2.50
Hdl Handle:
http://hdl.handle.net/10755/203167
Type:
Presentation
Title:
Best Practices in The Use of Vena Cava Filters to Prevent Pulmonary Emboli in Trauma Patients
Abstract:
(Summer Institute) Problem: The development of a deep venous thrombosis (DVT) and subsequent pulmonary embolism (PE) can have catastrophic implications including death. This project describes the unique characteristics of trauma patients and how the injuries they suffer may set up a cascade of events that leads to a fatal PE. Evidence: Fifteen databases were queried. The search resulted in 55 papers of which 12 were subsequently selected for analysis. This included one meta-analysis, two Level 3, five Level 4, and four Level 5 studies. Strategy: This project identified certain patient characteristics by utilizing a Risk Assessment Tool. There are unique characteristics and injury patterns in trauma patients that may make chemoprophylaxis for DVT contraindicated. The question is can we identify these patient characteristics early, and prophylactically place a VCF thereby reducing the incidence of fatal PE's Practice Change: This project seeks to determine best practices in the decision to consider the placement of a VCF early in the hospital course. The incidence of PE's among the adult trauma patient population at one Level 1 Trauma Center will be monitored for a two-year period and an analysis will be completed at that time to evaluate the effectiveness of this early and potentially life-saving intervention. Evaluation: The intervention is the early placement of a VCF in adult trauma patients that have a contraindication to chemoprophylaxis. The outcome will be the absence of a fatal PE or the development of a symptomatic non-fatal PE. The indicators utilized will be from the trauma registry databank and will be measured every six months. Results: Analysis is ongoing however to date there have been no fatal PE's reported on patients where an IVC filter was placed within 72 hours of admission. Recommendations: Continue to follow the standard practice guideline for early placement of IVC filters in high risk adult trauma patients. Lessons Learned: Mortality can be decreased by the review and implementation of new and innovative ideas in trauma care. Bibliography: Aito, S., Abbate, R., Marcucci, R., & Cominelli, E. (2007). Endogenous risk factors for deep vein thrombosis in patients with acute spinal cord injuries. Spinal Cord, 45(9), 627-631. Carter, Y.M., Caps, M.T., & Meissner, M.H. (2002). Deep venous thrombosis and ABO blood group are unrelated in trauma patients. Journal of Trauma, Injury, Infection & Critical Care, 52(1), 112-116. Cherry, R. A., Nichols, P. A., Snavely, T. M., David, M. T., & Lynch, F. C. (2008). Prophylactic inferior vena cava filters: Do they make a difference in trauma patients? Journal of Trauma, Injury, Infection and Critical Care, 65(3), 544-548. Cornwell, E.E., Chang, D., Velmahos, G., Jindal, A., Baker, D., Phillips, J…. & Campbell, K. (2002). Compliance with sequential compression device prophylaxis in at-risk trauma patients: a prospective analysis. American Surgeon, 68(5), 470-473. Denson, K., Morgan, D., Cunningham, R., Nigliazzo, A., Brackett, D…. & Albrecht, R. (2007). Incidence of venous thromboembolism in patients with traumatic brain injury. American Journal of Surgery, 193(3), 380-383. Dobesh, P. P. (2009). Economic burden of venous thromboembolism in hospitalized patients. Pharmacotherapy, 29(8), 943-953. Gosin, J.S., Graham, A.M., Ciocca, R.G., & Hammond, J.S. (1997). Efficacy of prophylactic vena cava filters in high-risk trauma patients. Annals of Vascular Surgery, 11(1),100-105. Haddadian, B., Shaikh, F., Djelmami-Hani, M., & Shalev, Y. (2008). Sudden cardiac death caused by migration of a TrapEase inferior vena cava filter: case report and review of the literature. Clinical Cardiology, 31(2), 84-87. Haut, E.R., Noll, K., Efron, D.T., Berenholz, S.M., Haider, A., & Cornwell, E.E. (2007). Can increased incidence of deep vein thrombosis (DVT) be used as a marker of quality of care in the absence of standardized screening? The potential effect of surveillance bias on reported DVT rates after trauma. Journal of Trauma, Injury, Infection and Critical Care, 63(5):1132-1135; discussion 1135-1137. Huseynova, K., Xiong, W., Ray, J. G., Ahmed, N., & Nathens, A. (2009). Venous thromboembolism as a marker of quality of care in trauma. Journal of the American College of Surgeons, 208(4), 547-552. Jacobs, David J., & Sing, Ronald F. (2003). The role of vena caval filters in the management of venous thromboembolism. The American Surgeon, 69(8), 635-642. Joels, C.S., Sing, R. F., & Heniford, B. T. (2003). Complications of inferior vena cava filters. The American Surgeon, 69(8), 654-659. Kercher, Kent, & Sing, Ronald F. (2003). Overview of Current Inferior Vena Cava Filters. The American Surgeon, 69(8), 643-653. Knudson, M. M., Ikossi, D. G., Khaw, L., Morabito, D., & Speetzen, L. S. (2004). Thromboembolism after trauma. Annals of Surgery, 240(3), 490-498. Langan, E.M., Miller, R.S., Casey, W.J., Carsten, C.G., Graham, R.M., & Taylor, S.M. (1999). Prophylactic inferior vena cava filters in trauma patients at high risk: follow-up examination and risk/benefit assessment. Journal of Vascular Surgery, 30(3), 484-488. Lu, Y., Ma, B., Guo, R., Wang, Y., Zhang, J., Wu, Y., Pang, G., Xin, J., …& Fletcher, J. (2007). Deep vein thrombosis in trauma: a prospective study of lower limb orthopedic trauma patients in Tianjin Hospital, China. International Angiology, 26(2), 165-170. Melnyk, B. M., & Fineout-Overholt, E. (2005). Making the case for evidence-based practice. In Evidence-Based Practice in Nursing and Healthcare. A Guide to Best Practice (p. 10). Philadelphia, PA: Lippincott Williams & Wilkins. Menaker, J., Stein, D. M., & Scalea, T. M. (2009). Pulmonary embolism after injury: More common than we think? Journal of Trauma, Injury, Infection, and Critical Care, 67(6), 1244-1249. Meissner, M.H., Chandler, W.L., & Elliott, J.S. (2003). Venous thromboembolism in trauma: a local manifestation of systemic hypercoagulability? Journal of Trauma, Injury, Infection & Critical Care, 54(2), 224-231. Paffrath, T., Wafaisade, A., Lefering, S., Simanski, C., Bouillon, B., Spanholtz, T....Maegele, M. (2010). Venous thromboembolism after severe trauma: Incidence, risk factors and outcome. INJURY, 41, 97-101. Platzer, P., Thalhammer, G., Jaindl, M., Obradovic, A., Benesch, T., Vecsei, V., & Gaebler, C. (2006). Thromboembolic complications after spinal surgery in trauma patients. Acta Orthopaedica, 77(5), 755-60. Proctor, MC., Sullivan V., Zajkowski P., Wolk, SW, Pomerantz, RA, Wakefield TW, & Greenfield, LJ. (2006). A role for interleukin-10 in the assessment of venous thromboembolism risk in injured patients. Journal of Trauma, Injury, Infection & Critical Care, 60(1), 147-151. Rodriguez, J.L., Lopez, J.M., Proctor, M.C., Conley, J.L., Gerndt, S.J., Marx, M.V…. & Greenfield, L.J. (1996). Early placement of prophylactic vena caval filters in injured patients at high risk for pulmonary embolism. Journal of Trauma, Injury, Infection & Critical Care, 40(5), 797-802; discussion 802-804. Rogers, F.B., Strindberg, G., Shackford, S.R., Osler, T.M., Morris, C.S., Ricci, M.A…. , & Pilcher, D.B. (1998). Five-year follow-up of prophylactic vena cava filters in high-risk trauma patients. Archives of Surgery, 133(4), 406-412. Schiff, RL, Kahn, SR, Shrier, I, Strulovitch, C, Hammouda, W, Cohen, E., & Zukor, D. (2005). Identifying orthopedic patients at high risk for venous thromboembolism despite thromboprophylaxis. Chest, 128(5), 3364-3371. Schultz, D. J., Brasel, K. J., Washington, L., Goodman, L. R., Quickel, R. R., Lipchik, R. J.,...Weigelt, J. (2004). Incidence of asymptomatic pulmonary embolism in moderately to severly injured trauma patients. Journal of Trauma, Injury, Infection, and Critical Care, 56(4), 727-733. Sharpe, R.P., Gupta, R., Gracias, V.H., Pryor, J.P., Pieracci, F.M., Reilly, P.M., & Schwab, C.W. (2002). Incidence and natural history of below-knee deep venous thrombosis in high-risk trauma patients. Journal of Trauma, Injury, Infection & Critical Care, 53(6),1048-1052. Stawicki, S. P., Grossman, M. D., Cipolla, J., Hoff, W. S., Hoey, B. A., Wainwright, G., Reed, J. F. (2005). Deep venous thrombosis and pulmonary embolism in trauma patients: An overstatement of the problem? The American Surgeon, 71(5), 387-391. Tapson, V. F. (2006). Identifying patients with deep vein thrombosis or pulmonary embolism: current standards and future directions. The American Journal of Medicine Supplement. 2-10. Velmahos, G. C. (2006). The current status of thromboprophylaxis after trauma: A story of confusion and uncertainty. The American Surgeon, 72(9), 757-763. Weiss, E.S., Hayanga, A.J., Efron, D.T., Noll, K., Cornwell, E.E., & Haut, E.R. (2007). Laterality of deep venous thrombosis among trauma patients: are we screening our patients adequately? Journal of Surgical Research, 141(1), 68-71. [© Academic Center for Evidence-Based Practice, 2011. http://www.acestar.uthscsa.edu]
Keywords:
Pulmonary; Trauma
Repository Posting Date:
16-Jan-2012
Date of Publication:
3-Jan-2012
Sponsors:
UTHSCSA Summer Institute

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleBest Practices in The Use of Vena Cava Filters to Prevent Pulmonary Emboli in Trauma Patientsen_GB
dc.identifier.urihttp://hdl.handle.net/10755/203167-
dc.description.abstract(Summer Institute) Problem: The development of a deep venous thrombosis (DVT) and subsequent pulmonary embolism (PE) can have catastrophic implications including death. This project describes the unique characteristics of trauma patients and how the injuries they suffer may set up a cascade of events that leads to a fatal PE. Evidence: Fifteen databases were queried. The search resulted in 55 papers of which 12 were subsequently selected for analysis. This included one meta-analysis, two Level 3, five Level 4, and four Level 5 studies. Strategy: This project identified certain patient characteristics by utilizing a Risk Assessment Tool. There are unique characteristics and injury patterns in trauma patients that may make chemoprophylaxis for DVT contraindicated. The question is can we identify these patient characteristics early, and prophylactically place a VCF thereby reducing the incidence of fatal PE's Practice Change: This project seeks to determine best practices in the decision to consider the placement of a VCF early in the hospital course. The incidence of PE's among the adult trauma patient population at one Level 1 Trauma Center will be monitored for a two-year period and an analysis will be completed at that time to evaluate the effectiveness of this early and potentially life-saving intervention. Evaluation: The intervention is the early placement of a VCF in adult trauma patients that have a contraindication to chemoprophylaxis. The outcome will be the absence of a fatal PE or the development of a symptomatic non-fatal PE. The indicators utilized will be from the trauma registry databank and will be measured every six months. Results: Analysis is ongoing however to date there have been no fatal PE's reported on patients where an IVC filter was placed within 72 hours of admission. Recommendations: Continue to follow the standard practice guideline for early placement of IVC filters in high risk adult trauma patients. Lessons Learned: Mortality can be decreased by the review and implementation of new and innovative ideas in trauma care. Bibliography: Aito, S., Abbate, R., Marcucci, R., & Cominelli, E. (2007). Endogenous risk factors for deep vein thrombosis in patients with acute spinal cord injuries. Spinal Cord, 45(9), 627-631. Carter, Y.M., Caps, M.T., & Meissner, M.H. (2002). Deep venous thrombosis and ABO blood group are unrelated in trauma patients. Journal of Trauma, Injury, Infection & Critical Care, 52(1), 112-116. Cherry, R. A., Nichols, P. A., Snavely, T. M., David, M. T., & Lynch, F. C. (2008). Prophylactic inferior vena cava filters: Do they make a difference in trauma patients? Journal of Trauma, Injury, Infection and Critical Care, 65(3), 544-548. Cornwell, E.E., Chang, D., Velmahos, G., Jindal, A., Baker, D., Phillips, J…. & Campbell, K. (2002). Compliance with sequential compression device prophylaxis in at-risk trauma patients: a prospective analysis. American Surgeon, 68(5), 470-473. Denson, K., Morgan, D., Cunningham, R., Nigliazzo, A., Brackett, D…. & Albrecht, R. (2007). Incidence of venous thromboembolism in patients with traumatic brain injury. American Journal of Surgery, 193(3), 380-383. Dobesh, P. P. (2009). Economic burden of venous thromboembolism in hospitalized patients. Pharmacotherapy, 29(8), 943-953. Gosin, J.S., Graham, A.M., Ciocca, R.G., & Hammond, J.S. (1997). Efficacy of prophylactic vena cava filters in high-risk trauma patients. Annals of Vascular Surgery, 11(1),100-105. Haddadian, B., Shaikh, F., Djelmami-Hani, M., & Shalev, Y. (2008). Sudden cardiac death caused by migration of a TrapEase inferior vena cava filter: case report and review of the literature. Clinical Cardiology, 31(2), 84-87. Haut, E.R., Noll, K., Efron, D.T., Berenholz, S.M., Haider, A., & Cornwell, E.E. (2007). Can increased incidence of deep vein thrombosis (DVT) be used as a marker of quality of care in the absence of standardized screening? The potential effect of surveillance bias on reported DVT rates after trauma. Journal of Trauma, Injury, Infection and Critical Care, 63(5):1132-1135; discussion 1135-1137. Huseynova, K., Xiong, W., Ray, J. G., Ahmed, N., & Nathens, A. (2009). Venous thromboembolism as a marker of quality of care in trauma. Journal of the American College of Surgeons, 208(4), 547-552. Jacobs, David J., & Sing, Ronald F. (2003). The role of vena caval filters in the management of venous thromboembolism. The American Surgeon, 69(8), 635-642. Joels, C.S., Sing, R. F., & Heniford, B. T. (2003). Complications of inferior vena cava filters. The American Surgeon, 69(8), 654-659. Kercher, Kent, & Sing, Ronald F. (2003). Overview of Current Inferior Vena Cava Filters. The American Surgeon, 69(8), 643-653. Knudson, M. M., Ikossi, D. G., Khaw, L., Morabito, D., & Speetzen, L. S. (2004). Thromboembolism after trauma. Annals of Surgery, 240(3), 490-498. Langan, E.M., Miller, R.S., Casey, W.J., Carsten, C.G., Graham, R.M., & Taylor, S.M. (1999). Prophylactic inferior vena cava filters in trauma patients at high risk: follow-up examination and risk/benefit assessment. Journal of Vascular Surgery, 30(3), 484-488. Lu, Y., Ma, B., Guo, R., Wang, Y., Zhang, J., Wu, Y., Pang, G., Xin, J., …& Fletcher, J. (2007). Deep vein thrombosis in trauma: a prospective study of lower limb orthopedic trauma patients in Tianjin Hospital, China. International Angiology, 26(2), 165-170. Melnyk, B. M., & Fineout-Overholt, E. (2005). Making the case for evidence-based practice. In Evidence-Based Practice in Nursing and Healthcare. A Guide to Best Practice (p. 10). Philadelphia, PA: Lippincott Williams & Wilkins. Menaker, J., Stein, D. M., & Scalea, T. M. (2009). Pulmonary embolism after injury: More common than we think? Journal of Trauma, Injury, Infection, and Critical Care, 67(6), 1244-1249. Meissner, M.H., Chandler, W.L., & Elliott, J.S. (2003). Venous thromboembolism in trauma: a local manifestation of systemic hypercoagulability? Journal of Trauma, Injury, Infection & Critical Care, 54(2), 224-231. Paffrath, T., Wafaisade, A., Lefering, S., Simanski, C., Bouillon, B., Spanholtz, T....Maegele, M. (2010). Venous thromboembolism after severe trauma: Incidence, risk factors and outcome. INJURY, 41, 97-101. Platzer, P., Thalhammer, G., Jaindl, M., Obradovic, A., Benesch, T., Vecsei, V., & Gaebler, C. (2006). Thromboembolic complications after spinal surgery in trauma patients. Acta Orthopaedica, 77(5), 755-60. Proctor, MC., Sullivan V., Zajkowski P., Wolk, SW, Pomerantz, RA, Wakefield TW, & Greenfield, LJ. (2006). A role for interleukin-10 in the assessment of venous thromboembolism risk in injured patients. Journal of Trauma, Injury, Infection & Critical Care, 60(1), 147-151. Rodriguez, J.L., Lopez, J.M., Proctor, M.C., Conley, J.L., Gerndt, S.J., Marx, M.V…. & Greenfield, L.J. (1996). Early placement of prophylactic vena caval filters in injured patients at high risk for pulmonary embolism. Journal of Trauma, Injury, Infection & Critical Care, 40(5), 797-802; discussion 802-804. Rogers, F.B., Strindberg, G., Shackford, S.R., Osler, T.M., Morris, C.S., Ricci, M.A…. , & Pilcher, D.B. (1998). Five-year follow-up of prophylactic vena cava filters in high-risk trauma patients. Archives of Surgery, 133(4), 406-412. Schiff, RL, Kahn, SR, Shrier, I, Strulovitch, C, Hammouda, W, Cohen, E., & Zukor, D. (2005). Identifying orthopedic patients at high risk for venous thromboembolism despite thromboprophylaxis. Chest, 128(5), 3364-3371. Schultz, D. J., Brasel, K. J., Washington, L., Goodman, L. R., Quickel, R. R., Lipchik, R. J.,...Weigelt, J. (2004). Incidence of asymptomatic pulmonary embolism in moderately to severly injured trauma patients. Journal of Trauma, Injury, Infection, and Critical Care, 56(4), 727-733. Sharpe, R.P., Gupta, R., Gracias, V.H., Pryor, J.P., Pieracci, F.M., Reilly, P.M., & Schwab, C.W. (2002). Incidence and natural history of below-knee deep venous thrombosis in high-risk trauma patients. Journal of Trauma, Injury, Infection & Critical Care, 53(6),1048-1052. Stawicki, S. P., Grossman, M. D., Cipolla, J., Hoff, W. S., Hoey, B. A., Wainwright, G., Reed, J. F. (2005). Deep venous thrombosis and pulmonary embolism in trauma patients: An overstatement of the problem? The American Surgeon, 71(5), 387-391. Tapson, V. F. (2006). Identifying patients with deep vein thrombosis or pulmonary embolism: current standards and future directions. The American Journal of Medicine Supplement. 2-10. Velmahos, G. C. (2006). The current status of thromboprophylaxis after trauma: A story of confusion and uncertainty. The American Surgeon, 72(9), 757-763. Weiss, E.S., Hayanga, A.J., Efron, D.T., Noll, K., Cornwell, E.E., & Haut, E.R. (2007). Laterality of deep venous thrombosis among trauma patients: are we screening our patients adequately? Journal of Surgical Research, 141(1), 68-71. [© Academic Center for Evidence-Based Practice, 2011. http://www.acestar.uthscsa.edu]en_GB
dc.subjectPulmonaryen_GB
dc.subjectTraumaen_GB
dc.date.available2012-01-16T11:01:04Z-
dc.date.issued2012-01-03en_GB
dc.date.accessioned2012-01-16T11:01:04Z-
dc.description.sponsorshipUTHSCSA Summer Instituteen_GB
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