associated with DVT.

2. Assess and document the location, size, and characteristics of the thrombus.
This information helps evaluate the severity of the clot, the potential for migration or obstruction, and the effectiveness of treatment. It also serves as a baseline for comparison in subsequent assessments.

3. Monitor and document peripheral pulses.
Diminished or absent pulses distal to the clot site may indicate compromised circulation due to clot extension or obstruction. Prompt recognition of reduced peripheral pulses is crucial for early intervention.

4. Assess for signs of pulmonary embolism (PE).
DVT can lead to PE, a potentially life-threatening complication. Monitor for signs such as sudden dyspnea, tachypnea, chest pain, hemoptysis, anxiety, or changes in mental status. Early detection and treatment of PE are essential.

5. Observe for signs of compartment syndrome.
Extensive or massive DVT can cause compartment syndrome due to increased pressure within the affected limb. Monitor for signs such as severe pain, swelling, paresthesia, pallor, and loss of pulse distal to the clot. Timely intervention can prevent tissue damage.

6. Perform regular neurological assessments.
Neurological changes may indicate complications associated with DVT, such as stroke or cerebral venous thrombosis. Assess for changes in level of consciousness, motor or sensory deficits, visual disturbances, or sudden severe headaches.

7. Monitor laboratory values.
Regularly assess coagulation studies, including prothrombin time (PT), activated partial thromboplastin time (aPTT), international normalized ratio (INR), and D-dimer levels. Abnormal results may indicate the progression or resolution of DVT or the effectiveness of anticoagulant therapy.

8. Evaluate for signs of bleeding or hemorrhage.
Anticoagulant therapy increases the risk of bleeding. Monitor for signs such as tachycardia, hypotension, melena, hematemesis, hematuria, ecchymosis, or bleeding from invasive lines or puncture sites. Early recognition and intervention can prevent complications.

9. Assess for skin changes and potential ulceration.
Chronic DVT can cause venous stasis ulcers. Monitor for skin discoloration, edema, increased warmth, or breakdown in the affected limb. Prompt identification and management of ulcers can prevent infection and further tissue damage.

10. Educate the patient on signs and symptoms to report.
Providing education empowers the patient to recognize and report any changes or symptoms promptly. Reinforce the importance of reporting pain, swelling, redness, warmth, shortness of breath, chest pain, or any other concerning symptoms.

7. Administering Medications and Pharmacologic Support

Administering medications and providing pharmacologic support are essential components of the comprehensive management of patients with deep vein thrombosis (DVT). Pharmacologic support in patients with DVT requires close monitoring of medication effectiveness, adverse effects, and potential drug interactions. Regular laboratory assessments, including coagulation studies and complete blood counts, are essential to ensure appropriate dosing and therapeutic efficacy while minimizing the risk of bleeding complications. Nursing professionals play a crucial role in administering medications, monitoring patient response, and educating patients about the importance of adherence and potential side effects.

1. Thrombolytic agents, such as alteplase, anistreplase, reteplase, streptokinase, tenecteplase, and urokinase
These agents are intended to bring about clot lysis (breakdown of the clot) and immediate normalization of venous blood flow. The use of thrombolytic medications to lyse DVT can cause intracranial bleeding, though this is infrequent, and death or impairment can result. The need should be compelling when thrombolysis is considered in a setting of known contraindications (Patel, 2019).

2. Morphine sulfate and anti-anxiety agents
These are given to decrease pain or anxiety and improve the work of breathing, maximizing gas exchange. However, caution should be practiced when giving morphine because current morphine use is associated with PE in DVT clients. The risk of PE increased with augmented morphine dosage only in clients treated with morphine within the past 30 days, according to a study (Lee et al., 2014).

3. Anticoagulants
The mainstay of medical therapy has been anticoagulation since the introduction of heparin in the 1930s. Other anticoagulation drugs have subsequently been added to the treatment armamentarium over the years, such as vitamin K antagonists and low-molecular-weight heparin (LMWH). Long-term coagulation is necessary to prevent the high frequency of recurrent venous thrombosis or thromboembolic events (Patel, 2019).

4. Opioid and nonopioid analgesics
This relieves pain and decreases muscle tension. Opioids produce their effect by acting as agonists at opioid receptors, which are found in the brain, spinal cord, and sites outside the CNS. Most opioids have a similar spectrum of adverse effects, such as respiratory depression, sedation, nausea/vomiting, and constipation (El-Tallawy et al., 2021).

5. Antipyretics (Acetaminophen)
This reduces fever and inflammation. Since NSAIDs are not recommended for clients with DVT, acetaminophen may be appropriate for short-term use. Regular monitoring for hepatotoxicity is required for clients who receive acetaminophen regularly and beyond the maximum dosage of 3 g daily (El-Tallawy et al., 2021).

8. Monitoring Laboratory and Diagnostic Procedures

Laboratory and diagnostic tests provide valuable information about the patient’s clotting status, the severity of the thrombus, and the effectiveness of treatment interventions. Monitoring laboratory and diagnostic procedures in patients with DVT allows healthcare providers to assess the effectiveness of treatment, detect potential complications, and adjust the management plan accordingly. Close collaboration between nursing professionals, laboratory personnel, and radiologists is crucial to ensure timely and accurate testing, interpretation of results, and appropriate interventions.

1. Ultrasonography
Ultrasonography is currently the first-line imaging examination for DVT because of its relative ease of use, absence of irradiation or contrast material, and high sensitivity and specificity in institutions with experienced sonographers. Compression ultrasonography entails imaging the calf to the groin in the axial plane. Some protocols use gray-scale ultrasonography alone, whereas others include Doppler interrogation (Hoffer & Cho, 2022).

2. D-dimer assay
D-dimer is a marker for clot lysis. This test can also be used to check the effectiveness of the treatment. D-dimer levels remain elevated in DVT for about seven days. Clients presenting late in the course, after clot organization and adherence have occurred, may have low levels of D-dimer. Current evidence strongly supports using a D-dimer assay in the setting of suspected DVT (Patel, 2019).

3. Impedance plethysmography (IPG)
This test uses an inflated cuff for blocking the venous flow and monitoring the blood volume increase in the limb. In some countries, IPG has been the initial non-invasive diagnostic test of choice and is sensitive and specific for proximal vein thrombosis. However, IPG also has several limitations; among them is insensitivity for calf vein thrombosis, non-occluding proximal vein thrombus, and iliofemoral vein thrombosis above the inguinal ligament (Patel, 2019).

4. Contrast venography
This test uses radiopaque contrast media injected through a foot vein to localize thrombi in the deep venous system. The criterion standard for diagnostic imaging for DVT remains venography with pedal vein cannulation, intravenous contrast injection, and serial limb radiographs (Patel, 2019).

9. Providing Perioperative Care

Providing perioperative care for patients with deep vein thrombosis (DVT) requires a comprehensive and tailored approach to ensure optimal outcomes. Individualized treatment plans are essential when providing perioperative care for patients with DVT. The management approach should be based on a thorough assessment of the patient’s medical history, clot characteristics, and overall risk profile.

1. Placement of a vena cava filter
The filter is inserted inside the vena cava. The filter catches blood clots before they travel to the lungs, which prevents pulmonary embolism. Inferior vena cava filters are not recommended in clients with acute VTE on anticoagulant therapy. An inferior vena cava filter is a mechanical barrier to the flow of emboli larger than 4 mm (Patel, 2019).

2. Thrombectomy
The most severe cases of DVT may require the surgical removal of the blood clot from the vein (thrombectomy). Surgical thrombus removal has traditionally been used in clients with massive swelling and phlegmasia cerulea dolens. When thrombosis is extensive, fibrinolysis alone may be inadequate to dissolve the volume of the thrombus present (Patel, 2019).

3. Replacement of venous valves
Percutaneously placed bioprosthetic venous valves are under development and may provide a minimally invasive therapy for the long-term complication of postthrombotic syndrome (PTS) due to valve destruction. Effective therapy should diminish one of the primary indications for aggressive thrombolytic therapy for acute DVT (Patel, 2019).

Recommended Resources

Recommended nursing diagnosis and nursing care plan books and resources.

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See also

Other recommended site resources for this nursing care plan:

• Nursing Care Plans (NCP): Ultimate Guide and Database ^{MUST READ!}
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• Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
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Other care plans for hematologic and lymphatic system disorders:

• Anaphylactic Shock
• Anemia
• Aortic Aneurysm
• Bleeding Risk & Hemophilia
• Deep Vein Thrombosis
• Disseminated Intravascular Coagulation
• Hemophilia
• Leukemia
• Lymphoma
• Sepsis and Septicemia
• Sickle Cell Anemia Crisis

References and Sources

Recommended journals, books, and other interesting materials to help you learn more about deep vein thrombosis nursing care plans and nursing diagnosis:

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• Behera, C., Devassy, S., & Gupta, S. K. (2017). Leg massage by mother resulting in fatal pulmonary thromboembolism. Medico-Legal Journal, 86(3).
• Bhutta, B. S., Alghoula, F., & Berim, I. (2022). Hypoxia – StatPearls. NCBI. Retrieved March 27, 2023.
• Douketis, J. D. (2023). Perioperative management of patients receiving anticoagulants. UpToDate.
• Doyle, G. R., & McCutcheon, J. A. (2015). Clinical Procedures for Safer Patient Care. BC Open Textbook Project.
• El-Tallawy, S. N., Nalamasu, R., Salem, G. I., LeQuang, J. A. K., Pergolizzi, J. V., & Christo, P. J. (2021). Management of Musculoskeletal Pain: An Update with Emphasis on Chronic Musculoskeletal Pain. Pain and Therapy, 10.
• Endig, H., Michalski, F., & Beyer-Westendorf, J. (2016). Deep Vein Thrombosis – Current Management Strategies. Clinical Medicine Insights: Therapeutics.
• Gebhard, C. E., Zellweger, N., Gebhard, C., Hollinger, A., Chrobok, L., Stahli, D., Schönenberger, C. M., Todorov, A., Aschwanden, M., & Siegemund, M. (2021, December 25). Prone Positioning as a Potential Risk Factor for Deep Vein Thrombosis in COVID-19 Patients: A Hypothesis Generating Observation. NCBI. Retrieved March 27, 2023.
• Gonthier, M.-C., Gendron, N., Eloy, P., Bourrienne, M.-C., Alhenc-Gelas, M., Pouplard, C., Tardy, B., Szymezak, J., Burdet, C., Gkalea, V., Faille, D., & Ajzenberg, N. (2021, September 24). Heparin-induced Thrombocytopenia Diagnosis: A Retrospective Study Comparing Heparin-induced Platelet Activation Test to 14 C-serotonin Release Assay. NCBI. Retrieved March 29, 2023.
• Gupta, N., Zhao, Y.-Y., & Evans, C. E. (2019, September). The stimulation of thrombosis by hypoxia. Thrombosis Research, 181.
• Hoffer, E. K., & Cho, K. J. (2022, August 15). Imaging in Deep Venous Thrombosis of the Lower Extremity: Practice Essentials, Computed Tomography, Magnetic Resonance Imaging. Medscape Reference. Retrieved March 27, 2023.
• Hotoleanu, C. (2020, April). Association between obesity and venous thromboembolism. Medicine Pharmacy Reports, 93(2).
• Keenan, L., Kerr, T., Duane, M., & Van Gundy, K. (2019, January). Systematic Review of Hormonal Contraception and Risk of Venous Thrombosis. The Linacre Quarterly, 85(4).
• Keiter, J. E., Johns, D., & Rockwell, W. B. (2015). Importance of Postoperative Hydration and Lower Extremity Elevation in Preventing Deep Venous Thrombosis in Full Abdominoplasty: A Report on 450 Consecutive Cases Over a 37-Year Period. Aesthetic Surgery Journal, 35(7).
• Klaiber, U., Stephan-Paulsen, L. M., Bruckner, T., Müller, G., Auer, S., Farrenkopf, I., Fink, C., Dörr-Harim, C., Diener, M. K., Büchler, M. W., & Knebel, P. (2018). Impact of preoperative patient education on the prevention of postoperative complications after major visceral surgery: the cluster randomized controlled PEDUCAT trial. Trials, 19(288).
• Lee, C. W.-S., Muo, C.-H., Liang, J.-A., Sung, F.-C., Kao, C.-H., & Yeh, J.-J. (2014, March). Pulmonary embolism is associated with current morphine treatment in patients with deep vein thrombosis. The Clinical Respiratory Journal, 9(2).
• Nicolas, D., Nicolas, S., Hodgens, A., & Reed, M. (2023, March). Heparin Induced Thrombocytopenia – StatPearls. NCBI. Retrieved March 29, 2023, from
• The North American Thrombosis Forum. (2022, February 17). Patient Pulse: Pain Relievers and Anticoagulation – What’s the Story? North American Thrombosis Forum. Retrieved March 27, 2023.
• Ouellette, D. R., & Mosenifar, Z. (2020, September 18). Pulmonary Embolism (PE) Clinical Presentation: History, Physical Examination, Complications. Medscape Reference. Retrieved March 28, 2023.
• Patel, K. (2019, June 5). Deep Venous Thrombosis (DVT): Practice Essentials, Background, Anatomy. Medscape Reference. Retrieved March 27, 2023.
• Schick, M. (2023, January 19). Deep Vein Thrombosis – StatPearls. NCBI. Retrieved March 27, 2023.
• Schreiber, D., & Brenner, B. E. (2020, October 30). Anticoagulation in Deep Venous Thrombosis: Advantages of Anticoagulant Therapy, Initial Anticoagulation Therapy, Long-Term Anticoagulation. Medscape Reference. Retrieved March 29, 2023.
• Sehgal, I. S., Dhooria, S., Agarwal, R., & Behera, D. (2017, December 30). Use of a Flexible Cryoprobe for Removal of Tracheobronchial Blood Clots. Respiratory Care. Retrieved March 27, 2023.
• Triffin, M., & Ketchum, D. (2020, May 18). Is Sitting With Your Legs Crossed Bad for You? Here’s What to Know | livestrong. Livestrong.com.
• Umerah, C. O., & Momodu, I. I. (2022, July). Anticoagulation – StatPearls. NCBI. Retrieved March 29, 2023.
• Unver, S., Kivanc, G., & Aiptekin, H. M. (2018). Deep breathing exercise education receiving and performing status of patients undergoing abdominal surgery. NCBI. Retrieved March 27, 2023.
• Vyas, V., & Goyal, A. (2022). Acute Pulmonary Embolism – StatPearls. NCBI. Retrieved March 27, 2023.
• Wade, R., Paton, F., & Woolacott, N. (2016). Systematic review of patient preference and adherence to the correct use of graduated compression stockings to prevent deep vein thrombosis in surgical patients. Journal of Advanced Nursing, 73(2).
• Wayne, G. (2023, March 18). Risk for Bleeding – Nursing Diagnosis & Care Plan. Nurseslabs. Retrieved March 28, 2023.
• Xu, L., Fu, C., Zhang, Q., He, C., & Wei, Q. (2021). The effectiveness of exercise training in treating venous thromboembolism: a systematic review. The Physician and Sportsmedicine, 49(1).
• Yu, A., Ding, W., Lin, W., Cai, J., & Huang, W. (2022, January). Application of pulmonary rehabilitation in patients with pulmonary embolism (Review). Experimental and Therapeutic Medicine, 23(1).
• Zhang, Y., Jin, J., Song, B., Wang, Y., & Liang, M. (2021, April 15). Vascular boot warming improves clinical outcomes of patients with deep vein thrombosis in lower extremities. NCBI. Retrieved March 27, 2023.