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Does incorporating a DVT risk assessment tool vs not using one decrease…
Does incorporating a DVT risk assessment tool vs not using one decrease the incidence of DVT's in patients?
DVT definition
DVT's are dangerous because they can detach and travel through the bloodstream to the lungs causing a pulmonary embolism which is when the arteries in the lungs become blocked due to a blood clot
S/S = leg pain or swelling, red discolored skin on leg, a feeling of warmth in the affected leg or may not notice any symptoms at all. If DVT leads to pulmonary embolism (PE) may see chest pain, SOB,lightheadedness and increased HR
DVT stands for deep vein thrombosis and it refers to abnormal coagulation in a deep vein that causes a blood clot to form
Risk assessment tools
Caprini RAM
Incorporates 40 risk factors and each is given a score of 1-5 points which then helps come up with a risk score (Zhang et al., 2020).
There are different risk factors listed and for each they may be worth different points to add up to your total score. For example age 41-60 is one point where hip, pelvis or leg fracture <1 mos ago is 5 points.
Other: Padua score, Kucher scale, RAP score
Autar Scale
Risk categories include: Age, BMI, physical mobility, particular DVT risks (contraceptive pill, pregnancy), trauma, surgery and high-risk disease (UC, sickle cell anemia, malignancy, varicose veins, etc) (Yin & Shan, 2015)
For each category there is a different amount of points broken down by patient condition. For example for the "age" category, patients 10-30 get zero points, patients 31-40 get 1 point, patients 41-50 get 2 points, patients 51-60 get 3 points and patients >61 get 4 points. (Yin & Shan, 2015).
Consists of 7 broad risk categories + 41 items total to decipher score
Who should be assessed?
Everyone in the hospital should be assessed for this, especially those with risk factors. This is something all nurses should be assessing for but a risk assessment tool may make it easier to predict the likelihood of each patient developing a DVT so proper prevention steps can be taken.
DVT risk factors
Risk factors include prolonged bed rest, birth control pills, after surgery, blood-clotting disorders, cancer, being overweight, smoking and more
Interventions based on level of DVT Risk
Caprini RAM
Low risk
Score of 0-1. No treatment was needed. Pts should perform ROM activities and other activities (Zhang et al, 2020)
Medium risk
Score of 2 is medium risk and score of 3-4 is high risk. Early ambulation, drug and/or physical prevention methods should be used (Zhang et al., 2020)
High risk
Very high risk
Score of >= 5. Both physical prevention methods and drug prophylaxis were used (Zhang et al., 2020).
Autar Scale
Low risk
Score of 7-10 points. Teach DVT prevention methods and have patients perform ROM exercises "such as flexing, stretching, and foot rotation" and encourage patients to get up and walk around if possible (Yin & Shan, 2015, p.179)
Moderate risk
Score of 11- 14 points. Pts will need SCDs, compression stockings, pharmacological prophylaxis (like Heparin) or a combination of those things in addition to education (Yin & Shan, 2015).
No risk
Score < 6 points. Educate patients --> tell pts to eat healthy, avoid wearing tight clothes, avoid sitting for prolonged periods and encourage exercise (Yin & Shan, 2015)
High Risk
Score of 15 points. Both mechanical and pharmacological prophylaxis is needed and the frequency of therapy should be increased (increase time SCDs are on or increase amount of Heparin received throughout the day) (Yin & Shan, 2015).
Prevalence statistics of DVT's in hospitals
These findings show that early risk assessment and prevention are super important in order to prevent DVT's from developing
When studied, "in the United States, about 478,000 fatal VTE events occurred each year. DVT often occurred in the lower limb vein. Studies had shown that 3/4 of DVT occurred in non-surgical patients of internal medicine and only 25% of patients who die of VTE in general hospitals had a recent surgical history" (Zhang et al., 2020, p.40)
Outcome of Studies/ Benefits of Risk Assessment Tool
These risk assessment tools can provide a standard assessment for all patients instead of each healthcare provider doing their own individual assessment where there could be room for error to misinterpret the patients risk of DVT
Early risk assessment and prevention of DVT's is super important
Both studies looked at showed the effectiveness of using a DVT risk assessment tool and reported them having a high predictive value for DVT. One study looked at the Autar scale while the other looked at the Caprini Model
With the first study, the "DVT incidence rate and the D-dimer level on postop day 3 in the intervention group were lower than that of the control group" (Yin & Shan, 2015, p. 179). The intervention group were assessed using the Autar DVT scale and given therapy based on their score while the control group received routine nursing only with no assessment scale used.
With the second study, they compared the predictive scores of DVT's using the Caprini model to the actual number of patients who developed DVT's. They found that the Caprini model "had a high predictive value for DVT and was suitable for clinical application" (Zhang et al., 2020, p. 44).
References
Zhang, X., Lu, W., & Shan, M. (2020). Predictive value of caprini venous thromboembolism risk assessment model for deep vein thrombosis in intensive care unit non-surgical patients. American Journal of Internal Medicine, 8(1), 40-44.
Yin, H.Z. & Shan, C. (2015). The effect of nursing intervention based on autar scale results to reduce deep vein thrombosis incidence in orthopaedic surgery patients. International Journal of Nursing Sciences, 2(2), 178-183
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