Orthopedic
Orthopedic
Introduction
Deep vein thrombosis is a thrombus in a deep vein, and they usually form in the legs. DVT requires immediate medical care since they can easily break and travel through the bloodstreams to the lungs, blocking the blood supply to the lungs. Therefore, DVT is often life threatening, for instance pulmonary embolism. Thromboses often develop in the thigh and calf veins and rarely develop on the pelvic or arm veins. These, therefore, pose a lot of risks to the orthopedic patients.
Orthopedic patients are those patients who require treatment for deformities, fractures, and injuries or disease of some part of the musculoskeletal system. These patients normally require immobilization, surgery, or both to correct their condition.
Whether DVT Starts Before or After Surgery
DVT is a major problem facing patients who undergo lower extremities surgery. DVT contributing factors include stagnant blood flow through the veins (stasis), coagulation, and damage to the walls of the veins. Other factors include age, metastatic malignancy, previous history of DVT or PE, vein disease such as varicose veins, current pregnancy or estrogen usage, smoking, obesity and genetic disorders. Coagulation is enhanced by debris tissue, fats or collagen presence in the veins. These materials are often released into the blood stream during orthopedic surgery. For instance, preparing bone to receive the prosthesis and reaming during orthopedic surgery can release antigens that stimulate the formation of clot into the blood stream. On the other hand, stasis increases the time of contact between vein wall irregularities and blood, and it also prevents natural anticoagulants from mixing with blood. When immobility or bed rest is prolonged, stasis is promoted. Damage to the vein can occur as the physician retracts the soft tissues during surgery, and this can also make the intercellular bridges break and release substances that promote clotting of blood.
Preventing DVT in Orthopedic Patients
DVT may be asymptomatic and, therefore, sometimes it is difficult to detect. Physicians, therefore, focus on preventing their development by the use of drug therapies or mechanical therapies. If this preventive treatment is not given, nearly 80% of orthopedic surgery would develop DVT. DVT has remained the most cause of immediate readmission to hospitals and joint replacement related deaths. The designed used for preventing DVT is three dimensional approach which is designed to deal with stasis and coagulation issues. A combination of several therapies is usually used. For example, graded compression elastic stockings, and an external compression machine may be fitted to the patient upon admittance to the hospital. Rehabilitation and movement begin the first day after surgery and then continue for several months. In the night before surgery, anticoagulants may be began and continue up to the time the patient will be discharged from the hospital.
The aim of the DVT prophylaxis is to prevent the DVT disposing factors such as vein wall trauma or vein wall dilation, stasis, and hyper-coagulation. Breathing and mobilization exercise can be achieved by nurses encouraging leg exercises and mobilization of patients. Venous return can be achieved through breathing exercises and patients should be advised to be observant of signs or symptoms that suggest DVT and the concerned nurses should be informed. Anti-embolism stocking provide a continuous stimulation of blood of in a linear manner, prevent dilation of the veins and stimulate endothelial fibrinolytic activity. The stockings should be smooth when fitted, the heel patch should be in the correct position, and the toe hole should be in the toes. The thigh gusset should be on the inner thigh, and rolling down the stocking may have a tourniquet effect.
Anticoagulants, for example, low-molecular-weight heparin, which increases the action of anti-thrombin and inhibits coagulation proteins’ number, can be administered as a prophylactic dose. This is usually through subcutaneous injection, and a predicted anticoagulant response. Use of AES may be combined with anticoagulants in moderate risk patience to minimize the risks. Intermittent pneumatic compression is an established DVT prophylaxis method which has no risk of hemorrhagic complications. In the market, there are a variety of the IPC devices ranging from the thigh and calf cuffs to foot pumps. These may be combined with the use of low molecular weight heparin and AES in high risk patients. Careful observation should be given to the patients as anticoagulants can cause bleeding. Also, any side effects of thee anticoagulants should be reported. Platelet count should be checked since there is a small risk of heparin-induced thrombocytopenia for patients who have been given low molecular weight heparin. This checking should be done one week after the first dose of the LMWH has been given to the patient. A drop in the patient’s platelet count may obviously indicate HIT. Therefore, observation for local reactions at the injection sites should be made by nurses, and switching to another brand of LMWH can be facilitated.
Conclusion
Venous thrombo-embolism poses a great risk to trauma patients; therefore, effective prophylactic methods should be available for patients. Venous thromboembolism can be hard to detect. Therefore, prophylaxis is preferred to treatment. It is more cost effective to prevent DVT than the treatment. Legs’ veins thrombi may be asymptomatic or symptomatic, and they mostly originate from the distal veins, while some extent to the proximal veins. Proximal vein thrombosis the most serious, both grow and embolize emphasizing the need for DVT prophylaxis.
References
Frederick A., Jr. (2010). Best Practices Preventing Deep Vein Thrombosis and Pulmonary Embolism. Retrieved from, http://www.outcomes-umassmed.org/DVT/best_practice/, On December 18, 2012.
L. Walker and S. Lamont, (2008) “Graduated compression stockings to prevent deep vein thrombosis, ”Nursing Standard, vol. 22, no. 40, pp. 35–38.
A. Rahman, M. C. Colak, L. Üstünel, M. Koc, E. Kocakoc, and C. Colak, (2009) comparison of different treatment managements in acute deep vein thrombosis patients. Vol. 15, no. 11, pp. CR588–CR593.
B. Xu, (2010) “DVT in acute stroke: the use of graduated compression stockings,” Australian Family Physician, vol. 39, no. 7, pp. 485–487.
B. A. Levy, K. Dajani, (2009) Incidence of deep venous thrombosis after temporary joint spanning external fixation, Journal of trauma, vol. 66, no. 4, pp. 1164–1166.
Mont MA, Jacobs J., (2012). Clinical practice guideline: preventing venous thromboembolic disease in patients undergoing elective hip and knee arthroplasty, Retrieved from, http://www.jaapa.com/dvt-prophylaxis-with-aspirinin-orthopedic-surgery-patients/article/234028/ On December 18, 2012.
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