Cardinal Health

Preventing Venous Thromboembolism: A Healthcare Professional Guide to Intervention 9 Stasis: Abnormalties of Flow Intervention Related Patient Related • Immobilisation - External fixation - Paralysis (stroke, spinal cord injury) - Partial weight bearing • Dehydration or blood loss • Intraoperative patient positioning • Laparoscopic procedures • Major surgery or trauma • Assisted delivery or C-section • Previous DVT/PE • Increasing age • Obesity (BMI>30kg/m 2 ) • Malignancy • Varicose veins / chronic venous stasis • Long distance travel • Pregnancy and postpartum • Acute medical illness (e.g. myocardial infarction, heart or respiratory failure) Mechanism of Action (IPC, FIT and GCS) IPC, FIT and GCS increase blood flow velocity IPC maximises blood flow by mimicking muscle contractions FIT maximises blood flow by mimicking the processes which occur during weight bearing ambulation IPC prevents distal trapping and ensures clearance of blood from behind valve cusps and soleal sinuses Hypercoagulability Intervention Related Patient Related • Trauma, injury, surgery • Dehydration • Excessive blood loss • Blood transfusion • Hormone therapy • Oral contraceptives • Assisted Reproduction • Increasing age • Disseminated Intravascular Coagulation • Heparin-Induced Thrombocytopenia • Hyperfibrinogenemia • Thrombophilia (inherited or acquired) • Obesity (BMI>30kg/m2) • Malignancy or cancer related treatments • Autoimmune disorders • Acute infection • Pregnancy and postpartum • Inflammatory conditions (e.g. inflammatory bowel disease) Mechanism of Action (IPC, FIT & Anticoagulants) FIT stimulates the release of endothelial derived relaxing factor (ERDF) which inhibits platelet aggregation IPC increases fibrinolytic activity Anticoagulants inhibit various phases of the coagulation pathway Vessel Wall Damage Intervention Related Patient Related • Venous distension - Extra circulating volume - Effect of anaesthetic • Trauma, injury, surgery • IV injection of irritants • Pacemaker wires • Central and peripheral venous access • Venous distension - Hormone mediated (preeclampsia) - Sepsis - Spinal cord injury • Previous DVT/PE • Varicose veins • Smoking Mechanism of Action (GCS) GCS reduce micro-tears secondary to venous distension GCS reduce venous distension resulting from various intervention and patient related factors such as those mentioned above Please Note: GCS – Graduated Compression Stockings (e.g. T.E.D.) increases blood flow velocity, minimise venous distension and reduce likelihood of vessel wall damage by limiting micro- tears from venous dilation. IPC – Intermittent Pneumatic Compression (e.g. SCDs) enhances venous return and increases fibrinolytic activity whilst clearing blood behind valve cusps. FIT – Foot Impulse Technology (e.g. A-V Impulse) increases venous return and stimulates release of Endothelial Derived Relaxing Factor (ERDF) which inhibits platelet aggregation. FIT has been shown to enhance circulation to reduce lower limb pain and oedema after surgery. Virchow’s Triad. Causal Factors for Venous Thromboembolism. Vessel Wall Damage Coagulation Changes Stasis Virchow’s Triad