Citation: Lavery J (2021) Clinical assessment of the leg for a suspected deep vein thrombosis. The Wells score, as highlighted, is comprehensive, but a patient’s history must not be overlooked, as many conditions that could predispose an individual to a thrombus are not included in its scoring system. The assessment can be done in primary care by a nurse practitioner or a GP. The scale and a postal questionnaire were used for data collection on 21 patients. Thomas (2014) identified that patients who are non-complex but have a suspected DVT are ideally placed to be diagnosed and managed in primary care. Please enable it to take advantage of the complete set of features! The Wells score is standardised and is transferrable for use in different areas of practice. Evidence-based information on dvt assessment tool from hundreds of trustworthy sources for health and social care. 2007;4(1):14-20. doi: 10.1111/j.1741-6787.2007.00074.x. Box 1. 2000 May-Jun;19(3):93-9. doi: 10.1097/00006416-200019030-00014. It must be noted that pregnancy is one exclusion of the Wells risk assessment; the tool has not been validated for use in this situation and false positives, along with the potential for unnecessary anticoagulation in people in such a high-risk group, could lead to unnecessary harm (Righini et al, 2013). National Library of Medicine Prevention and treatment information (HHS). It is JFK model risk assessment tool which includes every risk factors of the DVT. More recently, studies have found increased risk associated with a VTE in patients with severe Covid-19 admitted to critical care, despite prophylactic anticoagulation (Fontana et al, 2020; Hasan et al, 2020). Prevention of DVT after orthopaedic surgery: the A-V Impulse System. Decreasing the incidence of deep vein thrombosis through the use of prophylaxis. making tool to estimate a patient’s risk of a DVT; l Demonstrate the process of a leg assessment for a suspected DVT. The identification of a suspected DVT is the responsibility of nurses in all clinical settings, and the risk factors, implications and clinical assessment of suspected patients is in the skillset of all nurses. If there is >3cm difference to the asymptomatic side, a DVT is the likely diagnosis (Wells et al, 1997), Palpate foot pulses. Bethesda, MD 20894, Copyright A value of <500µg/L is conventionally used to safely rule out VTE; it has a low false-negative rate. Some studies suggest it has low sensitivity and specificity for DVT , while some practitioners suggest it may actually dislodge the DVT leading to pulmonary embolism. Once a full assessment of the patient has been completed, the following should be documented: The Nursing and Midwifery Council (2019) noted that safe and effective learning is a factor in proficient practice, and use of documentation that has transferability across environments can support this. It is important to be aware, however, that this list of differential disgnosis is not exhaustive. Those with cancer and already increased coagulability may have had chemotherapy, be immunocompromised or have acquired infections, which can combine to make them high risk. Then, we developed and delivered educational materials on using the tools to the nurses and providers. “The severe inflammatory processes manifested by Covid-19 can increase the incidence of deep vein thrombosis”. Results: Furthermore, studies show that the severe inflammatory processes manifested by Covid-19 can increase the incidence of DVT (Sebuhyan et al, 2020). Communication must be maintained throughout and the patient informed of the proposed plan of care. The Wells score reading from the consultant was compared with the reading of the nurse practitioners. DIAGNOSIS OF DVT -Ascending contrast venography is considered the most accurate diagnostic test for distal and proximal DVT, the test is invasive. Symptoms of a PE such as pleuritic chest pain, haemoptysis or acute shortness of breath need to be assessed as this will inform the need for diagnostic imaging, such as a computed tomography pulmonary angiogram. This can dislodge, then travel into the bloodstream and towards the lungs, where it can cause a pulmonary embolism (PE); this is a blockage in the pulmonary circulation that is known to be life threatening (National Institute for Health and Care Excellence, 2020). Visit our, Clinical assessment of the leg for a suspected deep vein thrombosis, 100 years: Centenary of the nursing register, 2020: International Year of the Nurse and Midwife, Nursing Times Workforce Summit and Awards, 210414 Clinical assessment of the leg for a suspected deep vein thrombosis, Free Webinar Series: Essential Skills – Continence Care Week, Exclusive: Nurses call for an end to ‘hair racism’ in the NHS, Don’t miss your latest monthly issue of Nursing Times, Nursing Times survey reveals state of nurses’ mental health one year into pandemic, How will genomics benefit my patients? Developments in D-dimer testing mean the age-adjusted D-dimer is now being used in combination with other clinical probability assessments to rule out suspicion of VTE, with the level of the result adjusted accordingly to calculate the risk to the individual. The clinical examination and consultation with the patient must be taken in the context of a full clinical history and the National Early Warning Score (NEWS) 2 system (Royal College Physicians, 2017). VTE risk assessment is a National Quality Requirement that forms part of the NHS Standard Contract 2020/21 (NHSE, 2020). DVT and PE are both in the category of venous thromboembolic (VTE) disorders. Patients score one point for any of the clinical features with which they present on the screening tool. Stage 2 involved pilot testing the tool with 38 surgical nurses who conducted repeated assessments on a prospective sample of 50 postoperative orthopaedic patients. Author: Joanna Lavery is senior lecturer adult nursing, Liverpool John Moores University, and locum advanced nurse practitioner acute medicine, Liverpool University Hospitals NHS Foundation Trust. Orthop Nurs. Careers. Whether further investigations are required as per NICE (2020) guidance; Date, time, your printed name, signature and designation. Visible signs of a DVT are an acutely swollen leg and dilatation of superficial veins; other features are the leg being hot to touch and pain on palpation of the calf. However, it may be on your nursing school exams, so just know that Homan’s Sign is tested by dorsiflexion of the foot while bending the knee…if the patient has pain, it’s considered a positive Homan’s. Pain specific to the deep venous system can be a symptom of a DVT (Wells et al, 2003), Measure the difference in circumference of the calves; this is measured 10cm below the tibial tuberosity. Clipboard, Search History, and several other advanced features are temporarily unavailable. clinical assessment; clinical assessment tools; deep vein thrombosis; orthopaedic nursing; surgical nursing; venous thromboembolism. 8600 Rockville Pike The nurse case manager served as a single point of contact for nurses, physicians, pharmacists, and patients with respect to VTE risk assessment and prevention. Conclusion: COVID-19 Resource Center. A D-dimer has the advantage that it is quick and can be taken with other routine blood tests for use in conjunction with a clinical history wherever there is clinical suspicion of VTE. Then, measure the circumference of the same leg but 10 –15 cm above the patella. This is an unprecedented time. Causes of a DVT Virchow’s triad (republished in 1998) refers to three factors that can contribute to a venous thrombosis: l Venous trauma, whereby damage occurs to the vessel walls; l Venous stasis, characterised by poor Venous trauma, whereby damage occurs to the vessel walls; Venous stasis, characterised by poor blood flow; Hypercoagulability, otherwise described as abnormal blood constituents (Welch, 2010). Conclusion: Despite finding the STOPDVTs clinical assessment tool was a useful guide for nursing assessment, surgical nurses often underestimated the potential importance of clinical signs. Nursingwritingservices.com DA: 30 PA: 21 MOZ Rank: 51. Stage 2: The STOPDVTs tool had acceptable face and content validity, the agreement between the expert nurse and surgical nurses on assessments of individual signs and symptoms varied between 44%-94%. It reflected that nurses will increasingly be required to identify and assess for DVT in both primary and secondary care, and so need the skills to assess the clinical risk of the patient. How to conduct a leg for assessment using the Wells screening tool. Mr.Kapil Sharma 1,Ms. Developing appropriate tools After reviewing the literature, we developed a nursing risk assessment tool and a provider order set. This site needs JavaScript to work properly. assessment/ intervention July: Postpartum orders reflect pneumatic compression sleeves until discharge for C/S September: Added VTE risk reassessment every 72h to the form November: Implementation of OB VTE screening tool/order form with the antepartum population July: Implementation of OB VTE screening tool/order form with the There are multiple risk factors for venous thromboembolic disorders, making them complex to diagnose, The two-level Wells score is a systematic standardised approach to deep vein thrombosis assessment, Other risk factors and variables must be considered during a deep vein thrombosis assessment, The procedure for a leg assessment for a suspected deep vein thrombosis is within the skillset of nurses, Nurses must be aware of referral pathways and National Institute for Health and Care Excellence guidance on managing patients with suspected deep vein thrombosis. Deep vein thrombosis occurs The JFK model risk assessment tool evolved through an evidence-based research and it proved that this model is working better than other models to assess the risk factors. ‘When voices unite on social media and are then amplified, the tables can quickly turn’. The NHS Long Term Plan focuses on improving the patient journey – which is key to increasing patient satisfaction and boosting proactive care – by screening and diagnosing at-risk patient groups at an earlier point in time (NHS, 2019). It is also crucial that these nurses be cognizant of the contraindications to mechanical prophylaxis Consultant and nurses were blinded to each other’s assessments. The risk assessment tool is not intended for use in pregnant women, for whom practitioners should refer to royal College of Obstetricians and Gynaecologists guidance for obstetric patients (rCOG, 2004). DVT risk assessment tools can provide systematic data on which to base nursing care plans. Relevance to clinical practice: The original DVT scale was developed and tested on a trauma/orthopaedic unit for its consistency, predictive validity and practical utility. The findings reveal a gap in nursing knowledge and skill in assessing for Deep Vein Thrombosis in postoperative orthopaedic patients. The procedure for a leg assessment for a suspected deep vein thrombosis is within the skillset of nurses. 2020 Aug 27;15(1):68. doi: 10.1186/s13012-020-01003-0. Depending on how likely you are to have a blood clot, your doctor might suggest tests, including: 1. Local symptoms were pain in the limbs, calf swelling and tightness, changes in the affected limb's skin temperature. The development of treatment pathways, as advocated by NICE (2020), were aimed at preventing unnecessary hospital admissions, thereby reducing costs to the NHS. 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