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VENOUS THROMBOEMBOLISM PROPHYLAXIS

Best Practices for Prevention (ACCP 2012, ISCI 2012, NICE 2015)

  1. Give low-molecular-weight heparin, unfractionated heparin, or fondaparinux to acutely ill patients at increased risk1 of DVT

  2. Use mechanical thromboprophylaxis (intermittent pneumatic compression or graded compression stockings) if at high risk for major bleeding2

  3. Do not use any prophylaxis for acutely ill patients at low risk of VTE

Sources:

  1. ACCP 2012: Kahn SR, Lim W, Dunn A, et al. Prevention of VTE in nonsurgical patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141:e195S–e226S. [https://guidelines.gov/summaries/summary/35263]

  2. ISCI 2012: Kalliainen JS, Adebayo L, Agarwal Z, et al. Institute for Clinical Systems Improvement. Venous thromboembolism prophylaxis. 2012. [https://www.qualitymeasures.ahrq.gov/summaries/summary/39365]

  3. NICE 2015: Venous thromboembolism: reducing the risk for patients in hospital. National Institute for Health and Care Excellence. 2015. [https://www.nice.org.uk/Guidance/CG92]

  4. J Thromb Haemost 2010: Barbar S, Noventa F, Rossetto V, et al. A risk assessment model for the identification of hospitalized patients at risk for venous thromboembolism: the Padua prediction score. J Thromb Haemost. 2010;8:2450–2457. [https://www.ncbi.nlm.nih.gov/pubmed/20738765]

1A Padua prediction score ≥4 suggests a patient at high risk who could benefit from prophylaxis. The score assigns 3 points each for active cancer, previous DVT, reduced mobility, known thrombophilic condition; 2 points for trauma and/or surgery in the past month; and 1 point each for age ≥70 years, heart and/or respiratory failure, acute MI or ischemic stroke, acute infection and/or rheumatologic disorder, BMI ≥30, and ongoing hormonal treatment (J Thromb Haemost. 2010).

2Significant risk factors for major bleeding include active gastroduodenal ulcer, bleeding actively or in the 3 months prior to admission, thrombocytopenia, elderly age, liver failure with elevated INR, renal insufficiency, acute stroke, uncontrolled systolic hypertension.

PRESSURE ULCERS

Best Practices for Prevention (ACP 2015, NICE 2015)

  1. Perform a risk assessment on every patient

  2. Use advanced static foam mattresses or overlays in patients at increased risk for pressure ulcers

  3. Do not use alternating air mattresses; they do not work better than static mattresses but cost more

  4. Turn high-risk patients frequently, at least every 6 hours

Sources:

  1. ACP 2015: Qaseem A, Mir T, Starkey M, Denberg T. Risk assessment and prevention of pressure ulcers: a clinical practice guideline from the American College of Physicians. Ann Internal Med. 2015;162:359–369. [https://www.guideline.gov/summaries/summary/49050]

  2. NICE 2015: Pressure ulcers: prevention and management. National Institute for Health and Care Excellence. 2014. [nice.org.uk/guidance/cg179]

CATHETER-RELATED BLOODSTREAM INFECTIONS

Best Practices for Prevention (IDSA/CDC 2011)

  1. Use a subclavian vein3 rather than jugular or femoral for nontunneled central venous access

  2. Promptly remove any catheter that is not essential; replace catheters placed under questionable aseptic technique within ...

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