Venous Thromboembolism (VTE) Reducing the Risk in the Fracture Clinic

  • Reference Number: HEY-500/2019
  • Departments: Orthopaedics

Introduction

This leaflet has been produced to give you general information about Venous Thromboembolism (VTE). Most of your questions should be answered by this leaflet.  It is not intended to replace the discussion between you and your doctor, 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.

What is a Venous Thromb0embolism?

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.

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). 

Why do I need to take precautions?

You are at risk of a VTE because you have suffered a limb fracture, have been fitted with a cast and may be unable to walk around as normal or have reduced mobility. By not walking your leg muscles reduce the blood pumping action that normally occurs, which increases the risk of VTE. VTE can occur in anyone, at any age.

What will be done to prevent VTE?

 Please read this leaflet and share the information it contains with your partner and family (if you wish) so that they can be of help and support.  There may be information they need to know, especially if they are taking care of you.

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 one daily injection and are called “low-molecular weight heparin”. Heparins are porcine-derived (from pigs) though other drugs are available for people whose religious or dietary views preclude the use of porcine products.

You may be may prescribed dabigatran (a blood-thinning medications in tablet form) as an alternative to injections, though this may not be appropriate for everyone. There are other types of blood thinning medications available, but your doctor will advise which is most appropriate for you if they are necessary. Please discuss with your doctor if you want to consider the possibility of taking dabigatran tablets whilst a lower limb cast is in place. You will then need to fill in a consent form.

What happens afterwards?

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 community pharmacies for safe disposal or arrangements for collection can be made through your local council Hull City Council (01482) 300300 or East Yorkshire Council (01482) 393939.

Can there be any complications or risks?

On rare occasions, a VTE can be fatal.

If you 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 or your GP.
  • Attend the Emergency Department
  • Alternatively you can contact the hospital Emergency Department via the hospital switchboard

If your calf becomes swollen/red or painful, you should

  • Contact the hospital ward on which you were a patient via the switchboard (01482) 875875 for advice.
  • Alternatively you can contact your General Practitioner (GP).
  • You should in the meantime, leave the stockings off and raise your leg slightly – for example on a footstool.

Whilst you are receiving blood thinning medicines your blood is thinner than normal.

You need to report any unusual symptoms to your General Practitioner (GP), particularly

  • Increased bruising
  • Any unusual bleeding
  • Dark ulcers at the injection site (if applicable)

 Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Orthopaedic Department: (01482) 674378

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.