Postop Vascular Complications

Postoperative vascular complications include deep vein thrombosis (DVT), pulmonary embolism (PE), hemorrhage, and shock. Virchow's triad — venous stasis, hypercoagulability, and endothelial injury — is maximally active after surgery. DVT can develop at any point postoperatively, with classic presentation often around 7–10 days; risk is present from the moment of surgery. Assess for unilateral calf swelling, warmth, and redness. Homans' sign is historically associated with DVT but is unreliable and no longer recommended — rely on objective findings and diagnostic studies (e.g., D-dimer, venous duplex ultrasound). When DVT is suspected: elevate the affected extremity, maintain bedrest, and never massage the leg — you risk dislodging the clot. A DVT becomes life-threatening when it embolizes: sudden dyspnea, tachycardia, pleuritic chest pain, and decreased SpO₂ signal PE — this is an emergency. Hemorrhage can be primary (within 24 hours, usually surgical bleeding) or secondary (after 24 hours, from infection eroding a vessel or mechanical failure such as a slipped ligature). Early hypovolemic shock presents with restlessness, tachycardia, and narrowing pulse pressure before blood pressure drops. Nursing priorities for prevention: early ambulation, sequential compression devices (SCDs) while in bed, adequate hydration, and administering prescribed prophylactic anticoagulants (e.g., enoxaparin, heparin). Key DVT risk factors include obesity, orthopedic surgery, oral contraceptive use, and prolonged immobility.