Venous Thromboembolism (VTE) – Reducing the Risk

  • Reference Number: HEY-149/2018
  • Departments: Vascular Surgery

This leaflet has been produced to give you general information. Most of your questions should be answered by this leaflet. It is not intended to replace the discussion between you and the healthcare team, but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team.

Introduction

This information sheet tells you about Venous Thromboembolism (VTE). It explains what it is, why you are at risk and how you can avoid it.  It is not meant to replace discussion between you and your doctor but can act as a starting point for such a discussion.  If after reading it, you have any concerns or require further explanation please discuss this with a member of the health care team caring for you.

What is a Venous Thromboembolism?

Venous thromboembolism (VTE) is a blood clot that can develop in the deep veins of the body, most often the leg. This can remain in the leg and cause pain and swelling of the leg or can move to the lungs causing breathlessness or chest pain.

Why am I at risk?

You are at risk because you have been admitted to hospital and may be unable to walk around easily. By not walking, the pumping action that normally occurs in your leg muscles will be reduced which increases the risk of VTE.

VTE can occur in anyone at any age. However, it has been identified that there is a greater risk for people who are immobile (not walking around), those who have had a major operation, and those who have a variety of medical conditions requiring hospital admission.

Why does having major surgery increase the risk?

When a wound occurs the body’s natural response is for the blood to become thicker and stickier. Although this prevents the wound from bleeding too much there is a greater risk a clot may form.

Why is it important that I take precautions to reduce the risk of VTE?

VTE is a potentially serious complication because a fragment of blood clot may break away and become lodged elsewhere in the body. A clot in the lung which may affect breathing is called a Pulmonary Embolism (PE).

What can I do to reduce the risk?

You may be given white knee length or thigh length stockings to wear. These will be measured to fit you. Some doctors may prescribe anticoagulants (blood thinning drugs) instead of, or in addition to the stockings. Anticoagulants are usually given as a once daily injection and are called “low-molecular weight heparin”. Heparins are porcine-derived (from pigs) though other drugs are available for people whose religious views preclude the use of porcine products. Some departments may give blood-thinning medications in tablet form as an alternative to injections, though this may not be appropriate for everyone.

How do stockings reduce the risk?

The stockings help in maintaining an even pressure on the muscles of the legs. They work by squeezing the blood from the smaller capillaries onto the larger veins in the leg, promoting good circulation.

What do I do with blood thinning medicines once I go home?

Sometimes patients are advised to continue with blood thinning injections or tablets after they are discharged home. If this is the case, you will need to give yourself a daily injection which the ward staff will show you how to do. If you are unable to do this we will show a family member how to give the injections or arrange for a District Nurse to come to your home. Used needles should be placed in a yellow sharps bin which you will be given. Used sharps bins can be returned to hospital or collected by the council collection service. In order to arrange sharps bin collection by the council, you need to ring the following number:

  • Hull City Council – (01482) 300300
  • East Riding of Yorkshire Council – (01482) 393939

What are the Risks of taking Blood Thinning Medications?

Blood thinning drugs, like any other drug, can have some side effects. For example, you may notice that you bruise easily. You need to report any unusual symptoms to your doctor, particularly increased bruising, any unusual bleeding or dark ulcers at the injection sites. Oral tablets can cause stomach upset and sometimes bleeding and dark bowel motions. Serious bleeding is uncommon (around 4 in 100). If you experience any bleeding that you cannot control or explain, or you notice soft black tarry stools, you should report to the Emergency Department of your nearest hospital as bleeding may lead to death. Please ensure that some else drives you to the hospital. For further information about your medication please read the patient information leaflet that comes with the medicine and/or you can consult your pharmacist, nurse or doctor.

Use and care of stockings

Stockings should be worn at all times during your hospital stay and after you are discharged. You should wear them for as long as you are advised to by the ward staff. As the stockings should be worn at all times, two pairs will be provided so as to allow you to wash them. When the stockings are removed for changing, they should be off for no longer than 30 minutes.  The stockings can be washed at 40oC, any higher and the stockings may shrink. They can be tumbled dried if the machine does not exceed 121oC.

The stockings are designed to fit snugly, but should not be tight. If you experience discomfort please discuss this with the nurse that is looking after you. The stockings should not be creased or roll down. This will cause uneven pressure and reduce the blood flow.

What if I need help taking the stockings on and off?

If you have difficulty in taking the stockings on and off please advise a member of the health care team who are caring for you and arrangements will be made to assist you with this.

What should I do if my calf become swollen, red and painful?

Contact the hospital ward on which you were a patient via the switchboard (01482) 875875 for advice.  Alternatively you can contact your GP or Emergency Services (111).

You should in the meantime, leave the stockings off and raise your leg slightly on a footstool.

What should I do if I become breathless or develop chest pains?

You should seek immediate medical advice either by telephoning the hospital ward on which you were a patient via the switchboard (01482 875875), Emergency Services (111) or your GP.  Alternatively you can contact the hospital Emergency department via the hospital switchboard or by attending directly.

The leaflet was produced by the Thrombosis Committee, Hull and East Yorkshire Hospitals NHS Trust and will be reviewed in April 2021.

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

  • you must be able to give your consent
  • you must be given enough information to enable you to make a decision
  • you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.