Learn exactly what VTE Prophylaxis is and why it’s so important to your role as a nurse. VTE’s are venous thromboembolism and preventable.
When you work on an inpatient nursing unit, something that is applicable to all patients is the prevention of VTE’s. VTE’s are venous thromboembolism and, as far as reimbursement and the patients are concerned, are preventable.
If we, as health care providers, take the initiative to ensure we are actively preventing these blood clots, patients will not get them and therefore not suffer the devastating complications from them as well.
Why You Need To Understand VTE Prophylaxis
If a sick patient is sitting in bed for days, they can get a clot in their legs. Then, you get them up with PT/OT all of a sudden, and BOOM it moves to their lungs and now you have a PE (pulmonary embolism) on your hands, which can be fatal. The clot can also move to the brain and cause a stroke, which can also be fatal. This is completely preventable with the appropriate interventions, and therefore should never, ever happen.
Order For VTE Prevention
With every admission you get, you should have an order for some sort of VTE prevention. It’s now part of most admission order sets and/or admission protocols. Typically, the only time nurses need to alert an MD about getting some sort of prophylaxis is if they didn’t use an admission order set, used a few general orders, and just forgot. Most docs that I’ve encountered are on top of this, so there’s only been a handful of times that I’d had to ask for something.
How To Prevent VTE Prophylaxis
There are a few different ways we prevent VTE’s.. below is a list of the least to most aggressive form.
Sequential Compression Devices, or SCD’s
Note: if you loudly ask a hard of hearing patient about his SCD’s, him, along with everyone within earshot, will think you asked him about his STD’s.
These are either thigh-high or knee-high and wrap around each leg. They inflate, one at a time, stimulating blood flow in the legs, thus preventing clots. However, these are only effective if they’re on.
So if your patient only wears them 4-6 hours a day, that’s the only time you’re preventing clots from forming.
- Pros are that they’re the least invasive and very effective.
- Cons are they’re only effective if worn, they can be a fall hazard, and they’re easy to forget to turn on.
TED Hose
Who the heck is Ted Hose? … These stockings are also thigh or knee-high.
They’re tight, support the legs, and prevent clots and edema. A lot of post-op patients are required to wear these and aren’t always appropriate otherwise, depending on what’s going on with the patient. If you just need to prevent clots and edema isn’t an issue, docs don’t typically order these.
- Pros are that they prevent edema as well as clots and also support the legs.
- Cons are they’re annoyingly difficult to put on, are hot, and must come off at night. Therefore, you won’t see a patient with an order for just TED’s because they’re not protected at night.
Subcutaneous Heparin
This is a shot, typically given in the belly. It’s a low dose of heparin; low enough to prevent clots, but not high enough to put them at high risk for bleeding. However, if your patient is going to surgery this afternoon and they have subcut heparin scheduled prior to surgery, you should question that.
- Pros are that they are consistently protected and you don’t have to move heaven and earth to convince them to wear their SCD’s.
- Cons are that they now have to receive a medication and the dose does pose a low bleeding risk, it’s a shot so they hate it, and you must remember to question this med if a bleeding event or surgery occurs.
Subcutaneous Lovenox
This is also a shot in the belly, but it’s more aggressive than subcut heparin. Docs may choose this medication for those patients that are at high risk for developing a clot and the need to prevent clots outweighs the risk of bleeding.
Pros and cons are similar to heparin except for the risk for bleeding are higher, as it is a more aggressive approach.
When your patient is already on a heparin drip. This thins their blood more than subcut heparin or lovenox, and does so quickly. Therefore, you’re adequately preventing clot formation. However, when/if they come off the drip, you’ll need to make sure you have an order for subcut heparin or SCD’s if they’re not being bridged to Coumadin or some other anticoagulant long-term.
Other means of prevention include frequent ambulation and range of motion exercises.
Educate Patients About Using Them
Things to remember with your mechanical prevention (SCD’s, TED’s, ambulating, range of motion).. these are only effective if they’re being use or done. So if your patient that can’t sleep with SCD’s on refuses to wear them, make sure they understand the risk of not wearing them if subcut heparin isn’t also ordered. And when you’re doing your hourly rounds, please check and make sure the pump is on! It’s so easy to forget and patients rarely know or think to remind you that the machine is off.
What To Do If Your Patient Refuses VTE Prophylaxis
Make sure you adequately explain to them why it is so very important.
Page the doc and let them know. (Educate the patient first and then call the doc because they’ll ask if you’ve explained it to them.)
Then chart that you’ve done both of those things and that they still refuse. If you have that patient a few shifts in a row and they continue to refuse, make sure you re-educate and re-document their refusal every single shift.
Some people will refuse no matter what you or the doctor do. It’s not the end of the world and it doesn’t mean you’re a bad nurse. Some people just won’t, and that’s okay. Just do everything you can to educate them, and document everything appropriately.
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