INTRODUCTION:

Deep vein thrombosis is a condition that occurs when a blood clot forms in a vein deep inside the body which mainly affects the large veins in the lower leg and thigh.

It is believed to be caused by altered physiologic mechanisms that are likely to occur with decreased mobility, surgery and traumatic injury. It is most commonly seen in adults above 60 years of age. When a clot breaks off and moves through the blood stream, it is called an emboli which can get stuck in the blood vessels in the brain, lungs, heart, or another area leading to severe damage. Risk for developing DVT can be assessed by well’s score¹.

Critically ill patients appeared to be at high risk of developing deep vein thrombosis during their ICU stay because they combine both general risk factors together with specific ICU risk factors of deep vein thrombosis, like sedation, immobilization, vasopressors or central venous catheter².

Well’s criteria for DVT is a reliable clinical tool to assess the risk of DVT in ICU patients after 48 hours of admission. The Well’s tool enables us to reliably stratify patients into high DVT risk ( >3), moderate DVT risk (1-2) and low DVT risk (< 1)³.

Deep vein thrombosis can be prevented by either pharmacological intervention which includes anticoagulants and mechanical interventions which includes the use of compression stockings. Intermittent pneumatic compression devices are thought to reduce or prevent stasis through promotion of blood flow velocity and may decrease coagulation through fibrinolytic activity¹.

As DVT is a life threatening complication, staff nurses caring for patients must perform risk assessment and provide prophylaxis through mechanical devices to prevent it⁴.

The investigators therefore felt the need to undertake an observational study to assess the risk and preventive strategies used for deep vein thrombosis among patients admitted in medical, surgical and cardiothoracic intensive care units of Father Muller Medical College Hospital, Mangaluru.

MATERIALS AND METHODS:

Research Design:

The descriptive cross sectional research design was used to conduct this study.

Research Setting:

The study was conducted in Intensive Care Units of Father Muller Medical College Hospital, Mangaluru.

Population:

The target population in this study consisted of all patients who are admitted in ICUs for more than 48 hours.

Sampling Technique and Sample Size:

Purposive sampling technique was used for the study. The sample consisted of 120 patients admitted in intensive care units of FMMCH, Mangaluru.

Instruments:

I – Baseline variables which consists of 4 items - Age, Sex, Diagnosis on admission, Previous h/o ICU admission.

II – Observational checklist using Well’s score for DVT risk assessment. Well’s score is a standardized tool³ which is interpreted through scoring such as, 3 or more score- higher risk of DVT, 1 or 2- moderate risk and 0 as low risk of DVT.

III - Observational checklist for preventive strategies used.

METHOD OF DATA COLLECTION:

The investigator obtained ethical clearance (FMMCIEC/CCM/124/2018) and written permission from the authorities of Father Muller Medical College Hospital, Mangaluru. Informed consent was obtained from the subjects who were selected by purposive sampling technique. Each subject who was admitted in ICUs for more than 48 hours were assessed for risk and preventive strategies for DVT for 3 consecutive days between April and June 2018. Baseline proforma was obtained either from the patients or the medical records. The risk score was assessed based on Wells criteria and patients were categorized under mild, moderate or severe risk. The preventive strategies used were also identified.

RESULT:

Table 1: Frequency and percentage distribution of samples according to baseline variables n=120

Sl No

Baseline variables

Frequency (No.)

Percentage (%)

Age

(Mean ±SD= 54.69±17.74)

<55

>55

45.6

54.4

Gender

Male

Female

Previous history of admission

Yes

115

4.2

95.8

Diagnosis

Medical

Surgical

106

88.4

11.7

Figure 1: Diagnosis of subjects on admission.

Table 2: Frequency and percentage distribution of risk assessment score. n =120

Sl No	Risk criteria (well’s score)	Frequency	Percentage (%)
1	Moderate DVT risk	94	78.3
2	High DVT risk	26	21.7

Table 3: Frequency and percentage distribution of preventive strategies used n=120

Sl No

Preventive strategies

Frequency

(%)

Mechanical modalities

Pneumatic compression devices

Compression stockings or crepe bandages

5.0

20.8

Pharmacological modalities used

LMWH

None

117

2.5

97.5

Table 4: Comparison of subjects with Well’s score and preventive strategies used N = 34

Well’s score	Mechanical modalities				Pharmacological modalities
	Pneumatic compression devices		Crepe bandages		LMWH
	F	%	F	%	F	%
Moderate DVT risk	3	50	7	28	2	66.6
High DVT risk	3	50	18	72	1	33.3
Total	6	100	25	100	3	100

Table 5: Association between risk assessment and baseline variables n = 120

Sl. No.	Baseline variables	Well’s score		χ²	p-value
		Moderate risk	High risk
1.	Age in years ≤ 55	48	7	4.78	0.02*
	>55	46	19
2.	Gender Male	51	15	0.09	0.7
	Female	43	11
3.	Previous history Yes	5	0	1.44	0.23
	No	89	26
4.	Diagnosis Medical	67	25	7.25	0.02*
	Surgical	27	1

*p<0.05 (significant)

DISCUSSION:

The selected subjects were between the age group 18 to 85 with mean age 54.69 ±17.74. More than half of them were males ie., 66(55%). Out of 120 subjects, 5(4.2%) had a previous history of ICU admission. The diagnosis on admission was related to neurological condition among 39(32.5%) of subjects.

A cross sectional study was done in Tehran, Iran, between August 2008 to July 2011 to evaluate the incidence of DVT among medical and surgical ICU patients using APACHE II scores and other demographic variables. Out of the 1387 observed, 500 patients had been classified as potential cases for DVT out of which maximum individuals belonged to an age group > 66 years. The incident rate was slightly high among males than females. Majority of individuals who developed DVT had a medical diagnosis⁵.

All the subjects in the current study who had completed 48 hrs of ICU stay had a risk of developing DVT as per the Wells criteria of assessment. Among the 120 subjects, 94(78.3%) were at moderate risk of developing DVT and 26(21.7%) of them had high DVT risk.

A similar study was done to determine the prevalence, incidence, and risk factors for proximal lower extremity DVT among ICU admitted patients. Out of 261 subjects selected for the study, their mean APACHE II score was 25.5±8.4. The prevalence of DVT was 2.7% on admission to ICU and the incidence was 9.6% over the ICU stay. The study identified four independent risk factors for ICU acquired DVT which included personal or family history of venous thromboembolism, end stage renal disease, platelet transfusion and vasopressor use⁶.

The use of preventive strategies in the present study showed only 31(25.8%) of subjects were on mechanical modalities and 3(2.5%) of them on pharmacological modalities.

A study was conducted in 2016 on deep vein thrombosis prophylaxis evaluation in ICU in Iran. The objective of the study was to investigate appropriate administration of deep vein thrombosis (DVT) prophylaxis in ICU in an educational hospital in Iran. The study included a total of 52 patients, out of which 88.46% had indication for DVT prophylaxis of which 10.71% received mechanical prophylaxis and 89.29% received pharmacological prophylaxis. Two-thirds of the subjects with pharmacological prophylaxis received enoxaparin while the others received heparin. The results proved that 32.61% of the patients received adequate prophylaxis, 17.39% received inadequate doses of prophylaxis and 6.52% received higher doses of prophylaxis⁷.

The present study revealed that the subjects above the age of 55years (p=0.02) and those with medical diagnosis on admission (p=0.02) were more prone to develop high risk for DVT as statistically significant at p<0.05.

The study at Tehran, Iran, 2008-2011 also observed significant DVT risk with patients age (p=0.02) and length of ICU stay (p=0.01)⁴.

CONCLUSION:

The findings of the study showed that there is a significant association between age and diagnosis with the risk of development of DVT. The subjects above the age of 55years are more prone to develop DVT and also those with medical diagnosis are at high risk for DVT. Hence effective use of preventive strategies can avoid the occurrence of DVT to a great extent. Use of mechanical or pharmacological modalities in patients admitted in Intensive Care Units for more than 48 hours can reduce the extra burden of patients from acquiring this complication during the hospital stay. There should be strict risk assessment of Deep Vein Thrombosis and implementation of preventive strategies accordingly among all the patients admitted in Intensive Care Units.

CONFLICT OF INTEREST:

The authors have no conflicts of interest regarding this research study.

ACKNOWLEDGMENTS:

The authors would like to thank the administrator of the hospital, staff and patients who were a part of this research study.

REFERENCES:

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Received on 22.11.2021 Modified on 28.05.2022

Asian J. Nursing Education and Research. 2022; 12(4):405-408.

DOI: 10.52711/2349-2996.2022.00086