ABSTRACT
Background: The role of anticoagulation in preventing and treating thromboembolic events due to presence of micro thrombosis that may affect various end-organs especially in coronavirus disease-19 (COVID-19). Patients receiving some form of anticoagulation therapy are predisposed to more risks of bleeding complications. These bleeding may range from minor to major, or even life-threatening events. Purpose: Low molecular weight heparin (LMWH) is one of the commonly used treatment modalities in COVID-19 and its complications are thrombocytopenia, anemia, bruises, and the rare ones are ecchymosis and/ or hematoma. Case presentation: A 75-year-old male COVID-19 patient weighing 85 kg was admitted to our intensive care unit (ICU) with shortness of breath, dry cough, and myalgia. On the 10th day, he develops ecchymotic patches over the anterior abdominal wall following administration of subcutaneous enoxaparin. This case describes the importance ofindividualizing the dose ofLMWH based on several risk factors.
ABSTRACT
Background: Home visit service to dialysis patients has established in Queen Mary Hospital renal unit for long times. However, such service was suspended due to COVID-19 pandemic. Objectives: We decided to perform the home visit (HV) by zoom to evaluate patient's home performance to both peritoneal patients (PD) and home haemodialysis (HHD) patients. Methodology: 'Zoom' was chosen to perform HV and a pilot run was started in December 2020. For pre-zoom preparation, a workgroup was formed by dialysis nurses;HV checklists were modified from existing one;consent forms were revised;zoom apps were allowed to use after approved by the internet technology (IT) department;two instruction guides were prepared to nurses and patients / helpers and special cell phone / i-pad stabilizers were provided to patients. One trail run was conducted with nursing staff and two trail runs were conducted with PD patient volunteers. Results: 26 PD and 1 HHD zoom HV was done in December 2020. During zoom HV, patient's home environments;techniques;PD / HHD related knowledge were evaluated. Performance improvement advice were given to patients and caregivers before end of HV. 1 patient was found contamination of transfer set and need to return to hospital for treatment. Evaluation forms were prepared to patients and nurses. 24 patients were satisfied with the zoom HV arrangement and agreed that zoom was easy to manage. 17 patients disagreed that their performance would be affected by external factors and causing some distractions. All 6 nurses agreed that zoom HV were easy to manage and they were satisfied. 2 of them were distracted by external factors and 4 of them were neutral on this point. Conclusions: Zoom HV is a convenient way to assess patient's condition and performance at home when physical visit is restricted during COVID 19 pandemic.