Key Takeaways: 6 Critical Guideline Updates to Prevent of Venous Thromboembolism (VTE)

Revised Guideline for Prevention of Venous Thromboembolism (VTE)

The updated AORN Guideline for Prevention of Venous Thromboembolism (VTE) provides recommendations on creating and implementing a protocol to prevent VTE, including deep vein thrombosis (DVT), via mechanical and pharmacologic prophylaxis.

It also provides guidance on preventing pulmonary embolism resulting from deep vein thrombosis. DVTs can travel to the lungs, becoming a life-threatening pulmonary embolism. As patient safety is paramount, all perioperative nurses need to be aware of these updates.

New Recommendations

NURSE-DRIVEN PROTOCOLS

NEW: Evaluate the feasibility of implementing a nurse-driven protocol to improve adherence to mechanical VTE prophylaxis. 1.4.

EXPLANATION:

• Mechanical VTE prophylaxis requires an order from a licensed independent practitioner, and including a nurse-driven protocol in the organization’s VTE prophylaxis ordering process (e.g., order sets) can facilitate mechanical prophylaxis initiation. 1.4.
• The benefit of nurse-initiated mechanical VTE prophylaxis with intermittent pneumatic compression (IPC) likely outweighs the risk of no mechanical prophylaxis in surgical patients at risk for VTE. 1.4.1.

RISK ASSESSMENT

NEW: The individual preoperative VTE risk assessment should be initiated in advance of the day of surgery. 2.1.1.

EXPLANATION:

• Initiating the VTE risk assessment before the day of surgery allows the patient to participate. Significant VTE risk factors (e.g., family history of blood clots, history of thrombophilia) are more likely to be identified when the patient and patient’s health care advocate (e.g., family member) are included in the VTE risk assessment. 2.1.1.

NEW: Use a standardized, validated VTE risk assessment tool. 2.2.

EXPLANATION:

• Using a standardized VTE risk assessment tool facilitates improved accuracy of VTE risk assessment, promotes adherence to VTE prophylaxis according to a stratified risk profile, and supports communication among team members using a standardized understanding of VTE risk. 2.2.1.
• In surgical patient populations, the Caprini VTE risk assessment tool (i.e., Caprini risk assessment model) is the most widely used and extensively validated tool for VTE risk and has been incorporated into clinical guidelines on VTE prevention. 2.2.1.

PROPHYLAXIS

NEW: Ask the patient about religious or cultural concerns with pharmacologic VTE prophylaxis. 3.2.1.

EXPLANATION:

• Heparin-based medications can have animal origins and can be of concern to some patients because of their religious or cultural beliefs. 3.2.1.

NEW: Instruct the patient to perform foot and ankle exercises. 4.6.

• Foot and ankle exercises should not be a replacement for early and frequent postoperative ambulation. 4.6.1.

PATIENT & FAMILY EDUCATION

NEW: Begin patient education about VTE prevention before surgery. 6.1.2.

• Providing preoperative education with a VTE pamphlet in presurgical testing increased patient knowledge of VTE and use of postoperative mechanical prophylaxis. 6.1.2.
• A nurse-led preoperative patient DVT training session using a guidebook was found to increase the level of patient knowledge about DVT and the frequency of performing postoperative DVT self-care practices. 6.1.2.

Review the full AORN Guideline for Prevention of Venous Thromboembolism

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