Surgery - Management of Post-Op Issues Flashcards
What are the main patient risk factors for VTE?
Age
Obesity
Varicose Veins
History of DVT/PE
Clotting disorders
What are the main surgical risk factors for VTE?
Trauma or surgery increased risk with
- Increased duration
- Pelvis or abdominal surgery for cancer
- Major limb amputation
- Major trauma or orthopaedic surgery
Immobility
Dehydration
What are the main medical risk factors for VTE?
Malignancy
Oestrogen therapy
Pregnancy or post partum
Medical co-morbidity
Severe infection
Lower limb paralysis
When is VTE characterised as high?
One or more risk factors
When should patients be assessed for VTE prophylaxis?
Within 24 hours of admission and re-assessed every 72 hours
What are the main non-pharmacological methods of VTE prophylaxis?
Normally used if low risk or alongside drugs in high risk:
- Mobilisation
- Avoid dehydration
- Stop meds which increase risk
What are the main mechanical methods of VTE prophylaxis?
Graduated elastic compression stockings
Intermittent Pneumatic Compression (IPC)
Foot impulse devices
What are the main pharmacological methods of VTE prophylaxis?
LMWH
Unfractionated heparin
Rivaroxiban, Dabigatran, Apixaban
What is the normal duration of treatment for VTE prophylaxis?
Continue until patient returns to usual mobility
Extended prophylaxis needed for some procedures:
- Fractured Neck of Femur - 4 weeks
- Abdominal/pelvic cancer surgery - 4 weeks
- Lower limb plaster cast - until out of case
- Total hip and total knee replacement - special case, needs extended prophylaxis with NOACs
Patient taught how to give and monitoring required
What are the main consequences of poorly managed pain?
Impaired recovery and increased length of stay
Decreased mobility and increased VTE risk
Decreased wound healing
Increased BP and Pulse
Increased Anxiety and disturbed sleep
Name some common causes of PONV
Anaesthetic agents
Opioid analgesia
Bowel surgery
Antibiotics
U&E disturbances
Bowel obstruction
What are the main consequences of poorly managed PONV?
Increased length of stay
Dehydration and electrolyte disturbance
Disrupt wounds
Reduce medicines absorption
What are the main risk factors for PONV?
Female
History of motion sickness
Previous PONV
Non smoker
Duration/type of surgery
Opiate use
What is Apfel scoring?
Used to assess the risk of PONV
Female = 1 point
History of motion sickness/PONV = 1 point
Non smoker = 1 point
Opiate use = 1 point
How is PONV treated?
Local hospital policy
Usually ondasetron, cyclizine, dexamethasone or prochlorperazine
Metoclopramide is NOT very effective for PONV
