September 2013/Cheryl Marsh, BS, RN, CNOR/Outpatient Surgery
The stakes are high when it comes to preventing deep vein thrombosis and pulmonary emboli. Between 300,000 and 600,000 people suffer DVT and PE each year, with 60,000 to 100,000 ultimately dying from the complications. When it’s not fatal, DVT can cause post-op morbidity, prolonged hospitalization and increased healthcare costs. An essential part of caring for surgical patients is to understand your role and responsibilities in preventing clots from forming.
1. Know the facts.
DVT commonly occurs when blood flow changes, which could cause clots to form in deep veins, often in the calf or thigh and less commonly in the chest or arm. Pulmonary emboli develop when clots break free from veins and travel to the lungs. The condition can prove fatal within minutes or hours.
Who’s at risk? Anyone who undergoes surgery, because injuries to vessels when surgeons operate and changes in blood chemistry caused by dehydration or general anesthetics increase the likelihood of clots forming. That said, the more invasive procedures in the abdomen or lower extremities put patients at increased risk.
Other factors that heighten DVT possibilities include advanced age, obesity, recent physical trauma, varicose veins, personal or family history of circulation problems, surgeries lasting longer than 45 minutes and hip or knee replacement surgery.
2. Pick the prophylaxis.
Muscles in prone, anesthetized patients aren’t working as they normally would; even sleeping individuals move slightly every few minutes to keep blood flowing properly.
Two effective preventative measures against DVT:
- Sequential compression devices. SCDs combat venous stasis and coagulation changes by squeezing legs to stimulate muscles and move blood through the veins.
- Anti-embolism stockings. Stockings protect against venous stasis and vessel wall damage by keeping leg muscles tight and firm, which reduces pooling of blood in the veins.
Using both in combination therefore protects patients against all 3 risk factors of DVT. The stimulation and constriction combine to regulate the blood’s chemistry and break down any blood clots that might form.