Upper-Extremity Deep Vein Thrombosis: How Clinicians at One Hospital Achieved Lower Rates

Patient with upper-extremity DVT, photo by Charlie Goldberg, MD (http://meded.ucsd.edu/clinicalmed)

At a suburban hospital in Indiana, clinicians noticed that the incidence of secondary upper-extremity deep vein thrombosis (DVT) at their facility seemed to be on the rise. As Lancaster and colleagues report in the May Emergency, this was alarming: upper-extremity DVT, once thought benign, is now known to be potentially dangerous, leading to complications such as symptomatic or asymptomatic pulmonary embolism, chronic venous insufficiency, and postthrombotic syndrome. Secondary upper-extremity DVT, which accounts for a majority of cases, can be linked to an identifiable risk factor. Patients may present with pain, swelling, and bruising in the area of the thrombosis—but many patients show no symptoms. So it’s essential that nurses know which patients are at risk and how to minimize that risk.

The Indiana clinicians reviewed the literature to deepen their understanding. They also tracked all patients who underwent ultrasonography at their facility and conducted retrospective chart reviews, gathering data for a full year. Several new risk factors were identified, including

• the use of the large veins at the antecubital fossa for peripheral IV access;
• the use of harsh medications administered via peripheral IV; and
• certain peripherally-inserted central catheter (PICC) flushing and care practices.

What they learned prompted several changes to nursing care, and the incidence of secondary upper-extremity DVT at this facility has since declined. To learn more about this quality improvement project and the changes that were implemented, read the article. And if you’ve cared for patients with this serious and increasingly common condition, please share your experience with us in the comments.