Introduction of Topic
Burden of Deep Vein Thrombosis
Deep vein thrombosis is a severe preventable cause of morbidity-mortality around the globe. This disease is so silent hence difficult in diagnosing it and so it is seen as a significant challenge regarding diagnosis. The Little level of clinical suspicion and higher incidence and fatality makes deep vein thrombosis a grave concern to the world (Jaff, et al, 2011). In the United States, 1 to 2 in every 1,000 people is likely to be affect by deep vein thrombosis annually. There is also an estimation that up to 100,000 Americans scampers to this disease every year (Jaff, et al, 2011). On the other side, the mortality rate is high (up to 30%) and research states up to 27% of people with deep vein thrombosis suddenly die even before they reach the hospital.
Cause of Deep Vein Thrombosis
Deep vein thrombosis is caused by a blood clot which forms in the veins deeply located in the body, more likely veins located deep in the legs or thighs (Chan, Spencer & Ginsbergm, 2010). A blood clot may occur due to restricted blood circulation or injuries (both physical and biological) which may damage the inner lining of the veins (Jaff, et al, 2011). The clot forming in the deep veins of the leg may break and move to the lungs where it develops a serious condition called pulmonary embolism. Also, a blood clot may arise due to conditions such as trauma, prolonged bed rest, or surgery.
Deep vein thrombosis is likely to be present during long periods of immobility. Individuals taking long journeys either by train or car and those overstaying in the hospital due to severe illness are more likely to experience this disease (Chan, Spencer & Ginsbergm, 2010).
Deep vein thrombosis affects air travelers too, especially those taking a flight for the first time (Chan, Spencer & Ginsbergm, 2010). Research also indicates over 40% of patients undergoing major bone surgery are more likely to be affected by deep vein thrombosis disease.
Deep vein thrombosis causes a lot of pain and swelling in the legs when it occurs. The pain and swelling symptoms should not be relied upon since deep vein thrombosis may occur without any warning signs (Chan, Spencer & Ginsbergm, 2010). The condition can be worse when a blood clot travels to the lungs forming pulmonary embolism which further cause pain in the chest and shortness in breath (Jaff, et al, 2011). Deep vein thrombosis can severely damage the lungs killing people on the spot before even medical attention arrives at the patient. For this reason, deep vein thrombosis should be fought by almost every individual for a full eradication.
Distribution of Deep Vein Thrombosis
Deep vein thrombosis distributions to people base on several factors including history as nearly 30% of patients who have had a blood clot in the past are likely to have it again (Jaff, et al, 2011). Children born of parents who have had deep vein thrombosis are at a higher risk of experiencing the blood clot (Jaff, et al, 2011). Age is another factor in the distribution of this disease. In this case, older persons, past 40 years are likely to get deep vein thrombosis (Chan, Spencer & Ginsbergm, 2010). People sitting or resting on the bed for a long time typically experience deep vein thrombosis. Blood circulation in the deep veins depends on muscle movements and so sitting or sleeping for long makes blood to pool in the legs resulting to a clot (Jaff, et al, 2011). Pregnant mothers and those who have just given birth are at higher a risk of getting deep vein thrombosis. The levels of estrogen rise in pregnant women, and it may result to the blood clot. Birth control pills and hormone replacement therapy also contribute to the distribution of deep vein thrombosis as they contain estrogen (Jaff, et al, 2011). Weight is also a critical factor in the distribution of deep vein thrombosis. High body mass index means high chances of your blood getting a clot (Chan, Spencer, Ginsbergm, 2010). Lastly, individuals at high risk of experiencing deep vein thrombosis are those who have other health issues such as lung disease, heart disease, or inflammatory diseases (Chan, Spencer, Ginsbergm, 2010). Research also indicates that people with cancer are likely to get this disease.
Clinical or Medical Interventions
Clinical/medical interventions are professional activities aimed at improving the quality use of medicines and recommendations which may bring change in the medical therapy of patients and medical taking behavior performed by registered medical personnel (Goodacre, et al, 2006). Treatments carried out on the deep vein thrombosis are aimed at preventing pulmonary embolism, morbidity reduction, and minimization of chances of deep vein thrombosis occurring again (Goodacre, et al, 2006). Deep vein thrombosis clinical interventions and treatment are designed to prevent the disease occurrence. The responses base on the prophylaxis guidelines which by healthcare providers must complied with (Goodacre, et al, 2006). Research reflects that over 125, 000 surgical patients demonstrated the rate of compliance with less than 13% individuals not complying. Clearly, this indicates that improvement on complies should address (Agnelli et al, 2006). Medical experts must intervene and fully comply with the prophylaxis prescribing effecting therapy to their patients.
I have chosen mechanical and pharmacological prophylaxis as clinical interventions used for deep vein thrombosis. Mechanical prophylaxis uses three methods to combat motionless blood. These methods are intermittent pneumatic compression devices (IPCD), Anti-embolism stockings/Graduated compression stockings (GCS), and Foot impulse devices, also known as foot pumps (FID) (Goodacre, et al, 2006). These three methods have no difference in their effectiveness, and so they are combined to produce the results. They use both the passive and active mechanical method to reduce the risk 0of deep vein embolism (Goodacre, et al, 2006). The Pharmacological prophylaxis, on the other hand, uses different approaches to arrive at its effectiveness. These procedures include but not limited to Fondaparinux, Heparins, and vitamin K antagonists.
Summary of data on efficacy for all hospitalized patients with deep vein thrombosis and pulmonary embolism located at gives the relevant evidence. The data results show comparison leaving gaps for where no studies are carried out. The most efficient method is bolded, and a dash indicates no data collection (Goodacre, et al, 2006). Pieces of evidence from the data show that mechanical and different approaches of the pharmacological prophylaxis have an excellent efficacy in decreasing deep vein thrombosis risk. (Agnelli et al, 2006). We are, however, unable to draw a clear conclusion about the comparative effectiveness of these methods as there in some areas significant differences are shown and not in others and so the data used in this case is only aimed at ranking deep vein thrombosis prophylaxis methods in order of effectiveness.
There are graded recommendations to these clinical interventions. The first proposal covers general use of mechanical prophylaxis. Recommendation: the choice of mechanical prophylaxis base on the patient’s clinical, surgical or preference factors (Agnelli et al, 2006). Any of the mechanical methods mentioned above give evidence for the chosen case. Encouraging patients' anti-embolism stockings every day up to the time they will not experience decreased mobility is also a recommendation in this case (Goodacre, et al, 2006). Recommendation on the pharmacological prophylaxis is that while choosing pharmacological agents, patient factors and local policies need an explicit consideration
Education Intervention
Educational intervention for deep vein thrombosis seeks to reform the practices by influencing both the intellectual and physical aspects of the disease. Deep vein thrombosis is a serious cause of morbidity and mortality to patients in hospitals (Lewis, 2007). In this case, an education intervention bases its facts on a nursing program aiming at a reduction incident of deep vein thrombosis to pregnant women in hospitals (Kehl-Pruett, 2006). Past studies powerfully support education on deep vein thrombosis prevention as an inhibition on the disease promotes policies like early ambulation encouraging self-assessments and reporting of deep vein thrombosis symptoms.
The research aims at measuring effects of nursing programs that are educative which reduces incidence of deep vein thrombosis on a population of post-delivery outpatient mother clinics. A randomized but controlled method used 500 post-partum mothers (Lewis, 2007). The population was randomly divided into two groups. The first group was the intervention groups and the other was a controlled group (Kehl-Pruett, 2006). Intervention groups received education on deep vein thrombosis nursing program whereas, the controlled group received hospital routine care on post-delivery mothers.
The results located at indicated that the number of women who received education experienced little to know new cases on deep vein thrombosis while those who received routine education on hospital healthcare experiences a higher number of new cases. By receiving knowledge on deep vein thrombosis using nursing program about post-delivery women, the educated mothers improved on implementation hence reduced risk of deep vein thrombosis (Kehl-Pruett, 2006). The finding of the study indicates that a nursing program about deep vein thrombosis is very vital in giving relevant education and that the whole population will benefit from the program.
The results of the study shows more than 35% of post-delivery women were illiterate as far as deep vein thrombosis is concerned (Lewis, 2007). The women, more specifically house wives are ignorant on the subject matter (above 80% of those who participated in the study). The histories of women researched on shows about 40% of those delivering are not aware of the deep vein thrombosis disease and so they are likely to suffer from it unknowingly (Kehl-Pruett, 2006). At risk of experiencing deep vein thrombosis disease are those undergoing caesarian delivery (above 45%). An explanation of these results will be, education intervention is key as it enlighten the masses. This is especially important as an enlightened community will stand out to be counted.
Education intervention gave the following as its recommendations. More research should be carried out by nurses and other healthcare providers to enable them provide relevant education to the patient and community concerning deep vein thrombosis (Lewis, 2007). According to the study, there is need to improve on resources which encourages nurses and other medical experts in educating patients and population about deep vein thrombosis.
Regulatory Legislative Intervention
Zero tolerance for deep vein thrombosis; centers for Medicare and Medicaid Services (CMS) has a declaration of non-reimbursement of preventable events for deep vein thrombosis upon the affected succumbing to the illness (Hoshi et al, 2011). Retention of foreign bodies, blood incompatibility, falling from bed by the patients is among the listed examples of the cases in point highlighted by this policy. The CMS is considering making the list long by adding PE and DVT.
The arguments by CMS, on the issue though do not agree with wrong site surgery policy and as such are never the predetermined events. Putting in place of all the recommended prophylaxis optimum and the associated thrombosis complications would assure the population of attaining the zero deep vein thrombosis goals by CMS (Hoshi et al, 2011). Surveillance bias policy in deep vein thrombosis; the presence of conflicting issues on deep vein thrombosis from the criticisms and endless debates on screening of asymptomatic patients with the trauma has made the deep vein thrombosis screening to be on high risk (Hoshi et al, 2011). The policy recommends for regular screening of people in prevalent region. The screen according to the policy is cost effective but criticism in the medic world is a direct opposite of the CMS findings.
Duplex screening by ultra sound is the most revered. It is also clear in the policy that deep vein thrombosis screening should meet the duplex imaging for ultra sound (Hoshi et al, 2011). Hospital Responsibility for deep vein thrombosis risk assessment on patients Hospitals from all levels are recommended to equip with tools for VTE (deep vein thrombosis) risk strategy (Viswanatha, 2012). The equipment for risk strategy should comply with the improved VTE prophylaxis. The hospital for instance Johns Hopkins Hospital have met the requirements from the CMS. The equipment documentation should come in line with prophylaxis order. The hospitals implementation of the policy would reduce the risk factors associated with deep vein thrombosis.
Studies conducted on deep vein thrombosis powerfully support laws and policies which govern healthcare providers as far as the disease is concerned. More than 30% of a population screened for deep vein thrombosis shows a great reduction in the disease as compared to those who are not screened (Viswanatha, 2012). Law interventions for deep vein thrombosis, based on the findings from a small population is of great importance as it helps in regulations of policies safeguarding patients in the long run.
Legislative intervention for deep vein thrombosis seeks to reform the practices by influencing both the intellectual ignorant members of the society as far as deep vein thrombosis is concerned. Deep vein thrombosis is a serious cause of morbidity and mortality to patients in hospitals (Lewis, 2007). In this case, legislative intervention bases its facts on a all the laws and policies aimed at reducing incident of deep vein thrombosis to both in hospitals and home care units. (Kehl-Pruett, 2006). Research support legislation on deep vein thrombosis prevention as an inhibition on the disease promotes policies like early ambulation encouraging self-assessments and reporting of deep vein thrombosis symptoms. Nurses and other medical experts should follow all the laws and policies to the letter as this is recommendation posed by legislative intension.
In conclusion, deep vein thrombosis poses a major thread to the society. The condition is more serious to pregnant mothers and people resting for long times without moving. Education, nursing intervention, and law intervention should be in the forefront so as to eradicate this condition fully. Funds should also be availed to nurses to enable them conduct research on deep vein thrombosis as they are the primary caregivers. By so doing, we shall fully fight the disease.
References
Agnelli, G., Bolis, G., Capussotti, L., Scarpa, R. M., Tonelli, F., Bonizzoni, E., & Valarani, B. (2006). A clinical outcome-based prospective study on venous thromboembolism after cancer surgery: the@ RISTOS project. Annals of surgery, 243(1), 89-95.
Chan, W. S., Spencer, F. A., & Ginsbergm, J. S. (2010). Anatomic distribution of deep vein thrombosis in pregnancy. Canadian Medical Association Journal, 182(7), 657-660.
DCCN; 25:53-8.-Lewis G (2007): Saving Mothers’ lives: Reviewing maternal deaths to make motherhood safer- 2003-2005. Confidential Enquiry into maternal and child Health: The sixth report of the confidential Enquiries into Maternal Death in the United Kingdom. London: RCOG Press.
Goodacre, S., Sampson, F., Stevenson, M., Wailoo, A., Sutton, A., Thomas, S., & Ryan, A. (2006). Measurement of the clinical and cost-effectiveness of non-invasive diagnostic testing strategies for deep vein thrombosis
Hoshi, A., Matsumoto, A., Chung, J., Isozumi, Y., & Koyama, T. (2011). Activation of coagulation by a thalidomide-based regimen. Blood Coagulation & Fibrinolysis, 22(6), 532-540.
Jaff, M. R., McMurtry, M. S., Archer, S. L., Cushman, M., Goldenberg, N., Goldhaber, S. Z., & Vedantham, S. (2011). Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension. Circulation, 123(16), 1788-1830.
Kehl-Pruett, W (2006): Deep vein thrombosis in hospitalized patients: a review of evidence-based guidelines for prevention.
Viswanatha, G. L., Mohamed, R., Rajesh, S., Sandeep, R. S., Mohammed, A., Anturlikar, S. D., & Patki, P. S. (2012). Anti-platelet and Anti-thrombotic Effects of a Poly-ingredient formulation: In vitro and in vivo experimental evidences. Oman Med J, 27(6), 10-5001.
