Blood Clots & DVT - A Nurse's Perspective

By Kathleen Hannon

In his podcast,Healthy Veins, Healthy Legs, Dr. Kistner talks about blood clots, how they happen and the treatment options relative to this condition. Listening to this program reminded me of when I was in nursing school some years ago and was assigned to take care of a person in the hospital who was there because of a blood clot.

The patient was in her forties and had been on a long flight from Hawaii to Michigan.  She got off the plane and noticed that one leg felt tight compared to the other. She went home and by the next morning her leg became very swollen, so she went to the emergency room and had an ultrasound exam, which determined that she had a blood clot in the deep veins in her leg, a DVT.

As part of my clinical training as a nursing student, I had to research the conditions with which my assigned patients had been diagnosed. Before I started that research process on DVT, I had assumed that blood clots were super easy to diagnose because my patient had a sudden onset of one leg becoming much more swollen than the other. I had also assumed, at the time, that DVT was something that only happened in one leg at a time. I was pretty surprised to learn that blood clots in legs don’t always cause swelling but they can cause calf pain without swelling or even shortness of breath when DVT is in the lungs (called a pulmonary embolism).

In fact, people who have DVT might not even have any pain or unusual swelling because some people already have swelling from other conditions, like heart failure, so the doctor may not be able to differentiate new swelling.  I also learned that healthy people who have DVT tend to bounce back much easier than people with health issues.

Dr. Kistner also talks about all the different ways to treat DVT depending on where the clot is and how the clotting affects the person physically. My patient was treated with an intravenous solution (IV) of a blood thinner called Heparin and also had to take a pill called Coumadin once she was discharged from the hospital. When she was in the hospital she had to stay in bed as much as possible and she was supposed to wear support stockings once she was sent home.

I asked the doctor who was treating her if the blood thinner was dissolving her clot and he said, probably not right at that time, but that he was hoping the blood thinner prevented the clot from getting any bigger. He said that, over time, the clot that was already there would stop growing and then slowly dissolve and/or the clot would become like bubble gum and attach itself to the wall of the vein and then blood would be able to work its way through a new passageway there.

When I asked him what would have happened to my patient if she wasn’t in the hospital on blood thinners, he said maybe nothing worse than leg swelling, but most likely the blood clot would continue to grow and part of it would break free, travel into the lungs and then she might possibly die.

He ordered some special blood work on my patient to see if she had been born with any underlying blood clotting problems. He also questioned her in great detail about any aches, pains or changes in her health, like sudden weight loss. He wanted to make sure she didn’t have a possible cancer somewhere because cancer might change the way her blood clots too.  Fortunately, my patient did not have a diagnosis of cancer and her physician was pretty convinced that she got her blood clot from sitting in an airplane seat for 14 hours without moving her legs or walking during that time.

 

For more information about DVT, venous disease and to take an online vein assessment, please visit the American Vein & Lymphatic Society Patient Information page.