Effect of implementing nursing guidelines on occurrence of deep venous thrombosis for critically iLL patients

ABSTRACT

Deep venous thrombosis [DVT] is a major health problem that results in significant morbidity and mortality for the critically ill patients in the critical care units. It was documented that DVT occurs in about two million Americans each year, whereas pulmonary embolism [PE] as a complication of DVT causes approximately 50.000 to 60.000 deaths. Moreover, it was revealed by a study done in Assuit University Hospital that out of 220 surgical patients, 12[5%] died with pulmonary embolism as a complication of DVT. Other research done at Alexandria University in El-Hadra Hospital on 50 orthopedic patients revealed that seven patients were detected with DVT, The critical care nurses are the key players in the prevention of DVT and its complications. They are in the ideal position to asses patient risk factors early and ask for DVT prophylaxis. The current study was carried out to evaluate the effect of implementing nursing guidelines on the occurrence of DVT for critically ill patients. Four critical care unites were used to collect the data for this study at Assuit University Hospital, sixty critically ill patients were included in this study, they were divided into two groups G1 [control group] and G2 [interventional group] 30 patients each. Two tools were used to collect the data of this study. Tool one "Patient's assessment for DVT, and Tool two the "DVT evaluation sheet". Findings of the current study revealed low incidence of DVT for the global sample, only two patients experienced DVT in the control group, and none of the interventional group experienced DVT. Moreover, it was observed that the preventive measures of DVT done by the critical care nurses for the control group using non-pharmacological and mechanical methods were not adequately performed. In addition, it was found that all the studied patients of control group did not wear the elastic stocking, while small proportion of this group performed leg exercises, changed their position, did deep breathing, and coughing exercises, and transfer on the chair. It was observed that most of the studied patients experienced low percent of DVT manifestations with no statistical significant difference between the both groups. The present study revealed also that nearly half of the studied patients were in moderate and high risk grades for DVT in the both groups. Based on the current study findings it can be recommended that this research should be repeated on a large sample size and in multi centers for generalization. Moreover, training programs should be established to update critical care nurses' knowledge and skills about DVT preventive measures, and how to use the technical skills to assess the occurrence of DVT using the evidence base nursing and medicine