Prophylaxis Flashcards

1
Q

What are the key steps in the VTE prophylaxis care pathway?

A
  1. Assess level of mobility, VTE and bleeding risk
  2. Balance risks of VTE and bleeding and prescribe as appropriate
  3. Reassess within 24 hours and when clinical situation changes
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2
Q

List some patient specific risk factors for VTE

A
  • Active cancer
  • Age >60
  • Dehydration
  • Thrombophillia
  • 1 or more medical co-morbidities
  • HRT or OCP
  • Pregnancy /
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3
Q

List some admission specific risk factors for VTE

A
  • Large decrease in mobility >3 days
  • Time for anaesthetic and surgery >90 minutes
  • Surgery of pelvis or lower limb
  • THR / TKR
  • Hip fracture
  • Critical care admission
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4
Q

List some patient specific risk factors for bleeding

A
  • Active bleeding
  • Acquired bleeding disorder (liver disease)
  • Anticoagulant use
  • Thrombocytopenia
  • Inherited bleeding disorders
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5
Q

List some admission specific risk factors for bleeding

A
  • Neuro / eye/ spinal surgery
  • Procedure associated with increased bleeding risk
  • Lumbar puncture / epidural
  • Spinal anaesthetic 4 hours prior or expected in the next 12 hours
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6
Q

What are the two main types of VTE prophylaxis?

A
  • Mechanical (Anti-embolism stockings or IPC)

- Pharmacological (LMWH or unfractionated heparin for severe renal impairment)

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7
Q

What general precautions can be taken to avoid VTE?

A
  • Patient education
  • Avoid dehydration (unless clinically indicated)
  • Encourage patients to mobilise ASAP
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8
Q

What can be considered to prevent VTE in patients in whom mechanical and pharmacological prophylaxis in contraindicated?

A

IVC filter - prevents emboli from clots in the legs travelling to the lungs and causing PE.

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9
Q

What 4 factors determine whether a patient receives prophylactic antibiotics?

A
  1. Patient’s risk of surgical site infection
  2. Potential severity of the consequences of an SSI in the patient
  3. Likely effectiveness of prophylaxis in the individual circumstances
  4. Potential consequences of antibiotic use for the patient (E.g. C. Dif risk)
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10
Q

By what route are prophylactic antibiotics usually given ?

Are there any specific exceptions?

A

IV administration.

Some special surgeries have specific routes E.g. eyes

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11
Q

When should prophylactic antibiotics be administered?

A

Within 60 minutes prior to skin incision. A single, standard, therapeutic dose is usually sufficient.

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12
Q

List some patient specific risk factors for surgical site infection

A
  • Extremes of age
  • Poor nutritional state
  • Obesity
  • Diabetes mellitus
  • Smoking
  • Co- existing infection elsewhere
  • Bacterial colonisation
  • Immunosuppression
  • Prolonged post op stay
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13
Q

List some operation specific risk factors

A
  • Length of surgical scrub
  • Pre-operative shaving
  • Skin antisepsis
  • Length of operation
  • Antimicrobial prophylaxis status
  • Surgical drains left in situ
  • Post operative hypothermia
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14
Q

What type of antibiotic would be used for prophylaxis in high risk surgery MRSA patients?

A

Glycopeptide

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15
Q

Are there any surgical complications where a second dose of prophylactic antibiotics would need to be administered?

A

Major intraoperative blood loss - consider additional prophylaxis after fluid replacement

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