What is Venous Thrombolytic Therapy?

Venous thrombolytic therapy is the name given to a group of medications which dissolve blood clots. Blood clots form in blood vessels (veins) for a variety of reasons. One of the most frequent causes is damage to the valves in the veins. These valves open and close like gates aiding in moving blood back to the heart from the legs against gravity. When a valve is damaged, blood is not as easily moved out of a vein. With sluggish blood flow, blood slows and clots develop. The "back up" of blood caused by the clot can cause symptoms of swelling and discomfort.

Receiving a "thrombolytic" (clot-dissolving), medication will, hopefully, destroy the clot, restore blood flow and reduce or eliminate your symptoms.

Where Is A Venogram Performed?

A venogram is performed in a specially equipped x-ray room located in the Radiology Imaging Department. An Interventional Radiologist, a specially trained physician in the study of blood vessels, will perform the venogram and begin administering the clot-dissolving medication.

What Can I Expect During Thrombolytic Therapy?

The beginning of therapy involves photographing the blood vessels and locating the clot. This is the venogram portion of the test. During the procedure you will need to lie flat. You will be covered with a sterile drape and an area on your arm, leg or neck will be cleansed with a liquid soap. An intravenous (small needle) will be inserted into your arm to provide you with fluids and/or medications.

A small plastic tube will be placed in your leg, arm or neck. A numbing medication wilt be used on this area to prevent discomfort. The medication will sting for a few seconds and then will make the area numb. Aside from this sensation, the procedure is relatively painless. The Radiologist will place a small plastic tube through the numbed skin into the vein, inject x-ray dye and photograph the clot.

Once the clot is located, the medication will be given through a special machine which administers it at a precise rate. The plastic tube will allow the medication to flow to the clot. While the medication infuses, you will need to remain relatively still to prevent movement or kinking of the tube.

Nursing Care and Management During Thrombolytic Therapy

Once the medication is started, you will be transferred to a nursing unit. Your heart rate, blood pressure, tube site and medication rate will be monitored closely. You will also be observed for signs of bleeding.

The medication may need to be administered over several hours, or even several days, in order to dissolve the clot. You may periodically need to return to the x-ray department for more photographs of the blood vessels to determine your progress.

When the clot is dissolved, or when no further improvement can be obtained, the medication will be stopped and the plastic tube in your arm or leg will be removed. Pressure will be applied to the site until bleeding is controlled.

How Will I Receive the Clot Dissolving Medication?

The medication is administered through a small plastic tube which is inserted in your arm, leg or neck. In order to determine if you have a blood clot and its location, the blood vessels (veins) must first be photographed. The study of the veins is called a venogram. With the use of x-ray dye, the blood flow through the veins can be studied and the clot pinpointed for treatment.

Considerations After Thrombolytic Therapy:

Your movement may be restricted during the infusion of the medications. It is important to take deep breaths frequently, both during and after therapy, due to your decreased activity. You may be placed on special medications to help prevent clot formation. These medications are called anticoagulants. Many people refer to them as "blood thinners". The medications lengthen the time it takes for your blood to clot rather than actually "thinning" it.

If you are placed on anticoagulants, special instructions will be needed. The effects of these drugs may make it necessary to adjust your diet, restrict medications and have your blood clotting time monitored by blood tests. Consult your physician for instructions. Additional procedures may be necessary to correct the damaged valves that caused clot formation. Your doctor will discuss these with you if appropriate.