Venous thromboembolism (VTE); this is the thing we used to call deep vein thrombosis (DVT). It is associated with an increase in morbidity and mortality in hospitalized patients. Over 150 years ago, Dr.Virchow identified three risk factors that can be assessed to determine if your patient may develop venous thromboembolism. They are: venous stasis and epithelial injury and alteration in coagulation. If your patient has these risk factors, they are more likely to develop a VYE and possibly pulmonary embolism (PE) which can be life threatening.
In recent article by Dr.Cohen, etal, the researchers determined that in only 40 percent of medical patients who were at risk for VTE and only 60 percent of surgical patients at risk for VTE received prophylactic treatment with Heparin or a low molecular weight Heparin (LMWH) injection. It is surprising that these prophylactic rates are so small; however, they may be the result of a lack of education on the part of our physicians.
Here's what you can do to decrease complications in your patients and assure that they don't develop venous thromboembolism and pulmonary embolism. When you assess your patient and identify that they have Virchow's triad of risk factors, check to see if the patient is already on Heparin or low molecular weight Heparin prophylaxis. If not, make sure that the patient gets sequential calf compression devices, also called SCDs, to compress the calves and decrease the risk of VTE formation.
From Cohen,A.T.etal. (2008) Venous Thromboembolism Risk and Prophylaxis in the Acute Hospital Care Setting (ENDORSE Study), A Multi‑National Cross‑Sectional Study. Lancet 371:387.
AgenoW. and Dentali,F. (2008) Prevention of In‑Hospital VTE, Why Can't We Do Better? Lancet 371:361.
David W. Woodruff, MSN, RN-BC, CNS, CEN
President, Ed4Nurses, Inc.