Venous thromboembolism risk and prophylaxis in a Saudi hospital

To evaluate the risk factors and physician's compliance to American College of Chest Physicians [ACCP] guidelines recommendations for venous thromboembolism [VTE] prevention at our hospital. This retrospective cohort study was conducted at King Abdulaziz Hospital, Al-Ahsa, Saudi Arabia from November 2009 to December 2009. We used the American College of Chest Physicians [ACCP] 2008 guidelines and Caprini's scores to assess VTE risk and to determine whether patients had received recommended prophylaxis. All hospital in-patients aged 15 years or above were assessed for risk of VTE by reviewing the hospital chart. A data sheet was developed to obtain the data on demographics, VTE prophylaxis medication, dose, route, duration, and associated risk factors. The primary endpoint was the rate of appropriate thromboprophylaxis. Nine hundred and sixty-eight patients were included. The mean age was 40 +/- 18.7 years, and 647 [66.8%] were women. According to the ACCP criteria, 547 [56.5%] patients were at risk for VTE. Of 210 patients that qualified for prophylaxis, 117 [55.7%] received some form of prophylaxis. However, 46 [39.3%] of them received ACCP-recommended VTE prophylaxis. In contrast, 25.6% of patients with no risk, according to Caprini score, had thromboprophylaxis prescribed. This study demonstrates that only a small proportion of eligible patients received the recommended VTE prophylaxis. Efforts should be made to develop strategies to improve patient safety practices

Central venous catheter practice in an adult intensive care setting in the eastern province of Saudi Arabia

To study the standard central venous catheter [CVC] practice in an adult intensive care unit [ICU] for potential improvement. This is a prospective descriptive study conducted in an adult ICU of the 300-bedded King Abdul- Aziz Hospital, Al Ahsa, Saudi Arabia. All consecutive patients admitted over 18 months [April 2007 to September 2008] were included. Details of CVCs, indications, complications, and patients' demographic information were recorded daily until CVCs were removed. Overall, 379 patients had 474 CVCs, which accounted for 3024 catheter-days, with a mean duration of 6.35 +/- 4.7 days [95% confidence intervals: 5.92-6.78]. The most common site of insertion was the internal jugular vein [230 [48.5%]]; 192 [40.5%] subclavian catheters, and 52 [11%] femoral. The CVC utilization ratio was 0.64. The catheter related local infection [CRLI] rate was 4.6 per 1000 catheter-day [the highest in the femoral site] and the catheter-related bloodstream infection [CRBSI] rate was 1.98 per 1000 catheter-day [the highest for the jugular route]. There were only a few mechanical complications including 2 pneumothoraces, 5 arterial cannulations, and a single significant catheter dislodgement causing respiratory failure. Our results suggest that the current CVC practice enabled us to keep the rate of complications low, which is comparable to international standards