| Primary Author: | Donna Ellis, MS |
| Co-Principal Investigators/Collaborators: | Irene Benson, MSN, Euphemia Connell, MS, Mary Sue Dailey, MSN, ACNS-BC, Diane Eckhouse, MS, OCN-BC, Ann Jorgensen, MS, CCNS, Diane Kuehlenz, MS, CCNS, Gina Minga, MS, ACNS-BC, Linda Sroka, RN, Joanne Lamantia Watts, MSN, ACNS-BC, FNP |
| Organization | Advocate Christ Medical Center |
Abstract
Purpose
Examine the incidence of UEVTE in patients on and not on anticoagulants and risk factors of developing an UEVTE.
Background
Venous thromboembolisms (VTE) affect millions of individuals worldwide. Upper extremity VTE (UEVTE) may cause pain and may eliminate the affected arm as a choice for peripheral IV access, necessitating the use of central lines. In addition UEVTE may lead to pulmonary embolism and death.
Materials & Methods
A retrospective chart review was conducted in an urban hospital system’s five acute care hospitals. A sample of 1756 hospitalized adult patients who had an upper extremity venous doppler ordered from July 2008-July 2009.
Results
In total, 41% of the patients had a positive duplex for an UEVTE; all of these patients had received a high VTE risk score. There were no differences between patients with or without UEVTE by age, hospital length of stay (LOS), VTE risk score and Body Mass Index (BMI). Individuals who smoked were more likely to have UEVTE (p=0.037). Sixty two percent of patients who tested positive for UEVTE had received chemoprophylaxis prior to the confirmation. The average LOS for all patients in this study was 14 days. This is 9.2 days longer than the national average LOS indicating medical complexity.
Conclusion
Sixty eight percent of the patients diagnosed with an UEVTE were on chemoprophylaxis at the time of their duplex scan. In addition, 15% had chemoprophylaxis initiated on the day the duplex was ordered or completed and the majority of the patients had a VTE risk score of 5.9. These finding suggests that these patients were not perceived as having a risk for VTE; or the VTE risk assessment was not re-evaluated after resolution of initial contraindications. Both smoking and medical complexity was more prevalent in the patients who developed UEVTE; factors warranting further investigation.
A study limitation is that specific risk factors were not examined for differences between these high risk groups which developed UEVTE.
Bibliography
Mustafa, S., Stein, P., Patel, K., Otten, T., Holmes, R., & Silbergleit, A. (2003). Upper Extremity Deep Vein Thrombosis. Chest (123), 1953-1956.
Spencer, F., Emery, C., Lessard, D., & Goldberg, R. (2007). Upper Extremity deep vein thrombosis: a community- based perspective. American Journal of Medicine , 678-684.
© Improvement Science Research Network, 2012
The ISRN published this as received and with permission from the author(s).