VTE Protocol
Presented by:
Selina Baskins, RN
Quality Coordinator
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Each Risk Factor Represents 1 Point
•Age 41-60 years
•Minor surgery planned
•Hx of prior major surgery
(<1 month)
•Varicose veins
•Hx of inflammatory bowel
disease
•Swollen legs (current)
•Obesity (BMI>25kg/m2)
•AMI
•CHF
•Sepsis
•Serious lung disease
including
pneumonia
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Each Risk Factor Represents 1 Point
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Abnormal pulmonary function
(COPD)
Medical patient currently at bed rest
Oral contraceptives
Pregnancy or postpartum (<1month)
Hx of unexplained stillborn infant,
recurrent spontaneous abortion (>3),
premature birth with toxemia, or
growth-restricted infant
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Each Risk Factor Represents 2
Points
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Age 61-74 years
Arthroscopic surgery
Malignancy (present or previous) Major
surgery (over 45 minutes) Laparascopic
surgery (over 45 minutes) Patient
confined to bed (>72 hours)
Immobilizing plaster cast (<1 month)
Central venous access
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Each Risk Factor Represents 3
Points
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Age ≥ 75 years
Hx of VTE/PE
Family Hx of thrombosis
Blood/bone marrow dyscrasias *
Thrombophilic condition **
Heparin induce thrombocytopenia
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Each Risk Factor represents 5
Points
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Elective major lower extremity
arthroplasty
Hip, pelvis, or leg fracture
Stroke
Multiple trauma
Acute spinal cord injury (paralysis
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Contraindications
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Contraindications to pharmacologic
prophylaxis i.e. active bleeding, current or
history of heparin induced
thrombocytopenia, platelet count <
100,000
Contraindications to sequential
compression devices, i.e. severe
peripheral arterial disease, CHF,
acute/superficial
VTE Other contraindications
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Standard of Care for assessed Risk Score: IF
INTERVENTIONS HAVE NOT BEEN ORDERED,
CALL MD
FOR ORDERS!
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0-1 Low Risk = Early and aggressive
ambulation
2 Moderate Risk Lovenox 40 mg
subcutaneous daily
(Choose one) Lovenox 30 mg
subcutaneous daily if CrCl less than 30
Graduated compression stockings
thigh, knee high
Sequential compression device
3-4 High Risk Lovenox 40 mg
subcutaneous daily AND Sequential
compression device
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Standard of Care for assessed Risk Score: IF
INTERVENTIONS HAVE NOT BEEN ORDERED,
CALL MD FOR ORDERS (Cont’d)
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(Choose one) Lovenox 30 mg
subcutaneous daily AND Sequential
compression device if CrCl less than 30
5 or more Very High Lovenox 40 mg
subcutaneous daily, Sequential
compression device AND graduated
Risk compression stocking
Lovenox 30 mg subcutaneous daily if
CrCl less than 30, Sequential
compression device
AND graduated compression stocking
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Other instructions
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If the patient received epidural
anesthesia, do not start Lovenox
until 24 hours after establishment
of stable hemostasis
If the patient has an epidural
postoperatively, do not start
Heparin/LMWH until epidural ha
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QUESTIONS????
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