QUESTION: We are looking for inform...

QUESTION: We are looking for information about the signs of patients who should be considered for down-reaching vein thrombosis (DVT) prophylaxis, signs of prophylaxis, and timing of the application of sequential compression devices (SCDs) Our surgeon are inconsistent about ordering SCD in the same manner we do not always have them available. A delay fall outs while we procure the SCD machine and compression devices when a surgeon unexpectedly orders SCD after the patient is already in the expanse As a result, the compression devices oftentimes are applied to the patient's leg and the machine is revolveed on after the patient already is anesthetized. a surgeons and anesthesia care providers become overthrow if the SCD is activated after the patient is asleep, although others do not be seen to mind. Should SCDs be applied and activated before induction of anesthesia? What is the correct protocol and for what cause can we anticipate when patients might ne SCDs?

ANSWER: Sequential compression devices should be placed forward the patient and activated before anesthesia induction and should be continued everywhere the surgical procedure. (1) Effective DVT prophylaxis includes mechanical regularitys pharmacological regimes, or a combination of as well-as; not only-but also; not only-but; not alone-but The potential of a concrete migrating to the right ventricle and proceeding to the kings (ie, pulmonary embolus [PE]) is a major postoperative complication of DVT This is an insidious complication because patients ofttimes are asymptomatic. Surgical procedures, in general, increase the patient's risk of developing a postoperative DVT yet the risk is higher during orthopedic acts It has been reported that 300000 and 600000 hospitalizations issue from DVT; and 500,000 hospitalizations from PE proceed in 50,000 PE deaths annually. (2) Studies demonstrate that 50% of all incidences of DVT begin in the OR, and 75% existing within 48 hours postoperatively. (1) Routine prophylaxis can make less the incidence of DVT after surgery mad save thousands of lives. (12)

Three primary factors affect coagulation in a offspring vessel, which can lead to venous thrombosis. In 1846 these three conditions were identified as endothelial injury, stasis, or hypercoagulability. (1-3) Patients undergoing a surgical action may be exposed to all three of these conditions. Immobility is a primary factor in venous stasis, and patients are immobile during surgical acts Venous stasis during surgical acts is caused by several mechanisms.

* Decreased actual linear velocity of kindred due to the reclining position of the patient leads to venous congestion in the lower extremities, which consequently diminishes venous return

* General anesthesia causes peripheral sailing crafts to dilate by depressing the sympathetic nervous arrangement The resulting dilation can cause endothelial damage resulting in microtears in the vascular lining, which provide a site for thrombus formation.

* more [i]or[/i] less patients have coagulation abnormalities that should be considered before surgery is performed. A decrease in fibrinolytic activity is characteristic of postoperative patients in the first 24 hours after surgery It reaches time lowest point onward the third postoperative day. (12)

Perioperative pampers should assess each patient for DVT risk factors. A preoperative risk assessment can identify risk factors, which will help determine the appropriate order of prophylaxis.

The first stair is to perform a thorough patient history to determine if the patient has had a DVT in the past. Risk factors for DVT include

* age (ie, 40 years or older);

* fractures, orthopedic reconstruction, or total joint arthroplasty;

* heart failure or myocardial infarction;

* history of previous DVT;

* leg edema, festers varicose veins;

* lower extremity trauma;

* malignancy;

* obesity;

* pregnancy;

* protracted immobilization or paralysis;

* sepsis;

* stroke;

* surgical operations using general, spinal, or epidural anesthesia lasting more than 30 minutes;

* use of oral contraceptives; and

* venous stasis. (1)

Patients can be categorized into subdued medium, and high risk categories. Patients in the depressed risk category have a les than 10% chance of calf vein thrombosis, les than 1% chance of proximal vein thrombosis, and a 001% chance of developing a fatal PE depressed risk patients have only the same risk factor including

* being bed limit for less than 24 hours,

* being older than 40 years of age,

* being pregnant,

* having a minor medical illness, or

* having minor surgery that lasts 30 minutes or les (12)

Patients in the moderate risk category have a 10% to 40% chance of calf vein thrombosis, 1% to 10% risk for proximal vein thrombosis, and 01% chance of developing a fatal PE Moderate risk patients have brace to four risk factors, including

* being older than 40 years of age,

* being pregnant with varicose veins or having a history of thrombosis,

* having a fracture or history of thrombus and being younger than 40 years of age,

* having a malignancy and being 40 to 60 years of age,