Venous Thromboembolism Prophylaxis Policy - Royal United ...

More documents

Recommendations

Info

8. Ensure that patients who are discharged with anti-embolism stockings: • Understand the benefits of wearing them • Understand the need for daily removal and hygiene • Are able to remove and replace them, or have someone available who will be able to do this for them • Know what problems to look for, such as skin marking, blistering or discolouration, particularly over the heels and bony prominences • Know who to contact if there is a problem 9. Ensure that patients who are discharged with pharmacological and/or mechanical VTE prophylaxis are able to use it correctly, or have arrangements made for someone to be available who will be able to help them 10. Notify the patient’s GP if the patient has been discharged with pharmacological and/or mechanical VTE prophylaxis to be used at home Document name: Venous Thromboembolism Prophylaxis Ref.: 795 Issue date: 30 July 2014 Status: Final Author: Josephine Crowe – Consultant Haematologist Page 18 of 57
Appendix 2: Guideline General Medicine Thromboprophylaxis First assessment carried out by admitting doctor Patient has had or is expected to have significantly reduced mobility for 3 or more days (i.e. bedbound, unable to walk unaided, or likely to spend a substantial proportion of the day in bed or in a chair Yes No Patient is expected to have ongoing reduced mobility relative to normal and has one or more risk factors (box 1) No Box 1. VTE risk factors: • Active cancer or cancer treatment • Aged over 60 years • Critical care admission • Dehydration • Known thrombophilia • BMI >30 kg/m 2 • Personal or first degree relative history of VTE • One or more significant medical comorbidities (heart disease; metabolic, endocrine or respiratory pathologies; acute infectious diseases; inflammatory conditions) • HRT or oestrogen-containing contraceptive • Varicose veins with phlebitis • Pregnant or given birth within 6 weeks No VTE prophylaxis needed Yes Risk of bleeding from pharmacological prophylaxis (box 2) Use LMWH. Check renal function No Prescribe dalteparin (see full guideline). If renal impairment (eGFR2) • Concurrent anticoagulant use (e.g. warfarin with INR>2) • Lumbar puncture/epidural/spinal anaesthesia within next 12 hours or previous 4 hours • Acute stroke • Platelets 230/120 mmHg • Untreated inherited bleeding disorders (e.g. haemophilia, von Willebrand’s) • Anticipated or recent procedure All VTE prophylaxis contraindicated Consider the use of anti-embolism stockings. Need to be measured and correctly fitted Wear day and night Document assessment and management Avoid dehydration Encourage mobility Give patient information leaflet Re-assess VTE and bleeding risks within 24 hours. Ensure prophylaxis is being given correctly Box 3. Contraindications to anti-embolism stockings • Suspected or proven peripheral arterial disease • Peripheral arterial bypass graft • Peripheral neuropathy or other sensory impairment • Fragile skin, dermatitis, gangrene, recent skin graft • Allergy to material • Heart failure • Severe leg oedema • Unusual leg size or shape • Major deformity preventing correct fit • Caution with venous ulcers or wounds Document name: Venous Thromboembolism Prophylaxis Ref.: 795 Issue date: 30 July 2014 Status: Final Author: Josephine Crowe – Consultant Haematologist Page 19 of 57
Page 1 and 2: Venous Thromboembolism Prophylaxis
Page 3 and 4: Appendix 2: General Medicine Thromb
Page 5 and 6: 3 Definition of Terms Used AES DH D
Page 7 and 8: Surgical patients on the combined o
Page 9 and 10: 7.2 Pharmacological prophylaxis and
Page 11 and 12: • Untreated inherited bleeding di
Page 13 and 14: Intermittent pneumatic compression
Page 15 and 16: References 1. Scottish Intercollegi
Page 17: Appendix 1: Guideline for the Preve
Page 21 and 22: Sequential Compression Devices for
Page 23 and 24: PATIENTS IN PALLIATIVE CARE If pati
Page 25 and 26: Patients with cancer Patients with
Page 27 and 28: Antenatal VTE risk assessment Previ
Page 29 and 30: Ante-natal or postnatal weight 170
Page 31 and 32: • Varicose veins with phlebitis
Page 33 and 34: Appendix 4a: Vascular, Gastrointest
Page 35 and 36: Patients undergoing general surgery
Page 37 and 38: Patients having day surgery If VTE
Page 39 and 40: • HRT or oestrogen-containing con
Page 41 and 42: Dalteparin Rivaroxaban 10mg po OD T
Page 43 and 44: ELECTIVE HIP REPLACEMENT ELECTIVE K
Page 45 and 46: UKA, TKA, revision TKA • IPC (kne
Page 47 and 48: HIP FRACTURE OTHER ORTHOPAEDIC SURG
Page 49 and 50: Appendix 5b: Trauma and Orthopaedic
Page 51 and 52: Appendix 5c: Trauma and Orthopaedic
Page 53 and 54: Appendix 6: Critical Care Thrombopr
Page 55 and 56: Document Control Information Ratifi
Page 57: Equality Impact: (A) Assessment Scr

Venous Thromboembolism Prophylaxis Policy - Royal United ...

Create successful ePaper yourself

Delete template?

Save as template?