Outline the nursing management for the prevention of deep vein thrombosis
Outline the nursing management for the prevention of deep vein thrombosis
Evidenced based patient safety project/Nursing Protocol and Procedures
Nursing Protocol and Procedures
Name: MCD Protocol
Scope: Organization-wide Page 1 of 12
Patient care is revised to meet the individual patient needs.
DISCLAIMER: This policy was developed solely for the use of Children’s Hospital of Chicago Medical Center and
its affiliates (“Medical Center”). The information contained herein shall not be relied upon by individuals or
entities outside Medical Center for accuracy, timeliness, or any other purpose.
PURPOSE:
To outline the nursing management for the prevention of deep vein thrombosis and venous
thromboembolism in patients who are thirteen years (13) of age or older.
DEFINITIONS:
Thromboembolism: Blood clot in an artery or vein is known as thromboembolism.
Deep Vein Thrombosis (DVT): Development of thrombosis in one of the deep veins of the
extremities, frequently the iliac or femoral veins or major upper extremity veins. These clots can
break off from the vein, travel through the heart, and lodge in the arteries of the lungs, causing a
potentially fatal pulmonary embolism.
Pulmonary Embolism (PE): A thrombus that breaks free from a vein, travels through the
veins, reaches the lungs, and lodges in a major or minor pulmonary vessel. A pulmonary
embolism is a potentially fatal condition that may cause death within minutes to hours.
Mechanical Compression device (MCD): A mechanical device that is used for pneumatic
compression, applied via a cuff that inflates and deflates uniformly. The cuff may be applied to
the extremity.
Thrombophlebitis: The formation of a venous clot accompanied by inflammation of the vein
wall. This may be the result of trauma to the vessel wall, hypercoagulability of the blood, or
infection. Intra or post-operative venous stasis, prolonged sitting, standing, or immobilization or
a long period of IV catheterization (eg. PICC line) may also cause thrombophlebitis.
Venous Thromboembolism (VTE): A condition including DVT and PE.
Venous thrombosis: A condition that occurs when a clot forms within a vein without
inflammation.
Nursing Protocol and Procedures
Name: MCD Protocol
Scope: Organization-wide Page 2 of 12
Patient care is revised to meet the individual patient needs.
DISCLAIMER: This policy was developed solely for the use of Children’s Hospital of Chicago Medical Center and
its affiliates (“Medical Center”). The information contained herein shall not be relied upon by individuals or
entities outside Medical Center for accuracy, timeliness, or any other purpose.
Supportive Data
The prevalence of blood clots in pediatric patients is on the rise. Nearly 80% of blood clots in
this population occur in the hospitalized setting and about 1 in 200 hospitalized pediatric patients
develop blood clots. Considering the long-term morbidity of blood clots, prevention is vital. It is
recommended that every child thirteen (13) years of age or older be assessed for the need of
MCD sleeves. If the patient is under the age of thirteen (13), application of MCD sleeves and
devices are per Physician/APN discretion only.
EQUIPMENT LIST:
Mechanical Compression Sleeves
Mechanical Compression Device
SECTION TITLES:
A. Pre-Procedural Patients
B. Intra-Procedural Patients
C. Post-Procedural Patients
D. Non-Procedural Patients
Nursing Protocol and Procedures
Name: MCD Protocol
Scope: Organization-wide Page 3 of 12
Patient care is revised to meet the individual patient needs.
DISCLAIMER: This policy was developed solely for the use of Children’s Hospital of Chicago Medical Center and
its affiliates (“Medical Center”). The information contained herein shall not be relied upon by individuals or
entities outside Medical Center for accuracy, timeliness, or any other purpose.
DVT Risk Factor Assessment Sheet
Directions: For patients 13 years of age or older review the risk factors listed below.
Total the number of Major and Minor Risk factors. YES = 1 point NO = 0 point
Major Risk Factor of 1 point or more = Place MCD Sleeves on the patient
Minor Risk Factor of 3 points or more = Place MCD Sleeves on the patient
Possible Risk Factors Yes / No
Major Risk Factors
Personal history of blood clot Yes / No
Personal history of known thrombophilia (clotting disorder) Yes / No
History of blood clots in immediate family (mother, father, brother, sisters, aunts, uncles, grandparents) Yes / No
Immobilization (bed ridden/wheel chair bound) for at least 72 hours prior to or following the
admission/procedure
Yes / No
Major orthopedic fractures: hip and/or pelvis Yes / No
Pregnancy or Post-Partum Period Yes / No
Morbid obesity (BMI >40 kg/m2) Yes / No
History of Anticoagulant Therapy Yes / No
TOTAL NUMBER OF MAJOR RISK FACTORS ________points
Minor Risk Factors
General Anesthesia Yes / No
Patient on Birth Control Pills / Hormone Therapy Yes / No
Scheduled Surgery time > 1hour Yes / No
Orthopedic fractures: Lower Extremity Yes / No
Disease etiology predisposing to DVT:
Crohn’s Disease/Ulcerative Colitis
Nephrotic Syndrome
SLE (Lupus)
Sepsis
Diabetes
Yes / No
Cancer Yes / No
Obesity (BMI>30- to 40 kg/m2 Yes / No
Scheduled surgery on the limb that has a central venous catheter Yes / No
Patients receiving Genitourinary, Gynecological or Extremity Surgeries Yes / No
TOTAL NUMBER OF MINOR RISK FACTORS ________points
Nursing Protocol and Procedures
Name: MCD Protocol
Scope: Organization-wide Page 4 of 12
Patient care is revised to meet the individual patient needs.
DISCLAIMER: This policy was developed solely for the use of Children’s Hospital of Chicago Medical Center and
its affiliates (“Medical Center”). The information contained herein shall not be relied upon by individuals or
entities outside Medical Center for accuracy, timeliness, or any other purpose.
CONTENT:
A. PRE-PROCEDURAL PATIENTS
STEPS NURSING MANAGEMENT
Assess the patient for risk
factors for DVT/VTE
The pre-procedure nurse (including all in-patient nurses) will
assess all patients thirteen (13) years of age or older using the
‘DVT Risk Factor Assessment Sheet’.
If the pre-procedure patient has any 1 or more Major Risk Factors
or has 3 or more Minor Risk Factors the patient is at risk for
DVT/VTE. Follow below steps.
Note: MCD use for patients under the age of thirteen (13) will be
to the discretion of the Physician/APN and will need an order
prior to application.
Locate and obtain
equipment and supplies.
Locate and obtain equipment and supplies:
• MCD sleeves can be obtained from Central Supply and on
the units’ equipment store rooms.
• MCD machines can be obtained from unit equipment store
rooms and VIP. They will also be stored in the Intra-
Procedural (OR) areas and in the PACU/Recovery areas.
Orders For In-Patient Nurses:
If patient meets criteria from DVT Risk Factor Assessment
Sheet obtain order from Physician/APN before placing MCD
sleeves on patient. If no order has been obtained before the
patient leaves the in-patient area place the MCD sleeves on
the patient’s bed.
For Procedural Department Nursing Staff:
No orders needed from Physician/APN if patient meets
minimum from DVT Risk Factor Assessment Sheet.
Note: If the patient is under the age of thirteen (13),
application of MCD sleeves is per Physician/APN orders only.
Nursing Protocol and Procedures
Name: MCD Protocol
Scope: Organization-wide Page 5 of 12
