What is your policy in DVT prevention following joint surgery

PAROPPY, BSN, RN · May 15, 2010

For our anticoagulation orders here's what we do:

On the evening of surgery and POD #1 the patient gets coumadin 5 or 7.5 mg (depending on their weight). POD #2 and after that we follow a sliding scale... (target INR is 2-3), the patient will get a dose of coumadin depending on what their INR is and what POD it is. Some of the surgeons order lovenox bridge therapy. When it is orderd, the first dose is given 24 hours post op and is usually ordered Q day. The lovenox is stopped once the INR reaches 2.

And of course there's all the obvious prevention strategies: venodynes, adequate hydration, early ambulation, etc.

Hope this helps!

starbin, BSN, RN · May 15, 2010

For our anticoagulation orders here's what we do:
On the evening of surgery and POD #1 the patient gets coumadin 5 or 7.5 mg (depending on their weight). POD #2 and after that we follow a sliding scale... (target INR is 2-3), the patient will get a dose of coumadin depending on what their INR is and what POD it is. Some of the surgeons order lovenox bridge therapy. When it is orderd, the first dose is given 24 hours post op and is usually ordered Q day. The lovenox is stopped once the INR reaches 2.
And of course there's all the obvious prevention strategies: venodynes, adequate hydration, early ambulation, etc.
Hope this helps!

Thank you so much Proppy. That helps alot.

jmgrn65, RN · May 15, 2010

our joints also get coumadin, and fragmin (similar to lovenox) until INR 2

starbin, BSN, RN · May 16, 2010

Is there any screening process to determine the risk level like high risk, medium risk and average risk? Or everybody gets a standard treatment? I wonder if it is common to do pre-op screening for DVT (like venous doppler ) on people with a history of previous blood clot.

bear_mom · May 19, 2010

Ours depends on the surgeon. Two use Coumadin. Two use Lovenox. One uses Arixtra. One uses just aspirin. Most use TEDs, one doesn't. All of them use some form of compression boot.

Emily

Penelope_Pitstop, BSN, RN · May 20, 2010

We have a "VTE Risk Assessment" that is done on all patients. It takes all sorts of risk factors for developing DVTs and adds them up to get a number. Physicians are supposed to base any DVT prophylaxis on this rating.

It's been forever and a day since I took care of a joint patient, but I remember TED and PCB to non-operative extremity, PT/OT consults, early and frequent ambulation beginning POD #1, and the physicians had a variety of drugs to choose from as well. I believe most of them went with Lovenox bridge to Coumadin. I'd have to look at the order sets when I go back to work. I can do that for you if you can wait a few days.

SnowStar4 · Jul 7, 2010

Most of our patients get Arixtra, some use Lovenox and some just aspirin to take home since Arixtra is super expensive. But they all take something. Most everything depends on the Doc's preference. Most use foot pumps or SCDs, TEDs, frequent ambulation and have the patients do exercises in bed. And of course, frequent assessments.

kimartin0623 · Jul 11, 2010

All patients receive coumadin the night before surgery (5 mg), then the coumadin dose is adjusted based on INR. Goal 1.8-2.2.

melsman1904 · Jul 16, 2010

In most cases, we are dosing with Coumadin 5-10 mg on the day of surgery with lovenox BID until the INR reaches 2. After d/cing the Lovenox, we use a sliding scale for the Coumadin. We also use TEDs, foot pumps, early ambulation, and hydration.

shareet · Feb 9, 2017

hello starbin I saw your post mentioning cgfns chaos..I am going through same phase ..can you please help? how can i contact you ...please extreamly needed help...

shareet · Feb 9, 2017

I am doing a paper on prevention of DVT following joint surgery. I would very much like to hear from the ortho nurses on what policy their facility has in place to prevent DVT after Knee or Hip surgery.

hello starbin I saw your post mentioning cgfns chaos..I am going through same phase ..can you please help? how can i contact you ...please extreamly needed help...