1

VTE Protocol

Presented by:Selina Baskins, RNQuality 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

Standard of Care for assessed Risk Score: IF INTERVENTIONS HAVE NOT BEEN ORDERED, CALL MDFOR ORDERS!

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

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????