Question about DVT Diagnosis

[harley_fan]

Has anyone ever seen a diagnosis of a DVT from just a positive Homan's Sign? If there are no risk factors (no smoking, no BCPs, active person, and younger) do they automatically r/o dx of DVT?

Thanks

[bluesky, BSN, RN]

she said that it is a preventitive medication and is not indicated for these situations.

Another winning resident moment...hopefully it was an R1 that fed you this hogwash...

To make a long story short, lovenox is the DVT prophylactic of choice because it is virtually impossible to get over anti-coagulated on it (unlike heparin and coumadin).

Secondly, coumadin takes several days to reach therapeutic levels which is why pts in A-fib, for example, are weaned on to coumadin while weaning off a heparin.

[bluesky, BSN, RN]

PS Whoops, once again I've answered a thread that's over a year old. Wonder if the OP is still around??

Hey don't feel too bad... I even missed your post about it!! Ha ha ha :rotfl:

[MissJoRN, RN]

PS Whoops, once again I've answered a thread that's over a year old. Wonder if the OP is still around??

Works for me! I just took care of an adult DVT (arm) pt who "flipped" a PE for me/ my orientee (apparently "flipping" a PE is not quite as bad as "throwing" one? LOL) Any little refresher is good for me since I so rarely care for adults and while I wasn't at all over my head I didn't feel as "on top" of things as I normally like to be. So see, your response was very timely!

[UM Review RN, ASN, RN]

Works for me! I just took care of an adult DVT (arm) pt who "flipped" a PE for me/ my orientee (apparently "flipping" a PE is not quite as bad as "throwing" one? LOL) Any little refresher is good for me since I so rarely care for adults and while I wasn't at all over my head I didn't feel as "on top" of things as I normally like to be. So see, your response was very timely!

I'm glad someone could make use of it--even if the Homan's sign doesn't work at all for arms! :chuckle

[rjflyn, ASN, RN]

Just an FYI it depends on which d-dimer test they do. One facility I was recently at a value >50 was positive. Apparently there is more than one.

Rj

OK, you have two questions here. The answer to number one is no. The definitive dx for DVT is made by a venous ultrasound of one or both legs. A positive Homan's might be an indication for a venous ultrasound, however.

No matter if there are risk factors, if your doc thinks you might have a DVT, the ultrasound is ordered to rule out.

Hopefully, the doc will also order a D-dimer, which will trigger for a PE. A D-dimer of >1000 triggers a followup CT angio which rules out or confirms a PE.

Hope that helps.

[UM Review RN, ASN, RN]

Thanks for popping in with that info!