The Main Issue of Concern
American College of Chest Physicians (ACCP) outlined guidelines based on evidence of thrombolytic and antithrombotic therapy. The guidelines featured recommendations to healthcare services providers aiming at managing and preventing venous and arterial thromboembolism in surgical and medical patients. These recommendations are carried out on conditions such as cerebrovascular, cardiac arterial-venous thromboses, peripheral vascular disease, and in the prevention of venous thromboembolism. Despite availing the guidelines to healthcare providers, hospitalized patients still fail to receive the appropriate and adequate protection against deep vein thrombosis (DVT).
The recommendations for the management and prevention of DVT entail applying mechanical prophylactic measures whose application needs to be understood by the healthcare providers. The mechanical prophylactic prevention measures entail several actions. These measures include exercising, the use of graduated stockings or the knee-high compression stockings use, exploring a variety of motions, and the use of pneumatic devices for compression. Ensuring DVT prevention has been achieved successfully requires the healthcare providers to conduct a timely assessment of patients.
The Importance of the Issue
In the case of UMMC Hospital, it is recommendable to apply knee-high compression stocking use. This measure helps reduce venous stasis and improves the venous return in the leg veins. The knee-high compression stocking measure is easy to use, and it does not increase bleeding risk in most patients. Healthcare providers should be careful when applying this measure since it relates to patients at a lower risk for DVT development. Furthermore, the knee-high compression stocking measure applies to patients who possess the contraindication of using the pharmacological recommended measures.
The knee-high compression stocking prevention measure of DVT is easily accommodative by most patients and can be possibly continued up to the basis of outpatient. The suitable patients for this measure are the ones who have a lower risk for DVT, particularly when paired with exercises of the foot and ankle for those capable of conducting them. Caution in the use of knee-high stockings is required for individuals who possess arterial insufficiencies of lower extremities since their arterial circulation has been compromised already. To obtain an extreme benefit and avoid tight-fitting stockings resulting in a tourniquet effect, selecting a proper fit is required. The knee-high compression stocking should be applied immediately to affected patients as recommended and be removed after 30 minutes shift to allow the assessment of the underlying skin.
The ACCP guidelines recommend the knee-high compression stocking measure for all hospitalized patients with anticoagulant contraindication. The patients exposed to high risks of developing anticoagulant contraindication are recommended to combine the substance use. The knee-high compression stocking prevention measure must be applied initially to surgical patients with higher risks for bleeding until reconsideration for anticoagulant has been made. Compression modes are considered to be effective and safe, although they require to be applied for the bedrest duration and not for a particular duration in a day. Nurses are advised to encourage the use and compliance of the patients.
Anecdote
The knee-high compression stocking measure entails applying the pharmacologic prophylactic step, which uses numerous kinds of anticoagulants to reduce the coagulability of blood. The applicable anticoagulants include unfractionated heparin, aspirin, pentasaccharides, warfarin, and heparin of low-molecular-weight. Providing excellent protection requires the medication to be administered to patients possessing moderately higher risk factors which other mechanical tools only can offer. Despite aspirin being an effective treatment for the prevention of prophylaxis for arterial thrombosis since it decreases the platelets’ aggregation, ACCP recommended guidelines discourage their use as a sole means of venous thromboembolism in any given patient since they are ineffective to act on the venous thrombi components. Furthermore, additional tools for preventing DVT are recommended for patients taking aspirin for other treatment reasons. Unfractionated heparin needs monitoring and adjustment of the partially activated thromboplastin period’s dosage plan based on the results.
Administration of heparin intravenously or subcutaneously results in either immediate provision of anticoagulant effect or delayed response of approximately 1 hour. Low-molecular-weight heparin provides a convenient and easy administration platform for patients in hospitals, with the drug being safe to be used on the elderly. The obese and renal impaired patients require dose adjustment as those with higher risks of bleeding are given low-molecular-weight heparin rather than unfractionated heparin, which ensures they have low bleeding instances. Patients in critical care and their DVT risk are moderate and require to use of prophylaxis together with low-molecular-weight heparin or heparin. Patients in high risky critical conditions require low-molecular-weight heparin. Warfarin provides a convenient pill taken orally in hospitals, and its continued at home by patients exposed to risk after being discharged. Patients should avoid certain foods since they alter warfarin’s effectiveness.
Consequences of Taking No Action
Failure to make dosage adjustments of low-molecular-weight heparin prophylaxis in the elderly and obese patients will lead to bleeding. Bleeding will worsen the condition of the hospitalized or the home-based patient. Failure to re-evaluate the risk factors of a patient by the nurses may worsen his/her condition. Failure to consider the patient’s bleeding potential when contemplating anticoagulant use by the patient advocates (nurses) may lead to delayed administration of assessment trials for DVT prevention.
Furthermore, obtained orders to administer prophylaxis for DVT risk development should be timely to initiate prevention mechanisms. Delay exposes the patients to risk factors that will be costly to rectify. Delay administering DVT treatment mechanism generates life-threatening complications such as pulmonary embolus in the patients. Furthermore, after the delay, their treatment will involve the use of costly doses, which may aggravate the bleeding problem. The costly doses will require the use of coagulants rather than prevention. Therefore, early prevention methods for all healthcare providers in patients provide the best options since they reduce DVT complication risks and avoid treatment options.
Recommendations
A combined therapy bringing together the tools of pharmacological and mechanical techniques should be adopted for patients considered to have a higher risk for DVT than those in need of lower anticoagulant doses. Furthermore, combined therapy should be recommended for the elderly since they are exposed to multiple risk aspects and increased bleeding probability. Adopting mechanical measures which possess little contraindications and are considered better adjuncts for patients requiring a reduction in dosage of measures entailing pharmacology will be appropriate.
ACCP recommended guidelines to discourage aspirins as a sole means of venous thromboembolism in any given patient since they are ineffective in acting on the venous thrombi components. Furthermore, ACCP recommended guidelines propose using unfractionated aspirins and low-molecular-weight heparin prophylaxis in all patients considered to be in an acute medical ill state without using contraindications anticoagulants for those having many risk factors for DVT prevention mechanism.
The nursing practice that entails the elimination of errors and the introduction of prevention mechanisms requires significant support from the field decision-makers (Bureau & Gordon, 2013). Healthcare providers should follow the ACCP guidelines since they provide the appropriate recent and scientifically proven recommendations to help in DVT prevention and treatment. The nurses who are patients’ advocates need to be aware of the risk factors which may expose the persons they represent to life-threatening conditions. Nurses should be curious about the risk factors and DVT prophylaxis to determine the appropriate use by their patients.
Reference
Bureau, B. & Gordon, S. (2013). From silence to voice: What nurses must know and communicate to the public (3rd Ed.) ILR Press/Cornell University.