Venous Thrombo-Embolism (VTE)

What is Venous Thrombo-Embolism VTE?

VTE is the collective term for Deep Vein Thrombosis (DVT); a blood clot in one of the deep veins in the body, usually in one of the legs. Pulmonary Embolism (PE) is a blood clot in the blood vessel that carries blood from the heart to the lungs.

Anyone can get a blood clot, but you are more at risk if you cannot move around much or if you are unwell. You may have heard of blood clots linked to long-haul plane journeys or the contraceptive pill, but most blood clots actually develop during or just after a stay in hospital. Your risk is also increased if you:

Are over 60 years old

Are overweight or obese

Have had a blood clot before

Are having hormone replacement therapy (HRT)

Are pregnant or recently given birth

Are dehydrated

Have cancer or receiving cancer treatment

Have a condition that causes your blood to clot more easily than normal e.g. antiphospholipid syndrome

On admission, you will have been assessed for the risk of developing a VTE and may have been given one or a combination of the following

Compression stockings (e.g. TED’s). (Anti-embolism stockings are made from elastic and can be either thigh or knee length. They reduce the risk of blood clots by gently compressing your legs. This increases the blood flow and prevents your leg veins from expanding, which stops blood pooling in your legs and forming a clot)

Sequential compression device (AV / Flowtron Boots) – a foot pump to keep your blood circulating

An injection containing a low weight molecular heparin – blood thinning injection

The stockings should be worn day and night during your stay in hospital. At home, you should wear them until you return to your normal or improved level of mobility. When you are discharged, your nurse will give you further advice regarding this.

Stockings should be removed for no longer than 30 minutes every day. Your legs should be washed and inspected for damage and skin discolouration or soreness. Stockings should be changed and washed every two to three days and a fresh pair applied. Do not allow your stockings to roll down as this will create a tight band causing constriction and affect your blood flow. When moving around, please make sure you are wearing slippers or shoes as the stockings can be very slippery on hard floors. These stockings can be difficult to put on. Therefore, the elderly and people with a disability may need some help from a carer or relative.

Putting on the stockings

• Insert your hand into the stocking as far as the heel

• Keeping your hand inside, turn the stocking inside out to the heel

• Position the stocking over the foot. Ensure the heel is centred in the heel pocket marked on the stocking

• Providing the heel fits, the inspection hole will be under the foot. In some cases, the stocking overlaps the foot and this is acceptable

• Pull the stocking up and fit around the ankle and calf

• Pull the remaining stocking up to its full length and ensure there are no wrinkles

• For full-length stockings, ensure the stocking fits to allow the knee to bend and the thigh gusset sits in the middle, on the inside thigh

Washing instructions

The stockings should be washed every two to three days. They can be washed with a mixed load of white garments on a standard 40° wash cycle. The use of bleach should be avoided. Stockings may be spun in a short spin cycle, but should not be wrung out by hand as this can damage the elastic fibres. Dry at room temperature or tumble dry at a low to moderate heat. The stockings should not be hung over the radiator to dry. With correct care, stockings should last two to three months (approximately 30 washes).

Further Advice

In addition, there are some very important and simple things you can do to help reduce your risk; get up and about as soon as possible, exercise your legs when in bed and make sure you drink at least 2 litres of fluid a day to stay well hydrated.

In some cases of DVT there may be no symptoms - however you should contact the Nurse in Charge at New Victoria Hospital on 020 8949 9000 immediately if you experience any of the following in the days or weeks after your operation:

Symptoms of a DVT

pain, swelling and tenderness in one of your legs (usually calf)

a heavy ache in the affected area

warm skin in the area of the clot

redness of your skin, particularly at the back of your leg below the knee

Symptoms of a PE

If a DVT is not treated, a PE (a blood clot that has come away from its original site and become lodged in one of your lungs) may occur. You may:

become breathless

have chest pain – a sharp stabbing pain that may be worse when you breath in

collapse suddenly

cough – this is usually a dry cough but you may cough up blood or mucus that contains blood

feel faint, dizzy or pass out

Both DVT and PE are serious conditions that require urgent investigation and treatment. If your symptoms are particularly severe, call for an ambulance to take you to Accident and Emergency.

A VTE that occurs within 90 days of admission is a reportable event and automatically results in an internal investigation. If any significant omission is found in your care, you will be informed by a member of the senior clinical team and be invited to a meeting to discuss the investigation findings and any resulting action plan.

Further Information

Venous thromboembolism in over 16s: reducing the risk of hospital acquired deep vein thrombosis or pulmonary embolism NICE NG89(March 2018 updated 2019)