Deep vein thrombosis (DVT) is a serious condition that can occur when someone is immobilized or has limited mobility. It happens when a blood clot forms in a deep vein, usually in the leg. This clot can break free and travel to the lungs causing a pulmonary embolism which can be fatal. For clients on bed rest, DVT is a major concern.
Nurses play a critical role in preventing DVT for bedridden patients through early ambulation and mobilization when possible, use of anti-embolism stockings or pneumatic compression devices, adequate hydration, and anticoagulant medication when needed. Selecting the right interventions requires assessing the individual patient’s risks.
Risk Factors for DVT
Certain factors can increase a person’s chance of developing DVT. These include:
- Prolonged immobility
- Advanced age over 40 years
- Obesity
- Pregnancy
- Estrogen therapy
- Personal or family history of DVT
- Recent surgery
- Trauma or fracture of lower extremities
- Cancer
- Sepsis
- Heart failure
- Varicose veins
- Smoking
For clients on bed rest, immobility is the key risk factor. The longer a person is immobile, the greater their DVT risk becomes. Someone on prolonged bed rest is at high risk.
Nursing Interventions to Prevent DVT
Early Ambulation
The best way to prevent DVT is to avoid prolonged immobility. Early ambulation or walking is recommended when possible. The nurse should help the patient sit up, dangle their legs, and walk short distances per physician orders. Even simple leg exercises while lying down can promote circulation.
Compression Devices
When ambulation is not yet possible, mechanical prophylaxis helps prevent blood pooling and stasis. Anti-embolism stockings promote venous return. Pneumatic compression devices squeeze the legs intermittently to empty the veins. These should be applied as soon as immobility begins and worn continuously until ambulation is resumed.
Adequate Hydration
Staying well-hydrated keeps blood volume normal and prevents thickening of the blood. The nurse should encourage oral fluids and monitor intake and output. Intravenous fluids may be ordered for patients too ill to drink sufficient volumes.
Anticoagulant Medications
Medications like heparin, low-molecular weight heparin, or warfarin are often prescribed for high-risk patients. These drugs help prevent clot formation and extension. The nurse administers anticoagulants per protocol and monitors for side effects like bleeding.
Assessing Patient Risk
Not every immobilized patient requires the same interventions. The nurse first assesses individual risk factors and consults the care team. A patient with multiple risks like advanced age, obesity, and sepsis requires more intensive prophylaxis than a younger, otherwise healthy patient.
| Risk Level | Interventions |
|---|---|
| Low Risk | Early ambulation, anti-embolism stockings |
| Moderate Risk | Above interventions plus pneumatic compression |
| High Risk | Above interventions plus anticoagulant medication |
This table outlines a sample approach, but the care plan must be customized and updated based on how the patient responds.
Conclusion
A nurse has several evidence-based interventions to choose from to prevent DVT in immobilized patients. Promoting early mobility is ideal. When prolonged bed rest is required, anti-embolism stockings, pneumatic compression devices, hydration, and anticoagulant medication can all help lower DVT risk. The selection of prophylactic measures is based on each patient’s unique risk factors, preferences, and response to treatment. With appropriate interventions, nurses play a key role in reducing the incidence of this dangerous thrombotic complication.