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Complex Respiratory Care

Phlebitis

>inflammation of vein; may be accompanied by pain, erythema, edema, streak formation, palpable chord

-no clot present

Venous Thrombosis

>formation of thrombus in association with inflammation of vein

A. Superficial Vein Thrombosis

B. Deep Vein Thrombosis

Virchow's Triad:

Venous Stasis

Endothelial Damage

Hypercagulability of Blood

Superficial Thrombophlebitis

>Clinical Manifestations

-palpable, firm, chord-like vein

>NSG Management

-elevate extremity

-apply warm, moist heat

-mild analgesic

-remove IV catheter

Venous Thromboembolism

>Clinical Manifestations

-unilateral leg edema

-extremity pain

-sense of calf/thigh fullness

-paresthesia

-warm skin

-erythema

-temperature >38

>Prevention & Prophylaxis

-early mobilization post-op

-frequent repositioning

-compression stockings

-Sequential Compression Devices

>Complications

-PE

-Chronic Venous Insufficiency

-Phlegmasia Cerula Dolens (swollen, blue legs)

Anticoagulants

-routinely used for prevention & treatment

>Vitamin K Antagonists

1. Warfarin

-acts indirectly on coagulation pathway

-48-72h to influence INR; several days to be therapeutic

-Blood test: INR (normal 0.75-1.25min; therapeutic 2-3min)

-Antidote: Vitamin K

>Indirect Thrombin Inhibitors

1. Unfractioned Heparin

-inhibits thrombin-mediated conversion of fibrin

-Blood test: PTT (normal 25-35sec; therapeutic 46-70sec)

-Antidote: protamine sulphate

2. Low-Molecular Weight Heparin (enoxaparin)

-greater bioavailability & larger half-life then heparin

-less risk of bleeding & does not require blood monitoring

>New Oral Anticoagulants

1. Dabigatran

2. Rivaroxaban

3. Apixaban

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