dvt prophylaxis and pulmonary embolism karen ruffin rn, msn ed

Download DVT Prophylaxis and Pulmonary Embolism Karen Ruffin RN, MSN Ed

Post on 17-Dec-2015

213 views

Category:

Documents

0 download

Embed Size (px)

TRANSCRIPT

  • Slide 1
  • DVT Prophylaxis and Pulmonary Embolism Karen Ruffin RN, MSN Ed.
  • Slide 2
  • Frequency in the US Up to 2 million people are affected annually by Venous Thromboembolism(VTE). Of those 2 million people it is estimated that 300,000 of them will develop and die from a Pulmonary Embolism (PE). The highest incidence of PE is with hospitalized patients. Autopsy shows that as many as 60% of patients dying in the hospital have had a PE, but the diagnosis is being missed 70% of the time. According to: Center for Disease Control (CDC), Department of Health and Human Services, Food and Drug Administration (FDA), The Surgeon General
  • Slide 3
  • Percentage if at risk for Development of a VTE All hospitalized patients, depending on acuity, have between a 10%-48% of developing a VTE All hospitalized patients, depending on acuity, have between a 10%-48% of developing a VTE Med-Surg patients placed on bed rest for a week (10%-13%). Med-Surg patients placed on bed rest for a week (10%-13%). Patients in the MICU (29%-33%). Patients in the MICU (29%-33%). Patients with Pulmonary Disease on bed rest for 3 or more days (20%-26%). Patients with Pulmonary Disease on bed rest for 3 or more days (20%-26%). Patients in the CCU with an MI (27%-33%). Patients in the CCU with an MI (27%-33%). Patients who are asymptomatic after a CABG (48%). Patients who are asymptomatic after a CABG (48%). Feied, C.F. & Handler, J.A., (2008)
  • Slide 4
  • Mortality and Morbidity Approximately 10% of the patients with an acute PE will die with in the first 60 minutes. Approximately 10% of the patients with an acute PE will die with in the first 60 minutes. 1/3 of those who live, the condition is diagnosed and treated. 1/3 of those who live, the condition is diagnosed and treated. 2/3 of the remaining patients go undiagnosed. 2/3 of the remaining patients go undiagnosed. Deaths that are a result of VTE/PE were shown to be the most common cause of preventable hospital deaths THAT IS HUGE! According to: Center for Disease Control (CDC), Department of Health and Human Services Food and Drug Administration (FDA), The Surgeon General
  • Slide 5
  • Mortality and Morbidity Race- Subtle population differences may exist, but the incidence is high in all racial groups. Race- Subtle population differences may exist, but the incidence is high in all racial groups. Sex- Women only when they are pregnant. Sex- Women only when they are pregnant. Age- Although the frequency for developing a PE increases with age, age alone is not an independent risk factor. It has more to do with co-morbidities. Age- Although the frequency for developing a PE increases with age, age alone is not an independent risk factor. It has more to do with co-morbidities.
  • Slide 6
  • Virchows Triad Vessel Damage Vessel Damage Vascular Constriction Vascular Constriction Blood Viscosity Blood Viscosity
  • Slide 7
  • Vessel Damage Endothelial cells allow blood to flow with ease through vessels. Factor VIII or Willibrands Factor Conditions/lifestyles that damage vessel walls: Past VTE- Pressure Ulcers Smoking- Cellulites High Cholesterol Varicose Veins
  • Slide 8
  • Vascular Constriction Trauma Surgery Insertion of central line Varicose Veins Restricted Mobility Sepsis Induction MI HF Stroke Any external force that cause damage to the vascular system can cause slow blood flow
  • Slide 9
  • Blood Viscosity Dehydrating Birth Control Pills High estrogen states Pregnancy Postpartum Cancer Sepsis Blood transfusions Obesity IBS Hematologic Disorders Elevated Blood Sugar Platelet Aggregation
  • Slide 10
  • Physiology of Clotting
  • Slide 11
  • Slide 12
  • What is the difference between a thrombus and an emboli? A thrombus is a clot that is stationary and a emboli is a thrombus that has broken off and is traveling. A thrombus is a clot that is stationary and a emboli is a thrombus that has broken off and is traveling.
  • Slide 13
  • Most Common Cause of a PE 90% are thrombi dislodged from deep veins in the calf. 90% are thrombi dislodged from deep veins in the calf. Some originate in the pelvis, particularly in pregnant women. Some originate in the pelvis, particularly in pregnant women. Fat embolus occur when long bones are broken (this is rare). Fat embolus occur when long bones are broken (this is rare).
  • Slide 14
  • What is a Pulmonary Embolism (PE)? Occlusion of a portion of the pulmonary vascular bed by an embolism. They can be a: Occlusion of a portion of the pulmonary vascular bed by an embolism. They can be a: Thrombus (Blood Clot) Tissue Fragment Lipids (Fat) Air Bubble
  • Slide 15
  • Pathophysiology Once the embolus is released into the blood stream they are distributed in: Once the embolus is released into the blood stream they are distributed in: 65% of the time both lungs 65% of the time both lungs 25% of the time right lung 25% of the time right lung 10% of the time left lung Lower lobes are 4 times more often upper lobes.
  • Slide 16
  • Pathophysiology Massive Occlusion- an embolus that occludes a major portion of the pulmonary circulation. Massive Occlusion- an embolus that occludes a major portion of the pulmonary circulation. Embolus with Infarction- An embolus that is large enough to cause an infarction (death) of a portion of lung tissue Embolus with Infarction- An embolus that is large enough to cause an infarction (death) of a portion of lung tissue Embolus without Infarction- Not sever enough to cause permanent lung injury. Embolus without Infarction- Not sever enough to cause permanent lung injury. Multiple Pulmonary Emboli- This can be chronic or recurrent. Multiple Pulmonary Emboli- This can be chronic or recurrent.
  • Slide 17
  • Risk Factors for DVT and PE Previous episode of thromboembolism Previous episode of thromboembolism Prolonged immobility Prolonged immobility Cancer Cancer Obesity Obesity Pregnancy Pregnancy Oral estrogen Oral estrogen Fever Fever Atrial fibrillation Atrial fibrillation CHF, Shock CHF, Shock Varicose veins Varicose veins Over 60 y/o Over 60 y/o Hematologic disorders Hematologic disorders Trauma Trauma Central Lines Central Lines Dehydration Dehydration Hypovolemia Hypovolemia Surgical Patients Surgical Patients
  • Slide 18
  • Prophylaxis Strategies The evidence based practice guidelines published by the ACCP in June 2008 incorporated data obtained from a comprehensive literature review of the most recent studies available. The recommendations are broken up in to different categories from general patient populations to specific groups and conditions. American College of Chest Physicians, (2008)
  • Slide 19
  • Understanding the Different Recommendation Categories Grade 1: Benefits outweigh risk Grade 2: Less certain about the magnitude of benefits versus risk Grade A: High quality evidence Grade B: Moderate quality evidence Grade C: Low quality evidence American College of Chest Physicians, (2008)
  • Slide 20
  • General Patient Population Every hospital should have a formal strategy for addressing VTE prophylaxis (Grade 1A) Mechanical methods of thromboprophylaxis should be used primarily in patients who have a high risk of bleeding (Grade 1A) It is recommended against the use of aspirin alone as thromboprophylaxis for VTE for any group of patients (Grade 1A) American College of Chest Physicians, (2008)
  • Slide 21
  • What about patients w/ a PICC line?????? We are a seeing and increased incidence of DVT in patients with PICC lines. We are a seeing and increased incidence of DVT in patients with PICC lines. How can we assess for it? How can we assess for it?
  • Slide 22
  • Clinical Manifestation of PE Massive Occlusion- Profound shock, hypotension, tachycardia, pulmonary hypertension, and chest pain. Massive Occlusion- Profound shock, hypotension, tachycardia, pulmonary hypertension, and chest pain. Embolus with Infarction- Pleural pain, pleural friction rub, pleural effusion, hemoptysis, fever, and leukocytosis. Embolus with Infarction- Pleural pain, pleural friction rub, pleural effusion, hemoptysis, fever, and leukocytosis. Recurrent PE- Occur in individuals who have had a history of previous emboli. Recurrent PE- Occur in individuals who have had a history of previous emboli.
  • Slide 23
  • Applying the Nursing Process Assessment Assessment Diagnosis Diagnosis Planning Planning Intervention Intervention Evaluation Evaluation
  • Slide 24
  • Assessment and Symptoms Homons sign Homons sign H&P H&P Cough Cough Sudden onset of SOB Sudden onset of SOB Agitation Agitation Lightheadness Lightheadness Fainting Fainting Dizziness Dizziness Sweating Sweating Anxiety Anxiety Rapid Breathing Rapid Breathing Tachycardia Tachycardia Air Hunger Air Hunger
  • Slide 25
  • What are your nursing diagnosis going to be??? Tell me your long and short term goals.
  • Slide 26
  • Diagnostics Arterial Blood Gases Arterial Blood Gases EKG EKG Echocardiogram Echocardiogram Chest x-ray Chest x-ray VQ scan VQ scan Spiral CT scan Spiral CT scan Pulmonary Angiogram Pulmonary Angiogram Pt, ptt, INR Pt, ptt, INR D-DImer D-DImer Split Fibrinogen Split Fibrinogen MRA MRA
  • Slide 27
  • WHAT ARE YOUR INTERVENTIONS FOR YOUR STATED GOALS? Remember to always have: AssessmentActionPsychosocialEducati

Recommended

View more >