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VTE Protocol

VTE Protocol. Presented by: Selina Baskins, RN Quality Coordinator. Each Risk Factor Represents 1 Point. Age 41-60 years Minor surgery planned Hx of prior major surgery (<1 month) Varicose veins Hx of inflammatory bowel disease Swollen legs (current) Obesity (BMI>25kg/m2) AMI CHF

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VTE Protocol

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  1. VTE Protocol Presented by: Selina Baskins, RN Quality Coordinator

  2. Each Risk Factor Represents 1 Point • Age 41-60 years • Minor surgery planned • Hx of prior major surgery (<1 month) • Varicose veins • Hx of inflammatory bowel disease • Swollen legs (current) • Obesity (BMI>25kg/m2) • AMI • CHF • Sepsis • Serious lung disease including • pneumonia

  3. Each Risk Factor Represents 1 Point • Abnormal pulmonary function • (COPD) • Medical patient currently at bed rest • Oral contraceptives • Pregnancy or postpartum (<1month) • Hx of unexplained stillborn infant, • recurrent spontaneous abortion (>3), • premature birth with toxemia, or • growth-restricted infant

  4. Each Risk Factor Represents 2 Points • Age 61-74 years • Arthroscopic surgery • Malignancy (present or previous) Major • surgery (over 45 minutes) Laparascopic • surgery (over 45 minutes) Patient • confined to bed (>72 hours) • Immobilizing plaster cast (<1 month) • Central venous access

  5. Each Risk Factor Represents 3 Points • Age ≥ 75 years • Hx of VTE/PE • Family Hx of thrombosis • Blood/bone marrow dyscrasias * • Thrombophilic condition ** • Heparin induce thrombocytopenia

  6. Each Risk Factor represents 5 Points • Elective major lower extremity • arthroplasty • Hip, pelvis, or leg fracture • Stroke • Multiple trauma • Acute spinal cord injury (paralysis

  7. Contraindications • Contraindications to pharmacologic prophylaxis i.e. active bleeding, current or history of heparin induced • thrombocytopenia, platelet count < 100,000 • Contraindications to sequential compression devices, i.e. severe peripheral arterial disease, CHF, acute/superficial • VTE Other contraindications

  8. 0-1 Low Risk = Early and aggressive ambulation 2 Moderate Risk Lovenox 40 mg subcutaneous daily (Choose one) Lovenox 30 mg subcutaneous daily if CrCl less than 30 Graduated compression stockings thigh, knee high Sequential compression device 3-4 High Risk Lovenox 40 mg subcutaneous daily AND Sequential compression device Standard of Care for assessed Risk Score: IF INTERVENTIONS HAVE NOT BEEN ORDERED, CALL MDFOR ORDERS!

  9. Standard of Care for assessed Risk Score: IF INTERVENTIONS HAVE NOT BEEN ORDERED, CALL MD FOR ORDERS (Cont’d) • (Choose one) Lovenox 30 mg subcutaneous daily AND Sequential compression device if CrCl less than 30 • 5 or more Very High Lovenox 40 mg subcutaneous daily, Sequential compression device AND graduated • Risk compression stocking • Lovenox 30 mg subcutaneous daily if CrCl less than 30, Sequential compression device • AND graduated compression stocking

  10. Other instructions • If the patient received epidural anesthesia, do not start Lovenox until 24 hours after establishment of stable hemostasis • If the patient has an epidural postoperatively, do not start Heparin/LMWH until epidural ha

  11. QUESTIONS????

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