Date issued: September 2019
For review: September 2021
Ref: A-182Medical specialities/Medicine/ZL/DVT v5
Your doctor suspects that you may have a deep vein thrombosis in your leg, so you have been sent to the Nurse Led DVT Service for investigations. This booklet contains useful information on the condition known as Deep Vein Thrombosis (DVT) or blood clot. It outlines the treatment you can expect to receive, and the steps you can take to give your treatment the best chance of success.
The DVT Service
The DVT service is run by nursing staff, trained in the investigation and treatment of Deep Vein Thrombosis. An overnight stay in hospital is not normally needed, as all of your treatment can be given during the day.
Between the hours of 9 am and 5 pm Monday to Friday (excluding bank holidays), you will be seen in the DVT clinic on the AAU (Acute assessment Unit) Level 6.
The nurse will ask you several questions about your symptoms to decide if you may have a DVT. You will then have a blood test called a D-Dimer if not already taken by your GP. This will detect any abnormal levels of clotting in your blood. (There will be a wait for this result of approximately 2 hours).
If the result of this test is negative, (no evidence of abnormal clotting in your blood) you may be discharged home and no further treatment is needed. Sometimes, we recommend this test be repeated at a later date. If your symptoms continue you should contact your GP for further advice.
If the test is positive it may suggest you have a blood clot and that further investigation is needed (by ultrasound scan). Ultrasound scans are carried out daily Monday to Friday (excluding bank holidays) and an appointment will be made for you on the next available list.
Until this time you will need a daily injection of Low Molecular Weight Heparin. (LMWH) an anticoagulant. Your first injection will be given before you leave the hospital. The injection will be given just below the skin surface in your tummy. You may feel a ‘bee sting’ around the area. It is quite normal to have a small bruise. If you need further injections you will need to return to the hospital daily.
Ultra sound scan Investigation
It is very important that have your scan once an appointment has been made.
The DVT nurses will inform you of the scan results following the examination. They will give you further advice and discuss these results with you and answer any questions you may have.
If the scan is negative, no evidence of a clot (DVT) has been found. At this time your injections of LMWH will be discontinued. However you may be given an appointment for a repeat scan in 7 to 10 days. It is very important to attend for this scan. If you are unable to do so, please contact the DVT clinic so the date can be rearranged for you. If your symptoms continue you should see your GP.
If your scan is positive and a clot (DVT) has been found in your leg, you will need to commence treatment for this. Different treatment options will be discussed with you.
Once a clot (DVT) has been confirmed you will start on a treatment anti coagulant. This tablet is to prevent any further clots developing. The DVT nurse will explain this and give you an advice booklet about anti coagulation treatment.
Glossary of terms
Low Molecular Weight Heparin (LMWH)
LMWH is an anticoagulant, given as an injection just under the skin in the tummy. LMWH will surround the clot, and stop it growing any bigger. It also increases the body’s natural chemicals that help to break down any pieces of the clot that might be in your blood. Within one hour of receiving the first injection, it will be working to its full effect.
Doppler Ultrasound Scan
This is a simple test carried out in the X-ray Dept. The test involves an instrument pressing on to the skin and moved along your leg, looking at the deep veins to see if a clot is present in your leg. It involves no radiation.
The technical terms for a medicine, which reduces the ability of the blood to clot. Although it is commonly known as a ‘blood thinner’ it does not actually thin the blood, it lengthens the time taken for the blood to clot.
Blood clots may form in an artery or vein and cause disruption to the flow of blood. If a blood clot forms in an artery, it can prevent the flow of fresh blood to that part of the body supplied by it e.g. as in heart attack or stroke. If a clot forms in a vein it limits blood flowing back to the heart. A clot forming in a leg vein is commonly called a deep vein thrombosis or DVT for short. This clotting can cause pain, redness, tenderness and swelling around the site of the clot.
Sometimes pieces of the clot, broken off by chemicals in the body, can travel to the lungs. This is known as a ‘pulmonary embolism’. If this happens, it can cause symptoms such as a sharp pain in the chest and shortness of breath.
If you experience any of these symptoms, you must contact your GP immediately, day or night. If your condition requires it, you will be treated with medication to prevent this from happening, following investigations.
D-Dimer is a blood test that detects the breakdown products of clotting in your blood. If the results of this test are within normal limits, it will mean that there has been no evidence of a deep vein thrombosis in your body. If the test results are raised, (positive) it may mean that you have a DVT, although many other conditions can cause this. Further investigation by ultra sound scan will be required to confirm the presence of a DVT.
A term for a piece/s of a blood clot, which the body’s chemicals have broken off, and it has travelled to the lungs. This type of clot can cause chest pain and difficulty breathing, but is treated in the same way as other types of blood clots in veins. If you experience any of these symptoms, you must contact your GP immediately, day or night.
If you have a DVT, you may notice swelling in your leg. It may also be tender and painful to touch. This is quite common as your veins are recovering. If the clot has damaged the valves in your leg, your leg may always have a tendency to swell from time to time.
Sometimes your leg may remain permanently swollen (post phlebotic limb) or you may develop varicose veins.
To help the veins to recover, it is important to look after your legs. You should:
Avoid standing for long periods (1-2 hours in the same position). Keep moving if you cannot sit down
- Put your feet up whilst sitting in a chair, your legs should be supported higher than the seat of the chair if possible
- Take plenty of gentle exercise, for example, walking, swimming
- You may be issued with support stockings / long socks by your GP, although not all patients will be suitable. (It is important to make sure they fit correctly and your practice or district nurse will assess you and measure your legs once the initial period of swelling and pain has subsided and your warfarin treatment is stable).
- You may find it helpful to moisturize the skin on your legs daily to help keep them supple.
Important points to remember
- If you take your medication as instructed, it is unlikely that you will have any problems.
- You can give your treatment the best chance of success by following these guidelines.
- Try to take your anti coagulation at the same time each day
- Tell your doctor or nurse about any other medicines you may be taking.
- Carry your anticoagulation therapy card with you at all times in case of an emergency.
- Remember to tell your doctor/nurse if you think you have taken too many tablets, or if you have missed a dose.
- If you go for any other treatment, for example, from another doctor, or a dentist or pharmacist, tell them you are taking an anticoagulant.
- Ensure you attend for blood tests when you are asked.
- It is important to keep alcohol intake to within the recommended units and NOT to binge drink, the clinic nurse will discuss this with you.