Prevalência dos fatores de risco para trombose venosa profunda em pacientes cirúrgicos em unidade de terapia intensiva / Prevalence of risk factors for deep venous thrombosis in surgical patients in intensive care unit

Objetivo: Avaliar a prevalência dos fatores de risco e medidas de prevenção para trombose venosa profunda de pacientes cirúrgicos em Unidade de Terapia Intensiva. Métodos: Estudo transversal, conduzido em 2019, com utilização da escala de Caprini para classificação de cada paciente quanto ao risco para trombose venosa profunda, e análise das intervenções adotadas. Resultados: Foram avaliados 68 pacientes. Os fatores de risco mais prevalentes foram procedimento cirúrgico de grande porte (96%) e restrição ao leito (90%). O risco para tromboembolismo venoso foi alto (62/91%), moderado (5/7%) e baixo (1/2%). A mobilização de membros foi aplicada a todos os pacientes, deambulação precoce foi realizada em 62% e 56% foram submetidos à profilaxia medicamentosa. Conclusão: A alta prevalência dos fatores de risco para trombose venosa profunda em pacientes cirúrgicos e a baixa aplicabilidade de medidas preventivas demonstram a importância da implementação de programas de educação continuada e medidas de monitoramento desses eventos.

Objective: To assess the prevalence of the risk factors and preventive measures for deep venous thrombosis in surgical patients in the Intensive Care Unit. Methods: Cross-sectional study held in 2019 using the Caprini scale to classify each patient regarding their risk for deep venous thrombosis, and analysis of the actions taken. Results: A total of 68 patients were evaluated. The most prevalent risk factors were being submitted to major surgical procedures (96%) and bed restriction (90%). The risk for venous thromboembolism was high (62/91%), moderate (5/7%), and low (1/2%). Limb mobilization was applied on all patients; early ambulation was performed in 62%; and 56% were submitted to drug prophylaxis. Conclusion: The high prevalence of risk factors for deep vein thrombosis in surgical patients and the low applicability of preventive measures show the importance of implementing continuing education programs and measures to monitor such events.

Development of the Nurses' Intention to Use Deep Vein Thrombosis Preventive Measures Questionnaire.

BACKGROUND AND PURPOSE: Deep vein thrombosis (DVT) is a serious condition resulting in poor patient outcomes. Therefore, methods to improve nurses' use of preventive measures for DVT are paramount. The purpose of this study was to develop and validate an instrument that captured nurses' intentions to use DVT preventive measures. METHODS: Instrument development occurred in several stages stemming from the recommended formatted structure associated with theory of planned behavior (TPB). Content validity was established with a panel of experts, then the instrument was pilot tested with a sample of intensive care unit (ICU) nurses. RESULTS: The final instrument consisted of four subscales, each subscale was tested with four items by content validity index (CVI) ranging between 0.8 and 1.0, and an overall S-CVI/Ave of 0.93. CONCLUSIONS: The instrument demonstrated high content validity. Future research will test the instrument for psychometric properties.

Remember the risks of intravenous therapy and know how to reduce them.

Nicola Brooks, Associate Dean, Faculty of Health and Life Sciences, De Montfort University, reflects on the potential problems that can occur with the administration of intravenous therapy.

Nurses' knowledge and attitudes regarding major immobility complications among bedridden patients: A prospective multicentre study.

AIMS AND OBJECTIVES: To gain insight into nurses' knowledge and attitudes regarding major immobility complications (pressure ulcers, pneumonia, deep vein thrombosis and urinary tract infections) and explore the correlation of nurses' knowledge and attitudes with the incidence of these complications. BACKGROUND: Immobility complications have adverse consequences, and effective management requires appropriate knowledge, attitudes and skills. Evidence about nurses' knowledge and attitudes regarding immobility complications is lacking. DESIGN: Cross-sectional study. METHODS: A total of 3,903 nurses and 21,333 bedridden patients from 25 hospitals in China were surveyed. Nurses' knowledge and attitudes regarding major immobility complications were assessed using researcher-developed questionnaires. The content validity, reliability and internal consistency of the questionnaires were validated through expert review and a pilot study. The incidence of major immobility complications among bedridden patients from selected wards was surveyed by trained investigators. Correlations between knowledge, attitudes and the incidence of major immobility complications were evaluated with multilevel regression models. RESULTS: Mean knowledge scores were 64.07% for pressure ulcers, 72.92% for deep vein thrombosis, 76.54% for pneumonia and 83.30% for urinary tract infections. Mean attitude scores for these complications were 86.25%, 84.31%, 85.00% and 84.53%, respectively. Knowledge and attitude scores were significantly higher among nurses with older age, longer employment duration, higher education level, previous training experience and those working in tertiary hospitals or critical care units. Nurses' knowledge about pressure ulcers was negatively related to the incidence of pressure ulcers, and attitude towards pneumonia was negatively correlated with the incidence of pneumonia. CONCLUSION: Clinical nurses have relatively positive attitudes but inadequate knowledge regarding major immobility complications. Improved knowledge and attitudes regarding major immobility complications may contribute to reducing these complications. RELEVANCE TO CLINICAL PRACTICE: Nursing managers should implement measures to improve nurses' knowledge and attitudes regarding major immobility complications to reduce the incidence of these complications in bedridden patients.

Complications of deep vein thrombosis.

Post-thrombotic syndrome is a common and chronic complication of deep vein thrombosis (DVT) that may develop in one out of two to three patients despite optimal anticoagulant treatment.

[The assessment of the effectiveness of long vs standard-length catheters in reducing complications: a randomized controlled trial]. / Valutazione dell'efficacia dei dispositivi venosi periferici a cannula lunga vs quelli di lunghezza standard nella riduzione delle complicanze: studio clinico randomizzato controllato.

INTRODUCTION: From 30 to 80% of hospitalized patients is inserted a peripheral venous catheter (PVC). The PVC may be associated to several infective and non infective complications. AIMS: To assess whether a long-length vs standard-length PCV reduces the incidence of CRCs; to assess the patients' preferences and costs. METHODS: Randomized clinical trial on 211 patients (339 cannulas) admitted to an emergency medical and surgical wards. Patients were included if >18 years and prescribed a PVC. After the randomization the PVC were inspected daily, until removal. RESULTS: 186 complications occurred with the standard CVPs vs 16 with the midline, per 1000 catheter days; 47 phlebitis were observed in patients with standard PVCs vs none in those with midline; also infiltrations (66 vs 2 per 1000 catheter days), asymptomatic thromboses (34 vs 7 per 1000 catheter days), occlusions and accidental removals were greatly reduced. The higher cost of midline is counterbalanced by the complications prevented. In addition midline patients referred less limitations (96% vs 50.7%) and an higher satisfaction (91.9% vs 53.7%). CONCLUSIONS: The midline catheters radically reduce PVC associated complications, are preferred by patients and the higher costs should be weighted against the complications avoided.

Differentiating between red legs and cellulitis and reviewing treatment options.

Red legs (RL) is a chronic inflammatory condition often misdiagnosed as cellulitis. Antibiotic therapy is not required and does not resolve the symptoms. The main causes of RL are chronic dermatological and venous disease, including chronic oedema. Raising awareness of this condition among health professionals could prevent misdiagnosis and unnecessary costly and potentially harmful antibiotic therapy. The aim of this paper is to highlight the differential diagnoses and management of red legs, and the author also includes an example through a case history.

Venous Thromboembolism: New Concepts in Perioperative Management.

Venous thromboembolism (VTE) is a serious pathophysiologic condition that is a major cause of morbidity and mortality, especially during the perioperative period. A collective term, VTE is used to describe a blood clot that develops inside the vasculature and results in a deep vein thrombosis (DVT) and/or a pulmonary embolism (PE). Deep vein thrombosis and PE are the third leading cause of cardiovascular mortality, superseded only by myocardial infarction and stroke. Patients who receive treatment for acute PE are 4 times more likely to die of a recurrent VTE within the next year. In hospitalized patients who have had surgery, the incidence of VTE and PE is estimated to be 100 times more prevalent than in the general population. The Joint Commission has established Surgical Care Improvement Project measures to address prophylactic interventions to minimize the incidence of VTE. This journal course will review the current approaches to pharmacologic and nonpharmacologic prevention and management of VTE during the perioperative period. Identification and treatment of deep vein thrombosis and acute PE are also described.

A randomised clinical trial comparing the patient comfort and efficacy of three different graduated compression stockings in the prevention of postoperative deep vein thrombosis.

AIMS AND OBJECTIVES: To compare the comfort levels of patients regarding the use of three different graduated compression stockings and to analyse the efficacies of the graduated compression stockings in relation to patient comfort and compliance in prevention of postoperative deep vein thrombosis. BACKGROUND: Graduated compression stockings are very important with other prophylaxis methods in postoperative deep vein thrombosis prophylaxis. In meta-analyses and systematic review studies, it was reported that knee-length and thigh-length graduated compression stockings had similar efficacies. However, there is no randomised study in literature regarding the patient problems and levels of comfort with the use of graduated compression stockings of different sizes and pressures. DESIGN: A randomised clinical trial design. METHODS: A total of 219 patients were randomised into three groups (n = 73 in each group). Group I was given low-pressure, knee-length graduated compression stockings, group II was given low-pressure, thigh-length graduated compression stockings and group III was given moderate-pressure, knee-length graduated compression stockings. The level of patients comfort regarding the graduated compression stockings and occurrence of deep vein thrombosis were examined. RESULTS: The vast majority of the patients (79·5%) in group III and 52·1% of the patients in group II stated experiencing problems during the use of the graduated compression stockings (p < 0·001). The graduated compression stockings were reported by the patients as being very comfortable in the group I (p < 0·001). No findings of thrombosis were observed in any of the groups. CONCLUSION: The low-pressure, knee-length graduated compression stockings are as effective as the other graduated compression stockings of different pressures and sizes in the postoperative deep vein thrombosis prophylaxis, and the patients have fewer problems while using these graduated compression stockings with a high satisfaction. RELEVANCE TO CLINICAL PRACTICE: The combined use of pharmacological, mechanical and physical methods and patient education is effective in the prevention of postoperative deep vein thrombosis. The use of low-pressure, knee-length graduated compression stockings in clinical practice may be recommended, as the patients have fewer problems while using these graduated compression stockings with a high satisfaction.

Trombosis venosa séptica profunda secundaria a osteomielitis aguda, artritis séptica y piomiositis por Staphylococcus aureus en 3 niños de Costa Rica / Septic deep venous thrombosis secondary to acute osteomyelitis, septic arthritis and piomyositis due to Staphylococcus aureus in 3 Costa Rican children

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Proactivity in VTE prevention: a concept analysis.

Venous thromboembolism (VTE) prevention is an international patient safety issue. The author has observed gaps in prescription and provision of VTE prophylaxis, and that the attitude to VTE is often reactive rather than proactive. This concept analysis aims to explore proactivity and apply it to VTE prevention to address this. Ten databases were searched (1992-2012) using the keywords proactive, proactivity, nurse, nursing, VTE/venous thromboembolism, prevent/prevention/preventing, behaviour, DVT/PE (deep vein thrombosis, pulmonary embolism). The Walker and Avant (2010) method of concept analysis identified the defining attributes as personal initiative, taking charge and feedback-seeking behaviour. Antecedents and consequences have been identified, and empirical referents are demonstrated. Defining proactivity in VTE prevention has the potential to increase prescription and, crucially, provision of prophylaxis, thereby improving patient care, reducing avoidable harm and improving the patient experience.

Accuracy of nurse-performed compression ultrasonography in the diagnosis of proximal symptomatic deep vein thrombosis: a prospective cohort study.

BACKGROUND: Compression ultrasonography (CUS) has been recognized as the diagnostic procedure of choice for the investigation of patients with suspected deep vein thrombosis (DVT); the aim of this study was to assess the diagnostic accuracy of nurse-performed CUS for symptomatic proximal DVT of the lower limb. MATERIAL AND METHODS: We prospectively evaluated all consecutive outpatients referred for suspected DVT from January 2011 to December 2012. All patients underwent bilateral proximal lower limb CUS, first by trained nurses and then by physicians expert in vascular ultrasonography, with every group blinded with respect to each other. This test was repeated after 5-7 days in all negative or unclear examinations. Interobserver agreement and accuracy of nurse-performed CUS were calculated, considering the physician's final diagnosis as the reference test. RESULTS: Six hundred ninety-seven patients were included in the study. DVT was diagnosed in 122 patients by expert ultrasound physicians with an overall prevalence of 17.5% (95% confidence interval [CI] 15.8%-20.6%). Nurse agreement with the physician in DVT diagnosis was excellent (Cohen's κ 0.82, 95% CI 0.79-0.85). Nurse-performed CUS had a sensitivity of 84.4% (95% CI 81.7%-87.1%) and a specificity of 97.0% (95% CI 95.8%-98.3%) with a diagnostic accuracy of 94.8% (95% CI 93.2%-96.5%). CONCLUSION: Our results suggest that nurse-performed CUS may be a potential useful alternative to physician performed CUS with a good accuracy. However, sensibility of nurse-performed CUS appeared suboptimal and future studies should incorporate in the evaluation of this technique other pretest tools that may increase its accuracy.

Deep vein thrombosis: diagnosis and treatment.

This article aims to give nurses an insight into proximal deep vein thrombosis (DVT). DVT is relatively common and is associated with significant morbidity and mortality. Complications such as post-thrombotic syndrome, venous leg ulcers, recurrent venous thromboembolism (VTE) - pulmonary embolism (PE) or DVT - and pulmonary hypertension can develop following DVT diagnosis. There is also a risk that a large PE could prove fatal. While VTE prevention is a clinical priority, nurses should also have appropriate skills and knowledge to care for patients with suspected DVT. Nurses need to be aware of the signs and symptoms of DVT, common diagnostic tests, pharmacological and mechanical treatments, and the follow-up investigations patients should be offered.

Nursing assessment of deep vein thrombosis.

The seriousness of deep vein thrombosis (DVT) and its accompanying morbidity and mortality make early and accurate diagnosis of key importance. Best clinical practice is supported by the use of a clinical decision model that determines risk based on predisposing factors and certain clinical signs and symptoms.

We've got it covered! Graduated compression stockings.

Hypercoagulability is a well documented feature of pregnancy and contributes to the increased incidences of venous thromboembolism (VTE) in pregnancy. Thromboembolism remains a leading cause of maternal death in the UK, though it's predicted that up to two thirds of these deaths could be prevented if appropriate thrombophylaxsis is adopted. This article aims to further midwives' knowledge in relation to thromboprophylaxsis, focusing in particular on graduated compression stockings (GCS). It aims to assist midwives in identifying those women at high risk of developing a VTE, explain the way in which compressio stockings can reduce thromboembolism and provide advice on their application and the clinical observations required.