Keywords

common characteristics, nursing care, patient safety, upper-extremity VTE

Authors

1. Watts, Joanne LaMantia MSN, APN, FNP-BC, ACNS-BC
2. Kuehnlenz, Diane MS, APN, CCNS, CWOCN
3. Sulo, Suela PhD
4. Connell, Euphemia MSN, APN, ACNS-BC
5. Dailey, Mary Sue MSN, APN, ACNS-BC
6. Eckhouse, Diane MS, APN, OCNS-C
7. Ellis, Donna MS, APN, ACNS-BC
8. Jorgensen, Ann MS, APN, CNS-BC, PCCN
9. Minga, Gina MSN, APN, ACNS-BC
10. Ong, Fely MSN, APN, CCNS
11. Sroka, Linda BS, RN, CHF
12. Benson, Irene MS, APN, ACNS-BC

Abstract

Purpose: The aim of this study was to explore the common characteristics of patients diagnosed with upper-extremity venous thromboembolism (UEVTE) during hospitalization.

Design: This was a retrospective chart review.

Setting: This study was performed at a Midwest multisite hospital of 5 acute-care hospitals and 2051 beds.

Sample: The sample was composed of 777 hospitalized adult patients who had a positive upper-extremity venous Doppler from July 2008 to July 2009.

Results: Patients were adults with a mean age of 66.6 (SD, 17.0) years and mean hospital stay of 15.7 (SD, 12.4) days. When assessing the arm clots, 398 patients (51.2%) had a right arm clot, 317 patients (40.8%) had a left arm clot, and 62 patients (8.0%) had clots in both arms. Patients were primarily admitted with medical conditions, and more than one-half were overweight or obese (59.2%). Nearly 50% of patients were at the highest venous thromboembolism (VTE) risk upon admission (n = 362), were tobacco users (n = 379), and had surgeries or invasive procedures performed prior to upper-extremity venous Doppler (n = 395). In 58.6% of the patients, chemoprophylaxis through intravenous anticoagulation therapy was administered during the first 3 days of admission. In patients with an intravenous catheter in an arm, UEVTE was likely to occur in the same arm (right and left arm, P < .001).

Implications: Nurses caring for patients with characteristics commonly found in cases of UEVTE should regularly monitor the arms of their patients and communicate findings in shift reports to heighten awareness of UEVTE risk. In addition, patients with medical diagnoses that prevent use of early anticoagulation for VTE prophylaxis such as gastrointestinal bleed, hematologic disorders, trauma, and hemorrhagic strokes should be frequently assessed for UEVTE. Learning the characteristics of patients who had UEVTE during their hospitalization and the role of early and late anticoagulation in the development of UEVTE would advance nurse assessment and lead to novel interventions and future research.