What You Need to Know aboutVenous Thromboembolism.pptVIP

What You Need to Know aboutVenous Thromboembolism By Bill Pruitt, RRT, AE-C, CPFT, MBA and Robin Lawson, RN, DNP Nursing2009, April 2009 2.3 ANCC contact hours Online: ? 2009 by Lippincott Williams Wilkins. All world rights reserved. What is venous thromboembolism (VTE)? An occlusion in a vein caused by a thrombus (most common) An embolus of an air bubble, fat droplets, amniotic fluid, clumps of parasites, tumor cells (less common) In I.V. drug users, a foreign substance such as talc can lead to VTE Where does VTE occur? Typically in leg veins 2% to 3% occur in arms Pulmonary embolism can occur when part of a deep vein thrombosis (DVT) breaks loose and travels through the right side of the heart into pulmonary artery Pulmonary embolism (PE) PE occludes blood flow to part of the lung and impairs gas exchange Affected portion of lung becomes necrotic and impairs oxygen delivery to other body tissues 90% of all PEs come from thrombi in the popliteal vein and larger veins above it What happens in DVT and PE When DVT obstructs venous circulation in a leg, collateral circulation may develop rapidly Patient may have few signs and symptoms; when they develop, are related to local inflammation and local tissue ischemia as well as degree of venous outflow obstruction What happens in DVT and PE Complications of DVT include venous valvular damage, chronic venous insufficiency (chronic pain, swelling, cramping, skin discoloration, ulceration in affected limb), PE PE obstructs blood flow in pulmonary arterial system What happens in DVT and PE Pathologic changes depend on degree of obstruction and patient’s condition If blood flow is obstructed in gas exchange areas of lung (alveoli and respiratory bronchioles), you’ll see V/Q mismatch and increased physiologic dead space ventilation What happens in DVT and PE Extensive PE causes large area of dead space ventilation, imposing increased work on right ventricle as a result of obstructed right ventricular outfl