Applying deep venous thrombosis prophylaxis is an appropriate intervention in all patients who are sedentary, however the higher incidence of deep venous thrombosis in critical illness justifies greater vigilance.
The risk of venous thromboembolism is reduced if prophylaxis is consistently applied. A clinical practice guideline issued as part of the Seventh American College of Chest Physicians Conference on Antithrombotic and Thrombolytic Therapy recommends prophylaxis for patients undergoing surgery, trauma patients, acutely ill medical patients, and patients admitted to the intensive care unit. The level of cited evidence was that of several randomized control trials. [1]
While it is unclear if there is any association with decreasing rates of ventilator acquired pneumonia, our experience is that when applied as a package of interventions for ventilator care, the rate of pneumonia decreases precipitously. The intervention remains excellent practice in the general care of ventilated patients.
Important considerations include that the risk of bleeding may increase if anticoagulants are used to accomplish prophylaxis. Often times, sequential compression devices (a.k.a. ‘venodynes,’ or ‘pneumoboots’) are not applied to patients when they go to or return from procedures.
References:
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Geerts WH, Pineo GF, Heit JA, et al. Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. Sep 2004;126(3 Suppl):338S-400S.
