PREVENTING DEEP VEIN THROMBOSIS POST ORTHOPEDIC SURGERY

CASSANDRA SCHMIDT, RN, BSN, GRADUATE PCNP STUDENT

INTRODUCTION
Background Deep vein thrombosis (DVT) is a serious medical condition that can cause deadly complications if not treated. Fortunately, deep vein thrombosis can be prevented by identifying modifiable risk factors or utilizing prevention strategies (Centers for Disease Control, 2012). Surgical patients are at an increased risk with more than 40% of orthopedic surgery patients developing DVT often leading to further complications such as long-term morbidity, pulmonary embolism, or death (Joanna Briggs Institute, 2008).
Search Strategy/Summary of Evidence Databases searched included CINHAL, Medline, PubMed, Joanna Briggs Institute and the Cochrane Database of Systematic Reviews. Strong evidence existed with evidence based clinical practice guidelines from The National Collaborating Center for Acute and Chronic Conditions as well as The Joanna Briggs Institute. There is evidence that the use of combined modalities employing anticoagulants and mechanical methods increases efficacy without increased complications in the highest risk surgical patients (Caprini, 2010). The advantage of stockings in surgical settings is that they do no increase the risk of bleeding (Phillips, Gallagher & Buchan, 2008).

INTRODUCTION
PICO Question In patients status post elective total hip arthroplasty and receiving anticoagulation therapy, how does utilization of physical interventions such as graduated compression stockings (GCS) in addition to anticoagulants compare to exclusive use of anticoagulants with regard to prevention of deep vein thrombosis (DVT)? Purpose The purpose of this project is to assess whether patient education about DVT risks and prevention will increase GCS compliance and therefore decrease DVT occurrence. This project also aims to increase physician awareness of effectiveness of mechanical interventions

PHYSICIAN INTERVENTION
Present evidence for change in practice Standardization of DVT risk assessment
50% Evaluation

80%

100% order rates for GCS

PATIENT INTERVENTION
20 Patients awaiting elective total hip arthroplasty Risk assessment >3= High Risk Automatic 5 points for selected surgery Pre-operative education class -Potential risk of DVT -Prevention of DVT -Physical interventions (GCS)
n=20 Age 49-79 63.65 7.7 8.11 1.42 Range Mean
Standard Deviation

DVT Risk 6-11 Score

PATIENT EVALUATION
Monitor patient compliance with graduated compression stockings through post surgical follow-up/survey -Rates of compliance during hospitalization and postdischarge -Always -Sometimes -Rarely -Never Occurrence rates of DVT

CONCLUSIONS
All patients undergoing elective total hip arthroplasty are placed as high risk for DVT with an automatic score of 5, regardless of overall health or comorbidities. Education promoting the use of graduated compression stockings during hospitalization and post-discharge leads to increased compliance with GCS and decreased incidence of DVT. Recommendations are made to include GCS in standard of care for all elective total hip arthroplasty patients. Increased education may be required to gain 100% compliance with GCS during both hospitalization and post-discharge. Further education to physicians is warranted to gain 100% ordering rates of GCS.

REFERENCES
Caprini, J. A. (2010). Mechanical methods for thrombosis prophylaxis. Clinical and Applied Thrombosis/Hemostasis, 16(6), 668-673. The Joanna Briggs Institute. (2008). Graduated compression stockings for the prevention of post-operative venous thromboembolism. Best Practice: evidence-based practice information sheets for health professionals, 12(4), 1-6. National Collaborating Center for Acute and Chronic Conditions. (2010). Venous thromboembolism: reducing the risk. Reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in patients admitted to hospital. National Institute for Health and Clinical Excellence (NICE), 50, 92-112.

Phillips, S. M., Gallagher, M., & Buchan, H. (2008). Use graduated compression stockings postoperatively to prevent deep vein thrombosis. British Medical Journal, 336, 943-944.