VTE Flashcards
The VTE protocol should be developed by an interdisciplinary team including?
a clinical team leader;
a quality improvement facilitator;
process owners, including frontline personnel from each discipline (eg, pharmacists, RNs, surgeons, anesthesia professionals);
information technology and health information system experts; and
patient representatives
The VTE protocol should
be evidence-based;
standardize assessment of VTE and bleeding risk;
provide clinical decision support for evidence-based prophylaxis based on level of risk for VTE and bleeding at critical phases of care (eg, admission, transfer of care, post surgery); and
be easy to use in clinical practice
Protocols for VTE prevention establish best practice at the local level
Include a standardized VTE risk assessment model.
Include a standardized bleeding risk assessment model.
Include a start time (eg, upon admission, before surgery, after surgery) for all types of prophylaxis based on the clinical condition of the patient.
The VTE protocol may include specialty- or procedure-specific (eg, orthopedic, cardiac) clinical decision support for prophylaxis
Assess the patient for the following VTE risk factors that contribute to venous stasis, vessel wall injury, and hypercoagulability
- age greater than 40 years
- cancer (ie, active or occult) or cancer treatment
- obesity
- previous history of VTE or stroke
- prolonged bed rest (> 3 days) or immobilization
- varicose veins
- presence of a central venous catheter
- trauma
- spinal cord injury
- inherited or acquired thrombophilia
- estrogen therapy (ie, oral contraceptive, hormone replacement therapy)
- critical care admission
- dehydration
- comorbidities, including
heart disease (eg, congestive heart failure, hypertension, pacemaker),
- metabolic or endocrine disease (eg, Cushing’s disease),
- respiratory disease (eg, chronic obstructive pulmonary disease),
- acute infectious disease(eg, sepsis, and
inflammatory conditions (eg, inflammatory bowel disease,rheumatoid arthritis,psoriasis
pregnancy and the postpartum period
smoking
steroid therapy
American Society of Anesthesiologists physical status classification of 3 or higher
recent surgery (ie, within 30 days)
preoperative hospitalization
blood transfusion
known non-O blood type
obstructive sleep apnea and
asplenia.
*Assess the patient for procedure-related VTE risk factors, including
- duration of surgery (ie, surgery and general anesthesia time longer than 90 minutes or longer than 60 minutes for procedures involving the lower limb or pelvis
- the intraoperative patient position (eg, excessive hip flexion, hyperextension of the knee, reverse Trendelenburg)
- use of a pneumatic tourniquet, especially during prolonged periods of inflation
- major orthopedic surgery (eg, hip arthroplasty, knee arthroplasty, hip fracture surgery)
- bariatric surgery
- cardiothoracic surgery
- vascular surgery
- general surgery involving the abdomen or pelvis (eg, hepatic resection
- urologic surgery involving the abdomen or pelvis (eg, nephrectomy)
- neurosurgery
- spine surgery
- immobilizing cast of a lower limb
- open procedure
- emergency procedure
- concurrent procedures
- transplant surgery
- cesarean delivery
- major foot and ankle surgery (eg, Achilles tendon rupture, total ankle arthroplasty, ankle fracture;
- major hand, wrist, or elbow surgery (eg, elbow arthroplasty)
- procedures involving hardware placement
- major plastic surgery (eg, body contouring, abdominoplasty, breast reconstruction)
When prescribed, verify that intermittent pneumatic compression devices are functioning and graduated compression stockings are applied before the administration of ?
regional or general anesthesia
When prescribed, verify that intermittent pneumatic compression devices are functioning and graduated compression stockings are applied before the administration of ?
regional or general anesthesia
*Assess the patient for potential contraindications related to use of the intermittent pneumatic compression device, including
any leg condition (eg, dermatitis, recent skin graft, gangrene) that pneumatic compression may exacerbate,2,48
known allergy or sensitivity to the sleeve or tubing material,48
cardiac failure or pulmonary edema from congestive heart failure,48,220
any factor that prevents correct fitting of sleeves (eg, exceeding the size limit, severe leg edema, deformity),48,231
pre-existing DVT, and
severe arteriosclerosis or other ischemic vascular disease.
When the manufacturer’s instructions for use require the use of stockinet, graduated compression stockings, or other material under the sleeves, verify that the material is
wrinkle-free when applied to the skin
During application of the sleeve, place the tubing on
the external surface of the sleeve facing away from the patient’s skin and away from locations that may create a pressure injury.
Verify that the sleeves for intermittent pneumatic compression devices are applied correctly, connected to the device pump, and operating and that the tubing is
away from locations that may create a pressure injury after the patient is transferred to the OR bed or repositioned.
When intermittent pneumatic compression is used, implement interventions to prevent unplanned hypothermia as recommended in
the AORN Guideline for Prevention of Unplanned Patient Hypothermia.
Sleeves for intermittent pneumatic compression devices used on the sterile field should be
sterile
*Apply graduated compression stockings according to the manufacturer’s written instructions. After application, verify that the
stockings are not rolled up the foot or down the leg,
stockings are smooth when fitted,
toe holes lie underneath the toes,
heel patches are in the correct position, and
thigh gussets are positioned on the patient’s inner thighs.
The intermittent pneumatic compression device should remain on for a minimum of how long daily during the intraoperative and immediate postoperative period unless removal is necessitated by patient care needs
18 hours
