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#7 ICU PATIENT CARE: SERIES OF BASICS

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It is obvious that patients in ICU are prone to develop Deep Vein Thrombosis since they are confined to the bed and also due to their clinical conditions, hence DVT prophylaxis is essential in ICU patient care.

PATIENTS AT RISK:

Medical patients:

  • Mobility significantly reduced ≥ 3 days

  • Reduced mobility + any VTE risk

Surgical patients:

  • Anaesthetic time > 90 minutes

  • Anaesthetic time > 60 minutes + operation involves pelvis or lower limb

  • Acute surgical admission with inflammatory or intra-abdominal

  • Expected reduced mobility

RISK FACTORS:

  • Active cancer or cancer treatment

  • Age > 60 years

  • Intensive care admission

  • Dehydration

  • Known thrombophilia

  • BMI > 30

  • 1 or more significant medical comorbidity

  • Personal or family history of VTE

  • Use of HRT or contraceptive

  • Varicose veins with phlebitis

There are two varieties of Thromboprophylaxis.

PRIMARY: To prevent the incidence of DVT

  • Unfractionated Heparin (UFH)

  • Low Molecular Weight Heparin (LMWH)

  • Fondaparinux

  • Pneumatic and graduated compression stokings

SECONDARY: Early detection and management of DVT

It is less commonly used

LMWH DVT PROHYLAXIS:.

  • Enoxaparin 20 mg Q12H preop

  • Enoxaparin 40 mg daily for at least 4 days post-op

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