EKHUFT DVT Service

 

The DVT Service is a separate and specific nurse led pathway in Ashford (William Harvey Hospital) and Canterbury (Kent and Canterbury Hospital)

Service times:

Monday to Friday: 8 am – 6 pm | Saturday: 8 am – 2 pm

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Contact details:

Ashford (William Harvey Hospital) – 01233 651841

Canterbury  (Kent and Canterbury Hospital) – 01227 864246  (DVT direct) / 01227 783170 (Ambulatory Care) / 01227 766877 extension 7224246 (if calling DVT via switchboard)

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Initial DVT assessment

Refer immediately for same-day assessment and management, if deep vein thrombosis (DVT) is suspected in a woman who is pregnant or has given birth within the past 6 weeks

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For all other people with suspected DVT, use the two-level DVT Wells score to assess the probability of a DVT:

  • Score one point for each of the following:
    • Active cancer (treatment ongoing, within the last 6 months, or palliative)
    • Paralysis, paresis, or recent plaster immobilization of the legs
    • Recently bedridden for 3 days or more, or major surgery within the last 12 weeks requiring general or local anaesthetics
    • Localized tenderness along the distribution of the deep venous system (such as the back of the calf)
    • Entire leg is swollen
    • Calf swelling by more than 3 cm compared with the asymptomatic leg (measured 10 cm below the tibial tuberosity)
    • Pitting oedema (greater than on the asymptomatic leg)
    • Collateral superficial veins (non-varicose)
    • Previously documented DVT
  • Subtract two points if an alternative cause is considered more likely than DVT

NOTE:  The risk of DVT is likely if the score is two points or more, and unlikely if the score is one point or less

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Further investigation

For people who are likely to have DVT (based on the results of the two-level DVT Wells score):

  1. Refer for a proximal leg vein ultrasound scan to be carried out within 4 hours. If a proximal leg vein ultrasound scan cannot be carried out within 4 hours of being requested:
    1. Take a blood sample for D-dimer testing
    2. Give an interim 24-hour dose of a parenteral anticoagulant (note that the weight of the person will be required to calculate the dose of parenteral anticoagulant). For more information on prescribing parenteral anticoagulants, see the section on Parenteral anticoagulants in prescribing information
    3. Arrange for a proximal leg vein ultrasound scan (to be carried out within 24 hours of being requested)

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For people who are unlikely to have DVT (based on the results of the two-level DVT Wells score), offer D-dimer testing:

  1. If the D-dimer test is positive, refer for a proximal leg vein ultrasound scan to be carried out within 4 hours. If a proximal leg vein ultrasound scan cannot be carried out within 4 hours of being requested:
    1. Give an interim 24-hour dose of a parenteral anticoagulant (note that the weight of the person will be required to calculate the dose of parenteral anticoagulant). For more information on prescribing parenteral anticoagulants, see the section on Parenteral anticoagulants in prescribing information
    2. Arrange for a proximal leg vein ultrasound scan (to be carried out within 24 hours of being requested)
  2. If the D-dimer test is negative, consider an alternative diagnosis to explain symptoms

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Contact details for:

Advice and Guidance is being made available for all specialties, and is being provided by consultant specialists at East Kent Hospitals.  To make a request or to check to if a query has been answered, you will need to log in via the electronic Referral System (eRS)

Click here for the "how to access" e-Referral Advice and Guidance Manual for instructions on how to make a request and check responses

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