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DVT Examination

Introduction

  • Wash hands
  • Introduce self
  • Ask Patientโ€™s name, DOB and what they like to be called
  • Explain examination and obtain consent
  • Expose the patientโ€™s legs. Check for any pain in legs. 

General inspection

  • Look at the patient from the end of the bed
    • Are they well/unwell?
    • Any breathlessness?
    • Are they in pain/discomfort?
  • Consider DVT risks
    • Signs of malignancy (e.g. cachexia)
    • Signs of immobility (e.g. walking aids)
    • Signs of recent surgery or trauma, pregnancy 
  • Look around the bed: medicines etc.

Leg inspection

Inspect with the patient standing:

  • Look at the patient’s skin: are there any colour changes?
  • Ankle/leg swelling (unilateral may indicate DVT; bilateral may indicate oedema, e.g. in heart failure)
  • Venous insufficiency signs
    • Venous eczema and haemosiderin deposits (red-brown patches)
    • Lipodermatosclerosis (โ€˜inverted champagne bottle legโ€™; increased venous pressure causes inflammatory cells to fibrose subcutaneous tissue)
    • Venous ulcers
    • Note any venous dilatation and tortuosity (varicose veins)
Stages of venous insufficiency

Palpation

Palpate with the patient supine:

  • Temperature: feel for temperature differences between legs using the back of your hand (minimum three places each side) 
  • Tenderness: palpate for calf tenderness with knee slightly flexed (squeeze near ankle and then up calves while watching face)
  • Pitting oedema: if present, establish how far oedema extends (and also check JVP)
  • Calf diameters: measure circumference 10 cm below tibial tuberosity (>3cm difference = significant)
  • Palpate pulses

To complete 

  • Thank patient and restore clothing
  • โ€˜To complete my examination, I would perform full cardiovascular and respiratory examinations. I would review the patientโ€™s observations, including oxygen saturations and respiratory rate. If these are abnormal, I would consider the possibility of a pulmonary embolism.โ€™
  • Summarise and suggest further investigations you would consider after a full history

Why don’t you test your knowledge?

How would you investigate a patient with a suspected DVT? Consider the Wells score in your answer.

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Name five risk factors for venous thromboembolism

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What is Virchow’s Triad?

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