Evidence on nurse-driven venous thromboembolism (VTE) protocols

Posted on April 28, 2014 by Lisa

Moore, Cathy, et al. “Enhancing patient outcomes with sequential compression device therapy.” American Nurse Today 8.8 (2013).

“AORN guideline for prevention of venous stasis.” AORN journal 85.3 (2007):607-624.

Ruesch, Cecilee, et al. “Using nursing expertise and telemedicine to increase nursing collaboration and improve patient outcomes.” Telemedicine and e-health 18.8 (2012):591-595.

US Department of Health and Human Services Military Health Systems. “Implementation guide to prevention of venous thromboembolism (VTE).”

Shimet, Troy, et al. “VTE prophylaxis: a nurse-driven protocol.” Critical Care Nurse 28.2 (2008):e51.

Barto, Donna. “‘Let’s be the driver of this bus: nurse driven protocols in acute care.”

Desiongco, Maribeth. “VT/VTE nursing protocol 2009.”

Agramonte, Vicky. “Georgia Hospital Engagement Network Healthcare Acquired Condition Affinity Group: VTE prevention, treatment and adherence to the CMS VTE Core Measure Set.”

What are some ways to increase compliance of VTE Prophylaxis as well as barriers?

Posted on December 17, 2013 by John

Biffl WL et al. ““Leaning” the process of venous thromboembolism prophylaxis.” The joint commission journal on quality and patient safety 37.3 (2011):99.

Tiryaki, Funda ; Nutescu, Edith A. ; Hennenfent, Joel A. ; Karageanes, Annette M. ; Koesterer, Larry J. ; Lambert, Bruce L. ; Schumock, Glen T.Anticoagulation therapy for hospitalized patients: Patterns of use, compliance with national guidelines, and performance on quality measures. American Journal of Health-System Pharmacy, 2011 Jul 1; 68 (13): 1239-44.

Wang Z et al.”Compliance with surgical care improvement project measures and hospital-associated infections following hip arthroplasty.” Journal of Bone and Joint Surgery; American volume 94.15 (2012):1359.

Brown, Alexandra Preventing venous thromboembolism in hospitalized patients with cancer: Improving compliance with clinical practice guidelines.
American Journal of Health-System Pharmacy, 2012 Mar 15; 69 (6): 469-81.

Li F ; Walker K ; McInnes E ; Duff J Testing the effect of a targeted intervention on nurses’ compliance with “best practice” mechanical venous thromboembolism prevention. Journal of Vascular Nursing, 2010 Sep; 28 (3): 92-6.

Gaston, Sherryl ; White, Sarah louise Venous thromboembolism ( VTE) risk assessment: Rural nurses’ knowledge and use in a rural acute care hospital. International Journal of Nursing Practice, 2013 Feb; 19 (1): 60-4.

Gaston, Sherryl, White, Sarahlouise, Misan, Gary. Venous Thromboembolism (VTE) Risk Assessment and Prophylaxis: A Comprehensive Systematic Review of the Facilitators and Barriers to Healthcare Worker Compliance with Clinical Practice Guidelines in the Acute Care Setting. The JBI Library of Systematic Reviews. 10(57):3812-3893, 2012.

Databases: CINAHL and Joanna Briggs. Keywords: VTE, Venous Thromboembolism, compliance, barriers

Reviewed by John Nemeth 4/14

What are the recommendations for use of graduated compression stockings in hospitalized patients?

Posted on April 15, 2013 by Amy

For medical patients:

DVT prophylaxis for medical patients. In: DynaMed Plus. References two practice guidelines that address use of stockings in hospitalized medical patients.

American College of Chest Physicians (ACCP) suggests usage of the stockings or intermittent pneumatic compression if risk factors for VTE and high risk for bleeding are present. Chest. 2012; 141 (2 Supp). Section 2.7 reviews evidence for use of compression stockings or other mechanical devices in hospitalized medical patients.

American College of Physicians (ACP) does not recommend use of graduated compression stockings for thromboprophylaxis. Ann Intern Med 2011 Nov 1;1559):625-632.
The section “Comparative Effectiveness of Mechanical Devices versus No Mechanical Devices” (p. 627) summarizes evidence and references studies.

There are additional recommendations for compression stockings in medical patients in DynaMed Plus:See prevention section of entry for Deep Vein Thrombosis.

Documents from the Joanna Briggs Institute EBP Database reviewed evidence and provided recommendations for use of compression stockings in hospitalized patients but did not specifically discuss frequency of changing stockings or other aspects of their use other than using knee-length stockings in surgical patients who are for some reason unable to tolerate the thigh-length stockings. See these documents for summaries and references to the evidence.

To retrieve the following documents use the Joanna Briggs Institute EBP Database. Copy and paste the document title in the search box.

Search for “Deep vein thrombosis prophylaxis” to find latest evidence summaries.
Search for “Graduated compression stockings clinician information” to find latest evidence summaries.

For surgical patients:

See guidelines section in entry forDeep vein thrombosis (DVT) prophylaxis for surgical patients. In: DynaMed Plus. To view summary of specific evidence, view section for a surgical specialty (e.g., general and abdominal surgery, neurosurgery, etc.)

To retrieve the following documents use the Joanna Briggs Institute EBP Database. Copy and paste the document title in the search box.

Search for “Hip fracture management older people” to find the latest recommended practices.
Search for “Graduated compression stockings for the prevention of post-operative venous thromboembolism” to view a 2008 technical report.

Reviewed and updated 4/8/2014 ldt

Is there evidence on the use of sequential compression (intermittent pneumatic compression) devices for treatment of active deep vein thrombosis?

Posted on February 8, 2013 by Amy

Bottom line: No evidence identified to support or refute use of sequential compression devices in hospitalized patients with active DVT.

Evidence summary resources (DynaMed, Joanna Briggs) do not mention these devices in relation to treating active deep vein thrombosis (DVT).

A PubMed search for these concepts: “Venous Thrombosis/therapy”[Mesh] AND “intermittent pneumatic compression devices”[MeSH Terms] AND (“humans”[MeSH Terms] AND English[lang])

Only identified one small (n=24) pilot study in patients with venous thrombosis in the proximal leg who received catheter-directed thrombolytic medication (CDT). Patients were randomized to either intermittent pneumatic compression device in addtition to CDT or CDT alone.
See: Ogawa T, et al. J Vasc Surg. 2005 Nov;42(5):940-4. Intermittent pneumatic compression of the foot and calf improves the outcome of catheter-directed thrombolysis using low-dose urokinase in patients with acute proximal venous thrombosis of the leg.

More research would be needed to confirm findings, generalize findings to broader population, etc.

Does trimming peripherally inserted central catheters (PICC) increase the incidence of thrombosis?

Posted on August 10, 2012 by Amy

Bottom line: There is not much published evidence addressing this question.

Summary:
Joanna Briggs: Peripherally Inserted Central Catheters: Occlusion
Reviews evidence associated with risk associated with misplacement or movement of the catheter tip and location of insertion site. I checked the references cited, but did not find any discussion of modifying or trimming the catheter.

PubMed:
peripherally inserted catheter AND thrombosis AND (trimmed OR trimming OR modif* OR cutting)

Evidence that specifically discusses trimming includes
Parvez. Thrombosis Research (2004) 113, 175—177: A comparison of changes in surface of catheter at site of trimming. Authors hypothesize that roughness introduced by trimming line can contribute to thrombosis.

EMBASE:
To view search click on the EMBASE link and then copy this search statement into the search box:

‘peripherally inserted central catheter’ AND thrombosis AND (trimming OR trimmed OR modif*)

Additional evidence that specifically discusses trimming includes:

Trimming of peripherally inserted central catheters: The end result
Pettit J. JAVA – Journal of the Association for Vascular Access 2006 11:4 (209-214)
This paper references a study showing how trimming affects the catheter tip. Possibly this reference is to the Parvez article from the PubMed results above. We do not have access to this Pettit paper, but you can request through interlibrary loan link in the Find It @ Emory menu for this article

Other papers in both the PubMed and EMBASE searches seem to mention trimming or cutting the catheter, but only as part of the procedures and not as a risk factor.

SEARCH METHODS
Resources searched:
Evidence summary resources: Joanna Briggs JBI+Connect
Large literature databases: PubMed, EMBASE

Search included combinations of these terms:
Peripherally inserted central catheter, catheter
trimming, trimmed, modif* (for modify, modified, modification, etc.)
thrombosis

Information on VTE prevention and care in the orthopedic and spine population

Posted on March 7, 2012 by John

Literature on prevention, treatments, guidelines, and the importance of VTE prevention is available. To access literature, go to Emory University’s instance of PubMed here. Then run the following search.

21422890[uid] OR 21323231[uid] OR 21198726[uid] OR 20847691[uid] OR 20479092[uid] OR 20479087[uid] OR 20436000[uid] OR 19725218[uid] OR 19411101[uid] OR 19405432[uid] OR 19201714[uid]

Does taking calf and thigh measurements weekly prevent complications from lower extremity DVTs in acute rehabilitation patients?

Posted on June 26, 2011 by Amy

JAMA 1998 Apr 8;279(14):1094.
This systematic review of clinical assessment and tests for diagnosing DVTs found that leg swelling (as with other symptoms and signs, see Table 2) occurred in patients with and without DVTs. Presence of 1 or more of these signs (pain, tenderness, edema, Homans sign, swelling or erythema) did not have good positive or negative likelihood ratios for diagnosing or ruling out DVT (see Table 3 for LRs from various studies. Now various clinical prediction rules have been developed that combine clinical assessment with test results.

Phys Ther 2004 Aug;84(8):729. This review suggests physical therapists should screen for DVT using such a clinical decision rule and refer any patients with 3 points or more to physician immediately for possible further testing. Points based on the following:
Add 1 point each for
1. active cancer
2. paralysis, paresis or recent plaster immobilization of lower extremities
3. recent episode of being bedridden after major surgery
4. localized tenderness
5. leg swelling
6. calf swelling > 3 cm compared with asymptomatic leg
7. pitting edema
8. collateral superficial veins
Subtract 2 points if alternative diagnosis as or more likely than DVT. Limitations: This review focused on outpatients.

Reviewed 4/21/2014 ldt

Evidence Matters

Evidence-based information for Emory

Tag Archives: Venous Thromboembolism