Every year, 14,000 Australians are diagnosed with VTE, with approximately 5,000 of these cases resulting in death.1 VTE is one of the leading preventable causes of death in hospital.2
An introduction to VTE1
Venous thromboembolism or VTE, commonly referred to as a blood clot, occurs when blood pools and thickens inside normal, healthy veins and blocks the flow of blood through the body. The term describes two conditions:
- deep vein thrombosis (DVT) – blood clots that form in the deep veins
- pulmonary embolism (PE) – blood clots that become lodged in the lungs.
A combination of blood stasis, plasma hypercoagulability and endothelial dysfunction is thought to
trigger thrombosis, which starts most often in the valve pockets of large veins.3
VTE can cause distressing symptoms including pain and cardiorespiratory distress.2,4 It is also associated with serious long-term complications which reduce quality of life and result in a substantial economic healthcare burden, including chronic venous insufficiency (post-thrombotic syndrome), chronic pulmonary hypertension which can lead to right heart failure, and recurrent thrombosis.4–6 VTE has a high mortality rate, and is estimated to account for up to 10% of hospital deaths.1,7,8
VTE is highly preventable9
VTE risk assessment in ALL patients upon hospital admission is mandatory in most states and territories10–12 and is recommended by the therapeutic guidelines,13 however studies continue to show that many hospitalised patients are not given risk-appropriate VTE prophylaxis.9
According to a 2013 Australian report:9
- Only 44% of clinical units always assess patients for VTE risk on hospital admission using a standardised risk assessment tool.
- About 1 in 4 patients at risk of developing VTE were not offered prevention.
VTE prevention and the nurse
There are a number of different aspects involved in VTE prevention, many of which may be the responsibility of nursing staff, depending on local policy.2,14,15
- Conduct VTE risk assessment within 24 hours of admission
- Assist the medical officer to conduct VTE risk assessment
- Nursing staff may have the responsibility to conduct VTE risk assessment
- Develop a VTE prevention plan for the at-risk patient
- Nursing staff may have the responsibility for ordering or accessing mechanical prophylaxis
- Deliver the VTE prevention plan
- Maintain the patient’s hydration
- Mobilise the patient
- Administer mechanical compression
- Administer pharmacological VTE prophylaxis
- Regularly assess VTE risk
- Reassess the VTE risk when there is a change in the patient’s condition
- Monitor for signs of VTE complications and bleeding
- Ensure VTE risk is reassessed by MO at least every 7 days during the patient’s hospital stay
- Transition from hospital and ongoing care
- Ensure patient is discharged with a care plan
- Educate patients on signs and symptoms of VTE
- Educate patients on the safe and effective use of post-discharge VTE prophylaxis, if indicated
Effective VTE prevention requires a multidisciplinary approach, in which nurses play a crucial role.2 To learn more about VTE, and to take a more detailed look at the roles and responsibilities nurses have in VTE prevention, complete VTE prevention for nurses, a short series of educational modules available free of charge at https://medpathways.com.au/course/vte-prevention-overview
- Clinical Excellence Commission. Clinical Focus Report: Hospital-Associated Venous Thromboembolism, 2015. Available at: https://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0008/278612/Clinical-Focus-Report-Hospital-Associated-Venous-Thromboembolism.pdf. Accessed June 2023.
- Australian Commission on Safety and Quality in Health Care. Venous Thromboembolism Prevention Clinical Care Standard, 2020. Available at: https://www.safetyandquality.gov.au/sites/default/files/2020-01/venous_thromboembolism_prevention_clinical_care_standard_-_jan_2020_2.pdf. Accessed June 2023.
- Wolberg AS et al. Nat Rev Dis Primers 2015;1(1):15006.
- Khan F et al. Lancet 2021;398(10294):64–77.
- Winter MP et al. J Thromb Haemost 2017;15(8):1531–40.
- Gibbs H. Aust Prescr 2007;30(2):38–40.
- Cohen AT et al. Lancet 2008;371(9610):387–94.
- Access Economics Pty Limited. The burden of venous thromboembolism in Australia, 2008. Available at: https://www.safetyandquality.gov.au/sites/default/files/migrated/Access-Economics_The-burden-of-VTE-in-Australia_2008.pdf. Accessed June 2023.
- Clinical Excellence Commission. Safer Systems Better Care – Quality Systems Assessment Statewide Report, 2013. Available at: https://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0007/258685/hs14-020-cec-qsa-report-dv3.pdf. Accessed June 2023.
- NSW Health. Prevention of Venous Thromboembolism Policy Directive, 2019. Available at: https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2019_057.pdf. Accessed June 2023.
- Government of Western Australia. Venous Thromboembolism Prevention Policy, 2023. Available at: https://www.wacountry.health.wa.gov.au/~/media/WACHS/Documents/About-us/Policies/Venous-Thromboembolism-Prevention-Policy.pdf?thn=0. Accessed June 2023.
- Queensland Health. Guideline for the prevention of Venous Thromboembolism (VTE) in adult hospitalised patients, 2018. Available at: https://www.health.qld.gov.au/__data/assets/pdf_file/0031/812938/vte-prevention-guideline.pdf. Accessed June 2023.
- Therapeutic Guidelines Limited. Therapeutic Guidelines, Cardiovascular 2018 (Updated: May 2023). Available at: https://tgldcdp.tg.org.au/guideLine?guidelinePage=Cardiovascular&frompage=etgcomplete. Accessed June 2023.
- Wickham N et al. Intern Med J 2012;42(6):698–708.
- Australian Commission on Safety and Quality in Health Care. Your guide to the NIMC VTE prophylaxis section, 2013. Available at: https://www.safetyandquality.gov.au/sites/default/files/2022-01/nimc-vte-brochure-pdf.pdf. Accessed June 2023.