MSDEC referrals for venous thromboembolism (VTE)

DVT

If a DVT is suspected, the patient can be anticoagulated as per guidelines and booked into a DVT clinic for an ultrasound.

Bookings

To book a patient into a DVT clinic between:

08:00-02:00

Ask the MSDEC ward clerk to book the patient in and print out an appointment letter.

02:00-08:00

Ask the MSDEC nurse who will fill in the excel document and the ward clerk will book them in the following morning. Please ensure up to date contact details for the patient are recorded.

Please ensure that the TTO has sufficient doses of anticoagulation to last until the appointment. If uncertain when the appoint is, please provide two weeks worth. Also ensure that you request the scan on PICS.

Upper Arm DVT

There is a small number of slots available for upper limb doppler scans but they are not part of the DVT clinic pathway above.

Bookings can only be made by direct communication with the ultrasound lead by phone during the normal working hours (Monday to Friday from 09:00-17:00).

Tel: ext.12305

If you see a patient outside normal working hours and suspect an upper arm DVT, start them on anticoagulation and handover to the team on the next normal working day to liaise with the ultrasound department for an appointment. Then inform the patient of the appointment.

Please ensure a PICS request is made and WELLS score and DDimer are documented in the request.

PE

Calculate PE WELLS score and measure DDimer if appropriate.

If PE WELLS score >= 4 or Ddimer positive, initiate anticoagulation and plan scan via following pathways:

• Weekday before 16:00 - book CTPA
• Weekday after 16:00 or on the weekend - calculate sPESI score to determine if patient is suitable for ambulatory management
• If sPESI =0, arrange return to SDEC for CTPA next working day. Book in SDEC returners book and send home with anticoagulation
• If sPESI >=1, discuss with senior to determine is patient requires admission

For pregnant patients, please download the specific guidance.