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Deep vein thrombosis
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Deep vein thrombosis:

diagnosis and treatment
NS727 Bonner L, Johnson J (2014) Deep vein thrombosis: diagnosis and treatment.
Nursing Standard. 28, 21, 51-58. Date of submission: August 20 2013; date of acceptance: October 14 2013.

Aims and intended learning outcomes

Abstract
This article aims to inform the reader about
This article aims to give nurses an insight into proximal deep vein proximal deep vein thrombosis (DVT),
thrombosis (DVT). DVT is relatively common and is associated with including signs and symptoms, diagnostic tests
significant morbidity and mortality. Complications such as post-thrombotic and available treatments. After reading this
syndrome, venous leg ulcers, recurrent venous thromboembolism (VTE) article and completing the time out activities
– pulmonary embolism (PE) or DVT – and pulmonary hypertension can you should be able to:
develop following DVT diagnosis. There is also a risk that a large PE could Identify the signs and symptoms of DVT.
prove fatal. While VTE prevention is a clinical priority, nurses should also Describe the methods used for
have appropriate skills and knowledge to care for patients with suspected diagnosing patients with DVT.
DVT. Nurses need to be aware of the signs and symptoms of DVT, common Discuss common treatments for DVT.
diagnostic tests, pharmacological and mechanical treatments, and the Summarise the possible complications that
follow-up investigations patients should be offered. may occur following diagnosis of DVT.

Authors
Introduction
Lynda Bonner
Consultant nurse for thrombosis and anticoagulation, A DVT is a thrombus or blood clot that can
King’s College Hospital NHS Foundation Trust, London. occur in any of the deep veins in the body.
Jacqueline Johnson However, DVT most commonly occurs in the
Coagulation clinical nurse specialist, King’s College Hospital NHS deep veins of the leg or pelvis (National Institute
Foundation Trust, London. for Health and Care Excellence (NICE) 2012a)
Correspondence to: lynda.bonner@nhs.net (Figure 1). Although most DVTs start distally in
the veins of the calf, they can extend proximally
Keywords into the veins at knee level and above the
knee; from here, the thrombus can break off
Anticoagulants, deep vein thrombosis, post-thrombotic syndrome, and travel to the lungs, causing a pulmonary
pulmonary embolism, venous thromboembolism embolism (PE) (Kearon 2003). Silverstein
et al (1998) estimated that the incidence of
Review symptomatic DVT and PE was 145 and 69
All articles are subject to external double-blind peer review and checked respectively per 100,000 adults. The collective
for plagiarism using automated software. term venous thromboembolism (VTE) refers to
both DVT and PE (NICE 2012a).
Online VTE is associated with significant
morbidity and mortality. The most common
Guidelines on writing for publication are available at complication of DVT is post-thrombotic
www.nursing-standard.co.uk. For related articles visit the archive and syndrome (Roberts et al 2013). It can occur
search using the keywords above. in more than one third of patients with DVT
(Kahn 2009), and can significantly affect the

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CPD vascular nursing

patient’s quality of life by causing pain, and The economic burden on the NHS of
heaviness and swelling in the leg (Kearon diagnosing and managing DVT is considerable.
2003). Severe post-thrombotic syndrome may The House of Commons Health Committee
develop in 5-10% of patients with a DVT (2005) reported that VTE associated with
and this may manifest in the development hospitalisation costs the NHS £640 million
of venous leg ulcers (Kahn 2009). Patients per year. Although prevention of VTE was
diagnosed with a DVT are also at risk of identified by the medical director of the NHS
developing a recurrent DVT or PE. If a patient as a clinical priority for improving quality and
develops a PE, it could be fatal if the embolus productivity in hospitals in recent years (West
is large enough to obstruct the arteries of the 2009), it is essential that nurses are familiar
lungs (Hirsh and Hoak 1996). An autopsy with ways to prevent VTE and how to support
study by Lindblad et al (1991) found that the and care for patients who develop signs and
incidence of fatal PE was approximately 40 symptoms of DVT or who require treatment
per 100,000 of the population. Non-fatal for a newly diagnosed DVT.
PE can also significantly affect the patient’s
quality of life. Shortness of breath, chest
pain and fatigue can result from pulmonary Signs and symptoms
hypertension because of increased pressure in DVT can occur without the patient showing
the pulmonary arteries caused by obstruction any signs or symptoms. Several factors
of blood flow by the PE (Ribeiro et al 1999). determine presentation of a DVT, including
1 A patient who has
Complete time out activity 1 the size of the thrombus, which can extend to
been recently diagnosed
occlude both proximal and distal veins, the
with a DVT tells you that
Because DVT is common and causes ability of collateral blood vessels to cope with
he has heard that DVTs
significant morbidity and mortality, NICE transporting blood to bypass the thrombus,
are invariably fatal.
(2010) has developed guidelines to assist and the severity of vascular occlusion
What would you say to
healthcare professionals in reducing risk (blockage) and inflammation caused by the
this patient to help him
associated with VTEs in hospitalised patients, thrombus (Kearon 2003). A DVT is more
achieve a more balanced
together with guidelines on the diagnosis and likely to cause symptoms when it obstructs
understanding of the
management of patients who are suspected of venous outflow, resulting in inflammation of
possible consequences
having VTE (NICE 2012a). the vein wall and surrounding tissue (Hirsh
of having a DVT?
and Hoak 1996). Common symptoms of a
FIGURE 1 DVT are warmth, redness, pain and swelling
2 Create a
in the affected limb. When a patient reports
presentation that you Veins of the right leg these symptoms, a clinician should undertake
could use to teach
a physical examination of the whole limb to
junior colleagues or Inferior
observe for signs suggestive of DVT. These
students about the vena cava
include tenderness on palpation, warmth,
signs and symptoms of
Common erythema, cyanosis, oedema and superficial
DVT. Include pictures
iliac vein venous dilation that can present as prominent
or diagrams of the
Proximal collateral veins (Kahn 1998).
typical appearance of Femoral vein
veins Complete time out activity 2
the affected limb in a
patient diagnosed with Great These signs and symptoms are not specific to
DVT. Ask the students saphenous DVT and can be present in numerous other
what sort of symptoms
Popliteal vein conditions. Therefore, clinical judgement about
they would expect the
the likelihood of DVT should also take into
patient to report and
account the patient’s individual risk factors
what they would expect Posterior tibial
for DVT, concurrent illnesses and medication,
to find on examination
medical and surgical history, and demographic
of the affected limb.
Distal
Peroneal
characteristics. By taking this information
Emphasise that DVTs veins into account, the clinician should be able to
are often clinically
improve their accuracy in predicting whether
asymptomatic so even
Anterior tibial a DVT is present or not (Kahn 1998). NICE
in the absence of many
JOANNA CAMERON

(2012a) recommends use of the two-level DVT

of these signs and
Wells score (Wells et al 2003), which has been
symptoms, a DVT could
validated for its ability to estimate reliably the
still be present.
clinical probability of DVT (Table 1). Each

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clinical feature is given a score. A total score
of two points or more indicates that a DVT
is likely and further investigations should be
undertaken.
Diagnosis
If the clinical probability of a DVT is likely
(two or more points on the two-level DVT
Wells score), then the patient should be
offered diagnostic testing without delay.
Clinical diagnosis of DVT is non-specific and
subjective and therefore objective diagnostic
tests must be used to reduce the chances of a
missed diagnosis, the consequences of which
could be very serious and even life-threatening
(Zierler 2004).
NICE (2012a) recommends the use of a
D-dimer test and ultrasound scanning for
the diagnosis of DVT. The NICE (2012a)
guidance also recommends that if a patient
has to wait more than four hours for a
diagnostic ultrasound scan, he or
she should receive an interim 24-hour
dose of a parenteral anticoagulant such as
low-molecular-weight heparin. The patient
should receive this treatment once daily while
he or she is awaiting the diagnostic scan.
Other diagnostic tests for DVT are available,
but it is beyond the scope of this article to
discuss these.
D-dimer test
D-dimer fragments can be measured by
a simple blood test. These small fibrin
fragments are produced and released
into the blood when fibrin blood clots are
broken down by plasmin. Although the
presence of high levels of D-dimer fragments
suggests a DVT may be present, D-dimer
fragments are not specific to DVT and can
occur in other conditions such as infection,
inflammation, pregnancy, trauma, surgery
and haemorrhage (Bockenstedt 2003). For
this reason, the D-dimer test is used for its
negative predictive value – it is unlikely that
a DVT is present in a patient with a low or
negative D-dimer test.
If both the D-dimer test is low or negative
and the two-level DVT Wells score suggests
that DVT is unlikely, the patient can be advised
that it is unlikely he or she has a DVT (NICE
2012a). In this situation, other causes of the
patient’s symptoms should be investigated.
Further diagnostic testing with ultrasound
scanning of the proximal (knee level or above)
leg veins is recommended if either the D-dimer
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TABLE 1
Two-level deep vein thrombosis (DVT) Wells score
Clinical feature Score
Active cancer (treatment ongoing, within 6 months or 1
palliative)
Paralysis, paresis or recent plaster immobilisation of the lower 1
extremities
Recently bedridden for 3 days or more or major surgery within 1
12 weeks requiring general or regional anaesthesia
Localised tenderness along the distribution of the deep venous 1
system
Entire leg swollen 1
Calf swelling at least 3cm larger than the asymptomatic leg 1
Pitting oedema confined to the symptomatic leg 1
Collateral superficial veins (non-varicose) 1
Previously documented DVT 1
An alternative diagnosis is at least as likely as DVT -2
Clinical probability simplified score
DVT likely 2 or more
DVT unlikely 1 or less
(Wells et al 2003, NICE 2012a)
test is high or the two-level DVT Wells score
suggests that DVT is likely (NICE 2012a).
Ultrasound scanning
Venous ultrasonography is accepted as the
primary non-invasive diagnostic test for the
diagnosis or exclusion of acute DVT (Zierler
2004). Although there are many different types
of venous ultrasonography – for example,
compression ultrasound, duplex ultrasound
or colour Doppler imaging – overall, venous
ultrasonography has a mean sensitivity and
specificity of 97% and 94%, respectively, for
the diagnosis of symptomatic proximal DVT
(Kearon et al 1998).
There are practical issues that the nurse
should consider if a patient requires venous
ultrasonography. The patient needs to be able
to change his or her position to allow scanning
to take place. It may be difficult for the patient
to tolerate the pressure from the ultrasound
scanhead, which needs to be placed firmly on
his or her skin, especially if the leg is painful. If
the patient has a wound or is wearing bandages
or a plaster cast, these can prevent or hinder
venous ultrasonography (Zierler 2004). Where
possible, bandaging should be replaced with a
small dressing to assist scanning.
If the patient has difficulty in repositioning
him or herself, the nurse should accompany
january 22 :: vol 28 no 21 :: 2014 53
CPD vascular nursing
the patient for the scan and assist with
repositioning. If the patient has a painful
leg then the nurse should discuss with the
individual the use of analgesia before the scan
to minimise further discomfort.
Complete time out activity 3
Results of diagnostic tests
Venous ultrasonography is highly accurate for
diagnosing proximal DVT; treatment can be
initiated without the need for further diagnostic
tests or treatment can be withheld if the scan is
negative (Kearon et al 1998). However, NICE
(2012a) recommends that patients with a
two-level DVT Wells score suggestive of DVT
and a positive D-dimer test should have repeat
venous ultrasonography six to eight days later,
even if the initial proximal ultrasound scan was
negative. This additional testing is necessary
to check that there has been no extension of a
distal DVT into the proximal veins, where a
DVT is considered to be clinically significant.
There has been much debate about the need to
scan for distal DVTs, which are less clinically
important than proximal DVTs because they
are unlikely to break off and cause a PE. If
the whole leg is scanned initially then a repeat
ultrasound scan is not necessary (NICE 2012a).
If a repeat venous ultrasonography scan
is required, the nurse should explain the
importance of this additional scan to the
patient in diagnosing or excluding DVT.
Failure to diagnose DVT correctly could result
in a fatal PE (NICE 2012a). Even if diagnostic
testing has suggested it is unlikely that the
patient has a DVT, it is still important for the
nurse to advise the patient about the signs
and symptoms of DVT and PE, and when
and where to seek medical help should these
3 You suspect a
symptoms occur (NICE 2012a).
patient may have a DVT.
Complete time out activity 4
How would you explain
to the patient what
investigations may be Treatment
necessary?
The aim of DVT treatment is to prevent the
extension of the DVT in the short term, and
4 Find out what DVT
to prevent recurrent DVT or a PE in the long
diagnostic pathway
term (Scarvelis and Wells 2006). Treatment
exists for outpatients
is also targeted at preventing complications
and inpatients in your
of DVT such as post-thrombotic syndrome
organisation. If you
(NICE 2012a). Normally the valves in the
work in primary care,
veins promote blood flow return, aided by
what steps would
contraction of the leg muscles. However, these
you take to arrange a
valves can be damaged by a DVT, which results
referral for a patient
in venous reflux and venous hypertension in
with suspected DVT
the leg. Venous reflux and venous hypertension
for diagnostic tests?
are the main contributing factors for the
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development of post-thrombotic syndrome in
the leg (Kearon 2003).
DVT treatment should take into
consideration the patient’s needs and
preferences (NICE 2012a). Allowing patients
to have a role in decision making in agreeing
treatment plans is important to encourage
adherence to treatment (Horne et al 2005,
Department of Health 2012). The nurse needs
to be a skilled communicator and to convey
effectively to the patient the importance of
adhering to the agreed treatment plan (World
Health Organization 2003). Verbal information
should be supported by written information
and should be tailored to accommodate the
needs of patients who do not speak or read
English or who may have learning disabilities
(NICE 2012a).
Treatment of proximal DVT consists of both
pharmacological and mechanical interventions
(NICE 2012a). This article focuses on the use
of anticoagulation and graduated compression
stockings because these are the most common
treatment options. Although it is beyond the
scope of this article, it is worth acknowledging
that in special circumstances patients may be
considered for insertion of an inferior vena cava
filter (University of Michigan 2013) or catheter-
directed thrombolytic therapy (NICE 2012a).
Pharmacological interventions
Anticoagulation is the mainstay of treatment
for DVT (Scarvelis and Wells 2006). Patients
are usually offered dual therapy with a
parenteral and an oral anticoagulant such as
a vitamin K antagonist. Warfarin is the most
commonly used vitamin K antagonist because
there is a high level of evidence supporting
its efficacy (Khoo et al 2009, NICE 2012a).
Low-molecular-weight heparin, unfractionated
heparin and fondaparinux are all parenteral
anticoagulants; the decision about which one is
best for the patient should take into account
the person’s comorbidities (such as
bleeding history and renal impairment),
contraindications and preferences (NICE
2012a). Low-molecular-weight heparin is
porcine derived (Harenberg et al 1990) and
some patients may object to its use on the basis
of cultural or religious grounds.
Administration of an oral and parenteral
anticoagulant should be started as soon as
possible after DVT diagnosis. The parenteral
anticoagulant should be continued for
at least five days, or until the patient has
achieved therapeutic levels – international
normalised ratio (INR) of 2.0 or above for a
© NURSING STANDARD / RCN PUBLISHING
minimum of 24 hours – of an oral vitamin K
antagonist such as warfarin (NICE 2012a).
The parenteral anticoagulant should then be
stopped and the patient will remain on the oral
anticoagulant for the duration of treatment.
The most common side effect of anticoagulants
is bleeding, so patients should be advised
to report immediately any bleeding to their
GP or emergency department depending on
the severity of the bleeding; they should also
inform the anticoagulation clinic.
Vitamin K antagonists The effectiveness of
vitamin K antagonists can be influenced by
many factors such as dietary changes, alcohol,
other medicines, diarrhoea, vomiting and
anorexia (Glee 2011). The maintenance of safe
and therapeutic levels of vitamin K antagonists
to reduce bleeding risk and likelihood of DVT
extension are dependent on dose adjustments
following frequent blood testing to measure the
INR (National Patient Safety Agency 2007).
Nurses should emphasise the need for patients
to attend for regular blood testing while they
are taking such antagonists and to inform
the anticoagulation clinic if they develop any
side effects or if there are any changes in their
wellbeing or medication for other conditions,
or if they become pregnant.
Novel oral anticoagulants The novel oral
anticoagulant rivaroxaban has recently
been licensed for the treatment of DVT.
Rivaroxaban is a direct inhibitor of activated
factor Xa and has been approved by NICE
(2012b) for the treatment of DVT. Unlike
traditional oral anticoagulants, such as
warfarin, rivaroxaban does not require regular
blood test monitoring. The drug has a rapid
onset of action so the use of parenteral
anticoagulants is not necessary when initiating
treatment for DVT (Khoo et al 2009). A dose of
15mg rivaroxaban twice daily is recommended
for 21 days, followed by a dose of 20mg once
daily for the duration of treatment.
Treatment duration can vary depending
on whether the patient has known risk
factors predisposing him or her to DVT, or
whether there are ongoing risk factors that
could predispose the person to a future DVT.
Suitability for rivaroxaban treatment and
dose adjustments should be considered
carefully in patients with renal impairment
(NICE 2012b). Approval for other novel
oral anticoagulants such as dabigatran and
apixaban is currently being sought for use in
the treatment of DVT.
Nurses should advise patients that
rivaroxaban should be taken with food to aid
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absorption and stored at room temperature
to maintain stability. Patients should also be
told to report any side effects of the drug, such
as dizziness, headaches or bleeding; and if
minor bleeding does occur, the patient should
be told to seek prompt medical advice. The
anticoagulant effect of the drug wears off in
about 24 hours. There is no specific antidote
to rivaroxaban currently available, however in
a clinical emergency, for example in the event
of a traumatic accident, all hospitals should
have agreed local protocols on how to manage
major haemorrhage (King’s College Hospital
Thrombosis Team 2012).
Patients taking rivaroxaban should check
with their doctor or pharmacist before
taking any new medications. As with all
anticoagulants, patients should avoid contact
sports or high-risk activities because of the
risk of bleeding from injury and they should
carry an anticoagulation alert card at all
times. Patients should inform their doctor or
dentist that they are taking rivaroxaban if they
have surgery or a minor procedure planned
(King’s Health Partners 2013). The effects of
rivaroxaban during pregnancy are not known
so patients should also inform their doctor if
they become pregnant.
The patient should be given relevant verbal
and written information about his or her
treatment plan, and alongside any carer should
be given the opportunity to ask questions and
be involved in decision making (Glee 2011).
The nurse should emphasise the importance of
adhering to anticoagulation treatment for the
recommended duration of time to minimise risk
of recurrent VTE, which could be fatal (Kaatz
et al 2010).
Duration of anticoagulation The duration
of anticoagulant treatment can be tailored
according to the patient’s comorbidities, the
risk factors that predisposed the person to
develop a proximal DVT, his or her individual
bleeding risk factors, and his or her preference
based on informed consultation with the
clinician. If a proximal DVT has been caused
by a risk factor such as recent surgery or
trauma (Kaatz et al 2010), three months of
anticoagulation treatment is recommended
(NICE 2012a). However, if there was no
obvious risk factor associated with the
development of DVT, and the risk of recurrence
is considered to be high, the duration of
treatment may be extended into the long term,
with annual review of ongoing risk factors.
Anticoagulation in cancer patients with deep
vein thrombosis If the patient has a DVT in the
january 22 :: vol 28 no 21 :: 2014 55
CPD vascular nursing
presence of active cancer, then anticoagulant
treatment should continue for six months or
longer (NICE 2012a). Low-molecular-weight
heparin is preferred over vitamin K antagonists
for DVT treatment in cancer patients. This
patient group might have poor appetite,
require chemotherapy, or be prescribed
interacting medications and these are factors
that could lead to erratic INRs in patients
taking vitamin K antagonists, which could
increase their risks of bleeding or developing
further VTE (Lee and Levine 2003). Treatment
with a low-molecular-weight heparin has been
shown to be an effective and safe alternative to
conventional vitamin K anagonists in cancer
patients with VTE (Linkins 2008).
Mechanical interventions
NICE (2012a) recommends the use of
graduated compression stockings following
diagnosis of proximal DVT. Superficial veins
have to cope with increased blood flow volume
diverted from any deep veins where a thrombus
is present. Because of the extra pressure in the
superficial veins, fluid can seep into the calf
tissues, which can lead to the development
of post-thrombotic syndrome. Graduated
compression stockings can minimise this effect
by exerting pressure on the limb and supporting
the superficial veins, and have been found
to reduce the incidence of post-thrombotic
5 What would you syndrome after DVT from 54.0% to 25.2%
discuss with a patient (Kakkos et al 2006).
to encourage him or her A below-knee graduated compression
to comply with wearing stocking producing an ankle pressure of
graduated compression greater than 23mmHg should be worn on
stockings following the affected leg for at least two years. The
a diagnosis of DVT? patient’s leg should be measured for a graduated
Include explanations compression stocking one week after the
of how stockings work, initial diagnosis of DVT or when any acute
what the benefits are, swelling has subsided, as long as the patient
and how the stockings has no contraindications (NICE 2012a).
should be worn and Contraindications listed by most manufacturers
cared for to ensure they of compression stockings include arterial
are kept in optimum insufficiency (such as peripheral arterial disease
condition. or neuropathy) that could impede blood
circulation, fragile skin (oedema, dermatitis or
6 Watch the video on skin grafts) that could become damaged, or a
subcutaneous injection diagnosis of unstable heart failure.
of low-molecular-weight To encourage adherence with the use
heparin via this weblink: of graduated compression stockings, the
tinyurl.com/vid-inject. nurse should ensure the patient is aware
List the main steps to that wearing the stocking will aid venous
cover when you are haemodynamics or venous circulation
teaching this technique (Kakkos et al 2006) and may reduce the risk
to a patient. of post-thrombotic syndrome developing
after DVT. Patients might need assistance to
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apply and remove the stocking, especially if
they have problems with dexterity, and some
may find it difficult to tolerate wearing them.
Patients who can tolerate wearing graduated
compression stockings should be advised
to wear them during the day and remove
them at night. Patients should ask the GP for
repeat prescriptions for their stockings, which
should be replaced regularly, according to
manufacturer’s recommendations. If patients
experience any numbness or tingling in their
leg or notice any skin damage when wearing
compression stockings, they should remove
them immediately and seek medical advice.
Complete time out activity 5
Additional nursing interventions
and advice
Teaching injection technique
Most patients with proximal DVT are
managed as outpatients; if they require
treatment with subcutaneous
low-molecular-weight heparin or
fondaparinux, a decision on who should
administer the injections needs to be made.
First, the nurse should assess the patient’s
willingness to self-administer the injections
and second, after teaching the patient the
correct injection technique, the nurse should
assess the person’s dexterity in relation to
injecting the drug safely and effectively. The
nurse supports the patient’s autonomy by
assisting him or her in controlling treatment
(Association for Physiological Science 2012).
In some cases, however, self-administration
might not be appropriate and the nurse should
consider other options, such as administration
by the patient’s carer, or by making a referral to
district nurses or practice nurses. Safe disposal
of used needles and syringes should also be
discussed with the patient. Nurses should
be aware of their local hospital policy for
promoting safe sharps disposal. In some cases,
the nurse may be required to obtain a signature
from the patient that he or she agrees to dispose
of the used sharps safely.
Complete time out activity 6
Follow-up investigations
Patients with proximal DVT of unknown
cause should be investigated for cancer and
thrombophilia depending on certain criteria
which are listed below (NICE 2012a).
Cancer screening Lee and Levine (2003)
commented on the association between VTE
and occult cancer, stating that an underlying
diagnosis of cancer is more likely in patients
who are diagnosed with unprovoked DVT
compared with patients who have provoking
risk factors such as recent surgery. Therefore,
if there are no obvious provoking factors for
developing a proximal DVT, NICE (2012a)
recommends that these patients be offered
investigations for cancer.
These investigations will usually be arranged
on an outpatient basis with a haematologist.
The nurse should ensure that the patient is
aware of the importance of attending this
appointment, so that he or she can be screened
for underlying causes of the DVT. The patient
should be advised to expect some or all of
the following investigations: medical history,
physical examination, chest X-ray, blood tests
and a urinalysis. In all patients over 40 years,
the need for an abdominal and pelvic computed
tomography scan should be considered, and in
women over 40 years a mammogram should
also be considered (NICE 2012a).
Thrombophilia testing Thrombophilia is an
umbrella term used to describe conditions that
can increase clotting tendency of the blood.
People who have thrombophilia have an
increased likelihood of developing DVT (NHS
Choices 2012). NICE (2012a) recommends
that full thrombophilia testing is only offered to
patients who are about to stop anticoagulation
treatment and have had an unprovoked
proximal DVT in addition to having a first-
degree relative with VTE. Blood testing for
thrombophilia is not usually performed until
patients have completed their anticoagulation
treatment, and only after they have been
counselled on the reasons why they are being
offered the test. If thrombophilia is diagnosed,
it may affect their anticoagulation management
plan for the future. Again, it is important
that if thrombophilia testing is recommended
that the nurse emphasises the importance of
patients attending the appointment so that the
underlying causes of DVT can be investigated
and assessed as to their likelihood of increasing
the risk of VTE in future.
Patient information
The nurse has a central role in educating the
patient (or his or her carer) about what action
to take, and when to seek urgent medical
advice, in the event of developing any signs
and symptoms of VTE or any side effects from
anticoagulant medication or compression
stockings. Patients should be given written
information to reinforce the verbal information
given by the nurse. Nurses should ensure they
document a synopsis of the verbal advice given

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Liberating the NHS: No Decision
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p4tlc2n (Last accessed: January 2
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CPD vascular nursing

7 Reflect on your role
in supporting patients
who require treatment
following diagnosis of
DVT. What are the five
most important aspects
to discuss with the
patient?
8 Now that you have
completed the article,
you might like to write
a practice profile.
Guidelines to help you
are on page 64.
and any written information leaflets that
have been provided. The Code (Nursing and
Midwifery Council (NMC) 2008) requires the
nurse to keep accurate records of discussions,
assessments, treatments and medicines given,
and their effectiveness. The Code (NMC 2008)
also recognises the importance of the nurse’s
role in acting as an advocate for the patient
by helping him or her to access information
relevant to his or her condition. Ensuring
the patient is fully informed will increase the
individual’s confidence, and better prepare him
or her for any action that may need to be taken
in future (NHS Institute for Innovation and
Improvement 2008).
Complete time out activity 7
Conclusion
An understanding of DVT is important for
all nurses because DVT can occur in any
setting and is associated with a significant risk
of morbidity and mortality. Although DVT
can be asymptomatic, nurses should be able
to recognise, and be vigilant for, the classic
signs and symptoms of DVT. Should these
occur, the nurse should immediately alert
the doctor so that an objective and prompt
diagnosis can be sought. The nurse should
keep the patient informed at all times about
what investigations to expect and therefore
needs a sound understanding of the tests used
to diagnose DVT. If a DVT is confirmed then
the communication skills of the nurse will be
paramount in reassuring and empathising with
the patient. This communication needs to be
reinforced by a comprehensive understanding
of the common treatments used for DVT
and the possible implications for the patient
following diagnosis.
The patient should be involved in decisions
about his or her care. These decisions should
be based on having the relevant facts available
to give the patient the opportunity to make an
informed choice, with the aim of providing
better care and treatment outcomes. In his or
her role as patient advocate, the nurse should
listen to the patient’s concerns about treatment
and be proactive in seeking solutions that are
tailored to the individual’s preferences and
circumstances. This collaboration in decision
making is essential for improving patient
adherence to treatment, especially when the
treatment is likely to last for at least three
months. The nurse is ideally placed to enhance
the care and experience of a patient with a
suspected or confirmed DVT NS
Complete time out activity 8

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