Risk Assessment for Non-Bariatric Surgical Patients 12-17 years old 1.0 DEFINITIONS 1.1. Altered mobility: A permanent or temporary state in which the patient is unable to ambulate freely, corresponds to a Braden Q scale for mobility 1-3 or activity 1-2. 1.2. Deep Vein Thrombosis (DVT): A thrombus in a deep vein. 1.3. Graduated Compression Stocking (GCS): Elastic stockings, either knee- or thigh-high, also known as TED hose. 1.4. Risk category: Refer to VTE Risk Factors algorithm below 1.4.1. Low risk: No VTE risk factors 1.4.2. Moderate risk: Multiple risk factors for VTE in the absence of altered mobility or has altered mobility with one or fewer additional risk factors. 1.4.3. High risk: Altered mobility plus two or more additional risk factors 1.5. Sequential Compression Device (SCD): A device designed to intermittently squeeze blood from underlying deep veins in the leg upon compression of an inflatable sleeve, and to allow the blood to flow again when it decompresses. 1.6. Venous Thromboembolism (VTE): A thrombus in a vein or one that has broken free and is carried in the bloodstream (embolus). 2.0 GUIDELINE 2.1. It is recommended that patient’s age 12-17 years be assessed for VTE risk factors, and based on that assessment, assigned to a risk category (low, moderate, high) using the VTE Risk Assessment & Prevention flowsheet in EPIC. 2.1.1. Nursing will complete the VTE Risk Assessment & Prevention flowsheet in EPIC at the time of inpatient admission, including in Same Day prior to surgery, and automatically place SCDs if indicated. 2.1.2. Reassessed at 24 hours of hospitalization by nursing staff. 2.1.3. This should be documented in the patient’s medical record in the VTE Risk Assessment & Prevention flowsheet in EPIC. 2.2. It is recommended that VTE prophylaxis be administered based on risk category as soon as feasible, but within 24 hours of assessment, unless there are contraindications (See below). 2.3. If planning to initiate Lovenox prophylaxis, it is recommended: 2.3.1. In surgical patients to seek surgical input regarding bleeding risk prior to initiation 2.3.2. Obtain Hematology consultation when considering alternative pharmacologic agents.
Venous Thromboembolism (VTE) Prophylaxis Page 2 of 3 VTE Prevention Intervention Based on VTE Risk Assessment 1 Baseline Mobility: usual state of mobility Altered Mobility: inability to ambulate freely, corresponds to a Braden Q scale for mobility 1-3 or activity 1-2 2 VTE Risk Factors: • Critically ill (in the intensive care unit) • Presence of a Central Venous Catheter (PICC, non-tunneled or tunneled) • Obesity (BMI >95th percentile for age) • Major Trauma (>1 extremity, pelvis or spine injury) • Active cancer/malignancy • Acute systemic infection/sepsis • Chronic Inflammatory disorder (IBD, Lupus) • Cyanotic heart disease • Estrogen therapy • Thrombophilic/Clotting disorder • Personal history of blood clots • Recent invasive surgery within past 30 days • Family history of clots in 1st degree relative 3Prophylactic Anticoagulation: utilize a form of low molecular weight heparin or subcutaneous unfractionated heparin. If a patient is already on other forms of anticoagulants no additional prophylactic anticoagulation is needed. Aspirin or other antiplatelet therapy is not considered VTE prophylaxis.
LOW RISK MODERATE RISK HIGH RISK Mobility Status1 Baseline Baseline Altered Altered Number of VTE Risk Factors2 0 1 or more 0-1 2 or more Interventions: with no contraindications present o Encourage highest degree of mobility Yes Yes Yes Yes o Sequential Compression Device (SCD) - Yes Yes Yes o Prophylactic Anticoagulation3 - - - Consider
Venous Thromboembolism (VTE) Prophylaxis Page 3 of 3
3.0 REFERENCES 4.1 Petty, J. K. (2017). Venous thromboembolism prophylaxis in the pediatric trauma patient. Seminars in Pediatric Surgery, 26, 14-20. 4.2 Mahajerin, A., Petty, J., Hanson, S. J., Thompson, A. J., O’Brien, S. H., Streck, C. J., . . . Faustino, V. S. (2016). Prophylaxis against venous thromboembolism in pediatric trauma: A practice management guideline from the Eastern Association for the Surgery of Trauma and the Pediatric Trauma Society. Journal of Trauma and Acute Care Surgery, 82(3), 627-636. 4.3 Landisch, R. M., Hanson, S. J., Cassidy, L. D., Braun, K., Punzalan, R. C., & Gourlay, D. M. (2016). Evaluation of guidelines for injured children at high risk for venous thromboembolism: A prospective observational study. Journal of Trauma and Acute Care Surgery, 82(5), 836-844.
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