Shelly,

We have worked on different scenarios to R/O acute DVT after hours at the
UW.  I think we would agree with your vascular surgeon on the first two
options, but not the third option of sending them home without treatment
or diagnostic workup.  If there are no contraindications to
anticoagulation and the patient is assessed to have risk factors for acute
DVT, the first dose of LMWH and warfarin is given and the patient is asked
to come back in the morning to be scanned by the vascular laboratory.  We
have also sent them to the short stay (<24 hour stay) unit to be treated
with LMWH and observed overnight, if the patient is not comfortable with
going home. However, it is important to note that Medicare Part A will not
reimburse for the < 24 hour stay because it is considered
"outpatient" treatment.  Then again, we have a difficult time getting
Medicare to pay for LMWH anyway so these patients might be better served
to be admitted and treated with IV heparin or LMWH as an
inpatient.

Unfortunately, we do not have a dedicated "thrombosis team" at the UW and
every discipline has their own way of treating or not treating acute
DVT. Fortunately, our vascular laboratory (sorry Watson!) is going to
extend their hours.


*******************************************************************************
Brenda K. Zierler, PhD, RN, RVT
Research Assistant Professor
Department of Biobehavioral Nursing and Health Systems
Adjunct Research Assistant Prof. Depart. of Surgery, Vascular Division
Box 356410                 Pager: (206) 663-8708
University of Washington   Phone: (206) 616-1910   FAX:(206)616-7495
*******************************************************************************

On Thu, 13 Apr 2000, Shelly Burns wrote:

> Hi all,
> I know this subject goes round and round but we are looking at a cutoff time
> for performing venous duplex.  The options for the ER :
> 1) to medicate with low dose heparin and send them home, return the next AM
> for the scan
> 2) to HOP the patient for 23 hours
> 3) or just send home and return for scan in AM
> These suggestions are from our Medical Director, a vascular surgeon, and he
> feels these are fine options.  Is anyone doing this?  He is somewhat of a
> trailblazer but it worries me if this is the right thing for the patient.  If
> you have a cutoff time what is it?
> Shelly Burns LPN, RVT
> Summa Health System
> Akron, Ohio
>