Prevention and Management of DVTs

Abstract

Background: Deep Vein Thrombosis (DVT), often resulting in Pulmonary Embolism (P.E.), comprises one of the causes of the increasing number of preventable and manageable deaths worldwide. The prevalence of DVT development cases in clinical settings among hospitalized patients irrefutably requires timely and effective prophylaxis. Objective: This paper seeks to identify the risk factors and practices that expose patients to developing DVT to evolve a care model and effective preventive and treatment approaches. Methodology: An extensive review of relevant literature on risks, causes, and detection of DVT in post-surgical patients is incorporated to guide the development of practical intervention methods. Conclusion: Mechanical care procedures must be utilized along with pharmacological prescriptions to manage DVTs. Equally, nurse and patient education are essential in preventing DVT development, especially in hospitalized settings.

Keywords: Deep Vein Thrombosis (DVT), Pulmonary Embolism (P.E.), Total Knee Arthroplasty (TKA), Total Hip Arthroplasty (THA).

Introduction

Deep vein thrombosis (DVT) is a severe condition that can lead to death. It can break off and travel to the lungs, where it can cause a pulmonary embolism (Waheed, Kudaravalli, and Hotwagner, 2021). It can also block the blood flow in the veins, which can cause pain and swelling. If left untreated, DVT can lead to permanent damage to the leg. If it gets to the lungs, it can cause pulmonary embolism, which can lead to death. Almost half of all DVTs are caused by being in the hospital for a medical condition or surgery. The other reason DVTs are more common is that people tend to lie in bed more often. Ideally, effective healthcare interventions can help manage DVTs to avoid fatal pulmonary embolism. The operative prevention and management of DVTs rely on a collective effort within healthcare systems, including proper education to medical practitioners, patients, and families. This paper aims to look at the incidence of DVTs developing in hospitalized patients and the best methods to prevent their development. The article explores existing medical literature on risks, causes, and management of DVTs to design an operative theoretical model for appropriate prevention and treatment of the condition.

Problem Statement

Deep Vein Thrombosis and Pulmonary Embolism comprise a critical global health problem. As PE can be severely fatal, DVT can equally result in post-thrombotic venous ulceration and deficiency, compromising the quality of life. Numerous DVT conditions are not detected due to complex, elusive, and costly diagnosis procedures. Thus, healthcare systems must comprehend various groups’ epidemiology and risk factors to develop DVT. Besides familiarizing with diagnostic methodologies to execute appropriate prophylaxis and timely treatment, medical practitioners should focus on maximum preventive efforts based on risk and cause assessment, especially in the surgical processes. Notably, treatment procedures need to prioritize mechanical preventive and treatment methods along with pharmacological prescriptions in managing DVTs exclusively for post-operative care patients. Most importantly, nurse and patient education must be incorporated into the effective prevention and management of DVTs.

To aid in developing practical DVT prevention and management interventions, the paper studies the following questions to achieve the listed objectives;

Research Questions

1. Do pharmacological or mechanical methods serve our patients better during their hospital stay and keep them from developing DVTs?
2. What educational tools can nurses use to help these patients after discharge to prevent DVTs and keep them from hospital readmission?

Research Objectives

1. Identifying risks and causes of deep vein thrombosis.
2. Identifying and developing methods used for DVT prophylaxis.
3. Coordination with the healthcare team to provide optimal patient outcomes.

PICOT Question

In hospitalized patients receiving DVT prevention prophylaxis(P), how do pharmacological methods (I) compared with mechanical methods (C) affect the occurrence of DVTs (O) within the hospital stay (T)?

Literature Review

Primarily, Cayley (2017) conducted a quantitative and qualitative study on the risk and prevalence of DVT development in hospital patients in various facilities. The study revealed that different risk factors enhance the chances of hospitalized patients experiencing blood clotting in the heart’s veins, including exposure to surgery, thrombosis, Virchow triad, vessel injury, and hypercoagulability. Additional risk factors include smoking, use of estrogens, and respiratory failure. Explicitly, Cayley (2017) reports an absolute risk of 10% to 20% among general medical patients and up to 60% among knee and hip surgery patients of developing DVT. The article essentially aids this intervention’s progress in identifying the risks related to patients’ development of DVT, which is critical in designing effective preventive interventions such as patient education.

Additionally, Lee et al. (2015) quantitatively investigated the incidence of deep vein thrombosis after various surgical procedures. The study found little positive correlation between hip and knee arthroplasties. Hip and knee arthroplasties are considered to be some of the most successful procedures in the field of orthopedic surgery. Approximately 1 million such procedures are performed annually in the U.S. and Europe. Although it is generally recommended for surgeons to consider the development of DVT following major orthopedic surgery, there are no reports of this condition in the country. Subsequently, the study established increased risks for developing DVT associated with certain types of orthopedic surgery, such as knee and hip arthroplasties. Although the incidence of DVT following a major orthopedic procedure is higher for asymptomatic patients than for those with symptomatic symptoms, the clinical significance of this condition is still unclear. Although most cases of DVT are not caused by the presence of a specific type of vascular disease, such as the isolated DVT found in the calf, it is still important to note that the incidence of this condition is a surrogate marker for the development of fatal pulmonary disease. According to the study, around 40% of the patients treated for DVT will develop a pulmonary embolism (P.E.) within three months, and 10% of these will die within an hour of their onset. This article principally guides this intervention development in focusing on explicit appropriate management of risks associated with particular types of orthopedic surgery, especially in preventing fatal pulmonary embolism.

As Cayley (2017) and Lee et al. (2015) aid the intervention development by specifying all risks associated with the development of DVT, Zhu et al. (2010) introduce the management phase of DVTs. A critical stage in managing all infections habitually entails diagnosing and detecting the patient’s condition. From 2005 to 2009, Zhu et al. (2010) analyzed 62 cases with a hemodynamic sonogram and 14 with a hemorrhogram. The analysis sought to experiment with the efficiency of hemorheology detection and color doppler sonography. These procedures were performed on patients with first hip arthroplasty, while 86 had hip fractures before and after the operation. Before and after the THA operation, the plasma D-dimer levels of the patients were analyzed. The DVT was studied in all the cases. The average age of the patients was between 34 and 74 years. After the operation, they were given low molecular weight heparin sodium. The study’s results had 17 of the total cases developing DVT, with preoperative color doppler sonography depicting the absence of abnormal echo, standard periodical variation, and regular strong blood flow signal without regurgitation. The study concluded that hemorheology and examination of plasma D-dimmer alongside color doppler sonography could be valuable in the timely diagnosis of DVT in core orthopedic surgeries. Accordingly, designing effective interventions for managing DVT would necessitate timely detection of the condition especially following major orthopedic surgery.

Shimoyama et al. (2012) combine identifying risk factors for DVT infection with detecting the condition after various clinical procedures. The article studies perioperative risk factors for deep vein thrombosis after total hip or knee arthroplasty. About 144 individuals had participated in at least one successful total hip or knee replacement operation. They were divided into 1 and 2 groups. The patients were divided into two groups. The first group was composed of those who developed DVT after the operation, while the second group was those who did not develop this condition. The researchers conducted a comparative analysis to examine the factors that could increase the risk of DVT after THA or TKA. The patients were then followed up with a Doppler US study to check for signs of DVT. This procedure was performed on every patient from the femoral to the lower limb. The study detected DVT in 61 patients (42%), with three patients having a proximal type of DVT. The researchers found that the presence of elevated plasma D-dimer values during the operation was associated with the development of this condition. They also noted that a history of hyperlipidemia was a risk factor for developing DVT. The high plasma D-dimer values and a history of hyperlipidemia were found to be risk factors for DVT. Thus, the study integrates the aspect of DVT detection to determine preexisting conditions that comprise risk factors for developing DVT. Determination of risk factors for DVT essentially forms the basis for preventive intervention programs, while timely detection guarantees better DVT management approaches.

Xing et al. (2008) studied the trends in the prevalence of deep vein thrombosis in patients undergoing total hip or knee arthroplasty over time. There is a perception in the medical community that the number of patients with deep vein thrombosis has decreased following the procedures for total hip and knee replacement. This study aimed to examine the incidence of DVT using a blood thinner known as warfarin during treatment for patients with THA or TKA. The study was conducted through a systematic review of the MEDLINE, Cochrane Library, and EMBASE databases. Two independent reviewers assessed the quality and characteristics of the data. They identified the most common DVT conditions in the study population. Fourteen studies were conducted on 4,423 patients who had THA or TKA. The incidence of DVT decreased over time, with the proximal and total DVT declining by =0.75 and =0.86, respectively. However, the risk of developing asymptomatic DVT was significantly higher, with an odds ratio of 1.85, implying a 95% confidence interval (CI). The study’s results revealed that the incidence of DVT in patients who underwent elective total knee replacement with warfarin was significantly lower than in those who did not receive warfarin. Hence, the study provides an evidence-based approach for treating patients with DVT using warfarin, which is valuable for developing effective intervention models.

Similarly, Bawa et al. (2018) investigate trends in Deep Vein Thrombosis Prophylaxis and Deep Vein Thrombosis Rates After Total Hip and Knee Arthroplasty. High-risk patients, such as those who have undergone total hip or total knee arthroplasty, are prone to experiencing deep vein thrombosis (DVT) after being operated on. This study aimed to analyze the trends in DVT prophylaxis and the incidence of DVT in patients following these procedures. The data collected during the study were used to analyze the commercial claims and encounters of patients who had undergone THA or TKA. They were then analyzed for post-operative medication claims. The drugs analyzed were warfarin, enoxaparin, rivaroxaban, and dabigatran. Therefore, the study complements Xing et al.’s (2008) research by presenting enoxaparin, rivaroxaban, and dabigatran as drug alternatives in treating Deep Vein Thrombosis.

Theoretical Model Development

According to Jean Watson, the human being is a valued individual who is regarded as being more than just a part of one’s body. Humans are additionally understood and supported in various ways and considered to have a fully functional integrated self. Health is a state of being that includes a high level of social, mental, and physical functioning. It can be defined as a person’s ability to maintain daily functioning and the absence of illness. According to Watson, the concept of environment or society refers to the idea that nurses have been around for a long time and that a caring attitude is a part of the profession’s culture.

The nursing model states that the profession is focused on promoting healthy lifestyles and preventing illness (Morris, 2015). It also focuses on treating diseases and providing care for the sick. According to Watson, holistic health care is a central component of nursing practice. She additionally states that nursing is a human science that is mediated by various factors, such as personal, scientific, and esthetic transactions. The Model shows the multiple steps involved in the nursing process, similar to the scientific research process. Assessment, evaluation, intervention, and plan are the steps involved in the process. A care plan is also a part of the process that helps the nurse determine the variables used to measure and examine the patient’s health.

The concept of intervention refers to the implementation of a comprehensive care plan. It also involves collecting and analyzing data. This process is then analyzed and interpreted to come up with a hypothesis. The nursing model states that the different needs of a person are categorized into three main categories: biophysical, psychophysical, and psychosocial. The lower-order conditions include the need for food and fluids, elimination, and ventilation. The middle-order needs include the need for activity, sexuality, and inactivity. Lastly, the higher-order needs include the need for affiliation, self-actualization, and achievement (Mudipalli, 2021).

Using Watson’s theory and framework in nursing care for DVT prophylaxis in post-operative care stands well. Any medical prophylaxis or treatment goal is centered around assessing the patient (Badireddy, 2021). Nurses not only perform a physical assessment, but we assess the patient as a whole. We look at physical, mental, emotional, and spiritual well-being to properly address and manage our patients’ care

Pathophysiologic and Pathopharmacologic Processes affected by DVTs

A type of thrombosis that can occur in the legs is known as venous thrombosis. It can be caused by decreased or mechanical alteration of the blood flow in the leg’s deep veins. While the valves can help promote blood flow, they can also be locations for hypoxia and venous stasis. Multiple studies have shown that the development of venous thrombosis in the sinus cavities is associated with a reduction in blood flow. This condition can trigger a reduction in the hematocrit and oxygen tension, leading to the formation of a hypercoagulable micro-environment. This could potentially lead to the downregulation of certain antithrombotic proteins, such as the EPCR.

Besides reducing the number of important antithrombotic proteins, hypoxia can also trigger the development of procoagulants. One of these is the P-selectin, an adhesion molecule that can attract immunologic cells to the endothelium. Although it is not clear if this molecule is located on the endothelium or within the extravascular tissue, it is widely believed that the tissue factor is the primary factor that plays a role in the formation of a thrombus.

The lower extremity is more prone to experiencing pulmonary embolism (P.E.) due to the higher clot burden (Sinclair et al., 2018). The most common cause of this condition is the superficial femoral and popliteal veins in the thighs. In calves, the peroneal and posterior tibial veins are also affected. Although calf vein DVT is less likely than other veins to cause large emboli, it can still propagate to the proximal thigh. About half of patients with DVT have an occult condition, and around 30% have demonstrated P.E.

When it is present, the symptoms and signs of DVT are nonspecific and can vary in severity and frequency. The presence of DVT in the legs and arms is similar to that of a heart attack. The superficial veins of the leg that are displaced are often visible or palpable. Sometimes, pain accompanied by dorsiflexion of the knee can trigger a calf discomfort known as the Homans sign. The most common symptoms of DVT in the lower leg include tenderness, swelling, and a 3cm difference in the circumference between calves. It is also possible that DVT is caused by a combination of 3 and an unrelated condition. Fever can also be triggered by DVT, especially in patients who have already undergone surgery. If it gets worse, symptoms such as chest pain and shortness of breath can be caused by pulmonary embolism.

Recommended Clinical Pharmacology

The goal of prophylactic therapy is to prevent venous stasis or to minimize the activation of blood coagulation. Various proven approaches, such as low-dose subcutaneous and oral anticoagulants, can be used to achieve this goal. These are followed by graduated compression stockings, low-dose and high-dose oral anticoagulants, and LMWHs65.

Low-dose therapy is performed by giving low-dose heparin, usually given subcutaneously before and after surgery, at a dose of 5000 U 2 hours before and up to 12 hours after. It is very safe and easy to administer and can reduce the risk of venous stasis by 50% to 70%. This method is ideal for patients with moderate-risk conditions. Although this can be safely used in certain patients, it should not be used in those undergoing spinal, ocular, or cerebral surgery.

Compared to warfarin, low-dose heparin is less effective in preventing venous stasis in patients undergoing major orthopedic surgery (Bartley, 2015). It can also increase the blood flow in the legs and improve the blood’s fibrinolytic activity. This method is very safe and can be very helpful in those with a high risk of bleeding. It is also very effective in preventing venous stasis in patients undergoing major knee surgery. It can additionally be very helpful in preventing this condition in those undergoing abdominal surgery.

Interventions

Although mechanical methods are less effective than drugs in preventing venous thrombosis, they are still safer for high-risk patients. Some of these include the use of graduated compression stockings and intermittent pneumatic devices. These can help increase blood flow and minimize stasis in the leg veins. Continuous mobilization is needed early and often for low-risk patients, such as those undergoing minor procedures. For moderate-risk patients, low-dose unfractionated and low-molecular-weight heparin is usually given. High-risk patients, such as those who have undergone major surgery, should be given either LMWH or LDUH. After discharge from the hospital, these patients should continue taking anticoagulation therapy.

For patients who have undergone major orthopedic surgery, such as hip fracture, knee replacement, or total knee replacement, an LMWH, a synthetic antithrombotic agent, or an adjusted dose of vitamin K antagonists is needed. The guidelines do not recommend using mechanical compression devices, dextran, aspirin, or any other type of aspirin as the sole method of preventing VTE. The use of graduated compression stockings can reduce the risk of venous thrombosis in patients who have undergone general surgical procedures. They can also prevent the development of venous stasis in those with neurological disorders, such as paralysis of the lower limbs. In combination with low-dose heparin, these stockings effectively prevent venous thrombosis in surgical patients.

Graduated compression therapy treats various conditions, such as leg pain and superficial veins. It can reduce the superficial veins’ size and improve the deep veins’ flow. External compression devices, short-stretch elastic wraps, are commonly applied to the knees and toes. On the other hand, intermittent compression devices, designed to increase blood velocity, are commonly used to treat other conditions. When a patient is on bed rest, they must maintain their posture and perform leg exercises to improve their vascular flow.

For daily assessments, nurses should use the compression method to assess their patients. They should also check for signs of loss of integrity, paleness, and pain or discomfort, especially around the bones. In addition, low-cost and easily-used physical therapy can help patients lower their blood pressure and improve their quality of life. For instance, performing active and passive exercises on the lower limbs can help decrease the formation of thrombus and venous reflux. Another benefit of this method is that it can reduce the risk of developing venous stasis and edema.

Evaluation and Implementation

The FDA has approved various antithrombotic devices and drugs for various indications. A small number of these are used for the primary prevention of VTE (Galson, 2018). However, other devices and drugs may be considered or used off-label for this purpose. Unfractionated and low-molecular-weight versions of the blood thinner heparin are commonly used for treating venous thrombosis. They can be delivered subcutaneously. A synthetic pentasaccharide known as fulparinux can also be used for this condition. We will evaluate the various drugs and devices currently available in the U.S. for this indication.

In addition, the agency will also look into the use of other antiplatelet agents, such as clopidogrel and aspirin, as well as warfarin, which can be used off-label for this indication. These drugs and devices that the FDA has not approved will be evaluated and identified if they are approved in the U.S. Low-molecular-weight (LMWH) drugs have better absorption and a longer half-life than their conventional counterparts. They also have a lower incidence of adverse effects when compared to unfractionated and ultra-high-molecular-weight (UFH) drugs.

The low-molecular-weight and ultra-high-frequency versions of warfarin have different half-life and acquisition costs. One of the drugs that the FDA has approved for this indication is the investigational oral drug known as daggatran. It can be used for the prevention of venous thrombosis. In July 2011, the FDA approved using rivaroxaban to prevent venous thromboembolism (VTE) in patients undergoing knee and hip replacement surgery. It can also be used off-label for other conditions. Other devices and drugs that can be used to prevent VTE can also be used off-label for certain conditions, such as those that are considered at high risk of bleeding. These include venous foot pumps, sequential compression devices, and inferior vena cava filters.

Management of Cultural Concerns Related to DVTs

Despite the strong evidence supporting the prevalence of venous thromboembolism in different racial and ethnic groups, the exact mechanisms by which this condition affects these individuals remain unclear (White & Keenan, 2019). African-Americans are more prone to experiencing venous thrombosis (VTE) than other racial groups. This is because they are more likely to be exposed to various risk factors, such as trauma, surgery, and medical conditions. They are also more likely to develop pulmonary embolism (P.E.). Today, individuals of various cultural and mixed backgrounds are in the African American community. Many came from Africa to various parts of the world after the slave trade. In America, intermixing among European and American Indians has been largely observed.

African-Americans are more prone to experiencing blood clots than other people, regardless of age or gender. They are also more likely to develop pulmonary embolisms and pregnancy-associated deep vein thrombosis, potentially life-threatening conditions (Regner, Shaver, & SWSC Multicenter Trials Group, 2019). Studies have shown that African-Americans are more prone to experiencing fatal physical injuries outside the hospital. A P.E. typically causes these injuries at an early age or an average of nine years younger than white individuals. In addition to being able to provide medical support, family members play an important role in the development of healthcare in the African-American community.

Today, the African-American community comprises individuals of various cultural and mixed backgrounds. Many came from Africa to various parts of the world after the slave trade. In America, intermixing among European and American Indians has been largely observed. The use of formal titles such as Miss, Mr., or Mr. is often used to establish rapport and show respect. Oral communication is preferred over written communication. African-Americans have been afraid of exploitation in the medical profession since the days of slavery. During this period, doctors forced slaves to participate in medical experiments.

African Americans have the highest risk of developing a DVT post-surgery. Cultural considerations for nurses should include the following. Since there is a fear of medical exploitation in the black community, clear communication on prophylactic treatment after surgery is key. Explaining the mechanisms of the pharmacological or mechanical side of prophylactic measures should be discussed in depth with the patient and their family members. Leaving room for an open discussion about their care and treatment post-surgery will allow the patients to cooperate with their treatment plan.

Role of Informatics in Impacting DVTs

Health informatics can help improve the efficiency of healthcare organizations by identifying potential errors and enhancing the quality of patient care. Some of these include improving the accuracy of patient records, issuing prescriptions more quickly, and preventing costly errors in insurance claims. According to estimates, around 1.5 million medication errors are reported annually, which can significantly impact patients’ health. The consequences of these errors can be very harmful, as they can lead to developing a worse condition or even cause death. Medical errors are typically the result of human error. For instance, if a patient is mistakenly given the wrong medication, this could lead to a worse condition or even cause death.

Examples of potential errors identified by health informatics include improper use of medical equipment and lack of communication between healthcare professionals. The medical community is now focusing on reducing the number of errors related to medication by implementing technology into the clinical process. This strategy will allow them to standardize the tracking of various diagnostic information and the administration of drugs. One of the potential solutions being studied is the use of digital systems to analyze and report diagnoses. These systems can help prevent erroneous or mislabeled diagnoses and prevent patients from getting the wrong medication. In addition, automated dispensing systems can help minimize the likelihood of patients getting the wrong medication due to a mismatch between their identity and the correct medication.

Using informatics to prevent medication errors, such as the scanning system in which we verify our patient’s identity and the medication we are giving them, can greatly when addressing patient that has a fear of medical exploitation. For example, a nurse coming into a patient’s room to give a heparin shot for DVT prophylaxis, the nurse can reassure the patient that is worried about medication error to be shown how the medication is verified with their specific MRN number.

Incorporation of Community Resources and Health Promotion in Managing DVTs

There are various resources available to help people with deep vein thrombosis. Blogs, online communities, and nonprofit organizations can provide helpful information and support groups, while in-person support groups can help individuals with this condition (Green & Bernhofer, 2018). Social media and websites can be useful sources of information and emotional support, but they should not be used for medical advice. Nonprofit organizations such as The American Blood Clot Association and Clot Connection offer resources to patients for DVT prophylaxis and management.

The American Blood Clot Association, a nonprofit organization, is dedicated to educating healthcare professionals and patients about the importance of treating and preventing blood clots. It is also working to raise awareness about the conditions known as deep vein thrombosis and pulmonary embolism. The organization’s programs focus on individuals at high risk of experiencing a blood clot and healthcare providers who treat patients with these conditions. The American Blood Clot Association aims to raise awareness about the importance of preventing blood clots and stroke. This will result in a reduction in the number of deaths related to these conditions.

Clot Connect is a service provided by the University of North Carolina’s Chapel Hill Blood Research Center. It connects health care professionals and patients with the latest information on various venous thromboembolism conditions. Clot Connect aims to improve the knowledge about thrombosis and anticoagulation among health care professionals and patients. Clot Connect aims to provide the most up-to-date information on the latest trends in thrombosis and anticoagulation.

In health promotion for DVT prophylaxis, the surgeon may tell a patient that blood clots could be a problem after surgery (Laryea & Champagne, 2013). They can occur right after the operation or within a couple of days following the procedure. DVTs can also occur because the patient’s body is less active following the procedure. Patients should wear compression sleeves to keep their blood flowing. While recovering, patients should raise their bed’s foot to be taller than the pillow end. They can also perform various exercises, such as ankle and leg lifts, that the doctor has suggested. After taking pain medication, patients must get out of bed and improve their activity.

Evaluation of Content and Methods for Creating Awareness of DVTs among Patients and their Families

A teaching method suitable for post-op patients prior to discharge on the importance of DVT prophylaxis would be a multimethod venous thromboembolism prevention education plan, including a video, pamphlet, and verbal instruction (Flevas et al., 2018). Further, nurses or doctors should give the patients a knowledgeable test immediately before instruction. This is to assess their knowledge base beforehand and evaluate if the teaching helped increase their knowledge. The nurse educator should follow up with patients two weeks later to give the patient a postinstruction test to assess their understanding of DVT prophylaxis. This postinstruction test will also help evaluate the teaching method used post-discharge.

Ethical Dilemmas in Dealing with DVTs

A study is currently underway to compare the effects of enoxaparin on the development and maintenance of venous thrombosis in plastic surgery patients. The two groups were randomized to receive either 0.5 mg/kg or 40 mg bid enoxaparin. Although the levels of anti-Factor Xa do reflect the activity of enoxaparin, they cannot directly measure the drug’s effect on the condition (Drugs and Technologies in Health, 2018). The authors could not provide definitive results due to the clinical signs.

The FDA has approved enoxaparin to prevent venous thromboembolism (VTE) in high-risk patients, such as those undergoing joint replacement or general surgery (Swanson, 2019). However, this drug is not approved for use in plastic surgery. A double-bid regimen of 40 mg of enoxaparin is required to prevent bleeding. Unfortunately, several patients are prone to experiencing over-anticoagulation after taking 40 mg of enoxaparin twice daily. This condition could lead to them experiencing more bleeding, blood transfusions, and even death.

One of the main reasons why the use of enoxaparin is not widely used is the short duration of the treatment. In a study, one woman suffered from a pulmonary embolism ten days after her operation. Despite being given enoxaparin during her hospitalization, she still had a 3.13% rate of DVT. A screening sonogram could have prevented this type of complication. A study detected a large proximal DVT in one of the patients with an inferior vena cava filter the day after surgery (Stone et al., 2017). However, the patient did not develop pulmonary embolism.

Recommendation For Further Research

In the study conducted for this paper, chemical prevention is the preferred method for DVT prophylaxis in post-op patients versus mechanical. Chemical DVT prophylaxis for post-op patients significantly reduces the mortality rate of developing a DVT. In contrast, mechanical DVT prophylaxis, though helpful to post-op patients, do not have the same efficacy. The length of stay and mortality rate of patients in an intensive care unit are factors used to determine the effectiveness of mechanical and chemical VTE prophylaxis. In 2010, a study by Gaspard and colleagues revealed that chemical VTE prophylaxis was more effective than mechanical prophylaxis in reducing hospital stay and mortality in post-surgical patients.

The researchers compared the effectiveness of chemical and mechanical VTE prophylaxis in 329 patients. They found that the former was more effective at reducing the risk of death and length of hospital stay. These results support our previous findings. The researchers used a combination of chemical and mechanical VTE prophylaxis for the study. They found that using either subcutaneous unfractionated or LMW heparin was very effective. These two drugs have a good safety profile and are well-studied.

Nurse Leadership Roles in Treating and Managing DVTs

Coming into a nurse leadership role after obtaining my BSN, it is my responsibility to see that nurses are educated and trained properly in DVT prophylaxis. In a post-surgical unit, nurses will regularly face DVT prophylaxis for their patients. Keeping my nurses updated on the latest research and evidence-based practices will be of the utmost importance. One way to implement full competency of DVT prophylaxis should be done in the form of skill labs and monthly education refresher training once a quarter. By doing this, I can assure that my staff stays updated on the most effective way to implement DVT prophylaxis for our patients and provide optimal outcomes for their discharge.

Conclusion

Thromboembolic events are major causes of morbidity, and prevention is important. One of the most common causes of death and morbidity in hospitalized patients is a venous thromboembolic event (VTE). This condition is usually caused by a deep vein thrombosis or pulmonary embolism. These events are estimated to cost the healthcare system billions of dollars annually. Various techniques can be used to prevent VTE, such as mechanical prophylaxis and chemical prophylaxis. These are usually combined with other procedures, such as GCS and IPC devices. Subcutaneous unfractionated heparin and low molecular weight heparin are the most commonly used drugs for treating VTE.

According to evidence-based guidelines, patients undergoing total knee or hip replacement surgery should receive at least 14 days of anticoagulation. They should continue this treatment for up to 35 days following the operation. Various methods for treating VTE prophylaxis are divided into pharmacological and mechanical. The former includes mobilization, venous foot pumps, and intermittent pneumatic devices. Conversely, the latter consists of low molecular weight heparin, aspirin, vitamin K antagonists, and newer oral anticoagulants. Compared to other agents, LMWH seems to be more efficient.

Nurse leadership involves staying educated in the current medical guidelines and evidence-based practices regarding DVT prophylaxis. To maintain adequate patient outcomes, nurse leaders should educate their staff and provide up-to-date, real-time instruction on keeping post-op patients safe from DVT development. Upon discharge, post-op patients can be taught the appropriate use of chemical prophylaxis and the resources available to them once at home.

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