Venous Thromboembolism in Intensive Care Unit

Venous thromoboembolism (VTE) represents a spectrum of disease which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), a common complication in critically ill patients. VTE is difficult to diagnose, expensive to treat and occasionally lethal despite therapy. Therefore preventive measures are paramount. DVT and PE contribute significantly to morbidity and mortality associated with critical illness. But VTE remains an underestimated problem in ICU patients, despite the findings of many randomized controlled trials performed in the fields of DVT prophylaxis during the past few decades This article reviews the risk of VTE in critical care patients, thromboprophylaxis and suggests strategies to reduce the burden of thrombo-embloic disease in critical care unit. Key words: Venous thromoboembolism; Intensive Care Unit. DOI: 10.3329/uhj.v5i2.4562 University Heart Journal Vol.5(2) July 2009 pp.84-88

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The Going Home Initiative: Getting Critical Care Patients Home With Hospice

Critical Care Nurse ◽

10.4037/ccn2011415 ◽

2011 ◽

Vol 31 (5) ◽

pp. 46-57 ◽

Cited By ~ 22

Author(s):

Paula Lusardi ◽

Paul Jodka ◽

Mark Stambovsky ◽

Beth Stadnicki ◽

Betty Babb ◽

...

Keyword(s):

Intensive Care Unit ◽

Palliative Care ◽

Critical Care ◽

Intensive Care ◽

Hospice Care ◽

Good Death ◽

Small Scale ◽

Considerable Effort ◽

The Past ◽

Critical Care Patients

Although considerable effort is being directed at providing patients and their families with a “good death,” most patients in intensive care units, if given the choice, would prefer to die at home. With little guidance from the literature, the palliative care committee of an intensive care unit developed guidelines to get patients home from the intensive care unit to die. In the past few years, the unit has transferred many patients home with hospice care, much to the delight of their families. Although several obstacles to achieving this goal exist, the unit has achieved success in a small-scale implementation of its Going Home Initiative.

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INVESTIGATING EFFECT OF NURSING INTERVENTIONS, BASED ON WELLS SCORE RESULTS, ON THE INCIDENCE OF DEEP VEIN THROMBOSIS IN PATIENTS ADMITTED TO THE INTENSIVE CARE UNIT

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2018.v11i5.24939 ◽

2018 ◽

Vol 11 (5) ◽

pp. 377

Author(s):

Morteza Habibi Moghadam ◽

Marzieh Asadizaker ◽

Simin Jahani ◽

Elham Maraghi ◽

Hakimeh Saadatifar ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Deep Vein Thrombosis ◽

Intervention Group ◽

Control Group ◽

Nursing Interventions ◽

Vein Thrombosis ◽

Wells Score ◽

Deep Vein ◽

Pitting Edema

Objective: Venous thromboembolism, including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common complaint in critically ill patients. Therefore, the present study was conducted to determine the effect of nursing interventions, based on the Wells results, on the incidence of DVT in intensive care unit (ICU) patients.Methods: The present clinical trial was conducted on 72 ICU patients without DVT and PE who met the inclusion criteria according to Wells score in Dr. Ganjavian Hospital, Dezful in 2012. The participants were investigated and randomly divided into intervention (n=36) and control groups (n=36). The intervention group received preventive nursing measures based on the risk level determined by the Wells score, and routine therapeutic interventions were performed for the control group. Then, patients were evaluated using Wells score, D-dimer testing, and Doppler sonography on the 1st, 5th, and 10th days. Data were finally coded and entered into SPSS version 23. Data analysis was performed using Chi-square, Fisher’s exact, and Mann–Whitney U tests.Results: The incidence of DVT in both groups showed that 2 patients of the control group who were identified to be at risk using the Wells score were diagnosed with DVT while none of the patients of the intervention group experienced DVT. The present study showed that 22.2% of the patients of the control group suffered from non-pitting edema, which was significantly different from the intervention group (p=0.005).Conclusion: The results of the present study showed that using the Wells score for early identification of the at-risk patients and nursing interventions based on this score’s results is helpful in the prevention of DVT. Appropriate nursing interventions were also effective in reducing the incidence of non-pitting edema in the lower extremities.

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Surveillance Ultrasound in the Neuro Intensive Care Unit: Time to Deep Vein Thrombosis Diagnosis

Neurocritical Care ◽

10.1007/s12028-018-0652-3 ◽

2018 ◽

Vol 30 (3) ◽

pp. 645-651

Author(s):

Kristi L. Hargrove ◽

Colleen A. Barthol ◽

Stefan Allen ◽

Crystal Franco-Martinez

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Deep Vein Thrombosis ◽

Vein Thrombosis ◽

Deep Vein

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Sonographic and Clinical Features of Upper Extremity Deep Venous Thrombosis in Critical Care Patients

Critical Care Research and Practice ◽

10.1155/2012/489135 ◽

2012 ◽

Vol 2012 ◽

pp. 1-8 ◽

Cited By ~ 2

Author(s):

Michael Blaivas ◽

Konstantinos Stefanidis ◽

Serafim Nanas ◽

John Poularas ◽

Mitchell Wachtel ◽

...

Keyword(s):

Risk Factors ◽

Critical Care ◽

Upper Extremity ◽

Strong Predictor ◽

Venous Catheter ◽

Acute Thrombosis ◽

Vein Thrombosis ◽

Therapeutic Anticoagulation ◽

Deep Vein ◽

Critical Care Patients

Background-Aim. Upper extremity deep vein thrombosis (UEDVT) is an increasingly recognized problem in the critically ill. We sought to identify the prevalence of and risk factors for UEDVT, and to characterize sonographically detected thrombi in the critical care setting.Patients and Methods. Three hundred and twenty patients receiving a subclavian or internal jugular central venous catheter (CVC) were included. When an UEDVT was detected, therapeutic anticoagulation was started. Additionally, a standardized ultrasound scan was performed to detect the extent of the thrombus. Images were interpreted offline by two independent readers.Results. Thirty-six (11.25%) patients had UEDVT and a complete scan was performed. One (2.7%) of these patients died, and 2 had pulmonary embolism (5.5%). Risk factors associated with UEDVT were presence of CVC [(odds ratio (OR) 2.716,P=0.007)], malignancy (OR 1.483,P=0.036), total parenteral nutrition (OR 1.399,P=0.035), hypercoagulable state (OR 1.284,P=0.045), and obesity (OR 1.191,P=0.049). Eight thrombi were chronic, and 28 were acute. We describe a new sonographic sign which characterized acute thrombosis: a double hyperechoic line at the interface between the thrombus and the venous wall; but its clinical significance remains to be defined.Conclusion. Presence of CVC was a strong predictor for the development of UEDVT in a cohort of critical care patients; however, the rate of subsequent PE and related mortality was low.

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