Journal of Vascular Nursing

From the Editor's Perspective…

Cindy Lewis — 2010-06-01

As nurses, we care passionately about the care we give and continually seek ways to improve and demonstrate our value. We have embraced the quality agenda as an opportunity to demonstrate our continued value and impact on patient care, wherever we deliver our care. Healthcare's focus on high-quality care gives nurses the opportunity to articulate what we do. When implementing new quality measures, we have had to identify, analyze and tell the stories of our nursing roles and their impact on patients' experiences, the enhancement of our safety measures and the effectiveness of our practices. We have needed to apply and utilize tested tools, change techniques and adopt best practices to ensure successful patient outcomes.

Definition of immobility in studies of thromboprophylaxis in hospitalized medical patients: A systematic review

Jessica D. Emed, David R. Morrison, Laura Des Rosiers, Susan R. Kahn — 2010-06-01

Background: Venous thromboembolism (VTE) is a common, serious and preventable complication in hospitalized patients. Thromboprophylaxis in medical patients is safe, effective, and cost saving, but remains underutilized. Although immobility plays an important role in determining VTE risk in medical patients, no clear criteria exist to guide clinicians in assessing immobility when making decisions about thromboprophylaxis.Objectives: A systematic review was conducted to determine how immobility is defined and operationalized in randomized controlled trials (RCTs) of thromboprophylaxis in medical inpatients.Methods: PubMed database was searched until September 2008 for RCTs of thromboprophylaxis in medical patients. Articles retrieved were further hand-searched to identify additional RCTs. Definitions of “immobility” were assessed.Results: Twenty-one RCTs were retrieved, 18 were retained and 17 of these defined, to varying degrees, “immobility.” Studies used several definition criteria, including the patient's degree of activity (14 studies), time spent immobile or mobile (13 studies), distance walked (4 studies) and underlying reason for immobility (4 studies); 14 studies used a combination of criteria. Definitions were clearly operationalized in 15 studies. The concept of “immobility” was utilized in study introductions (4 studies), inclusion/exclusion criteria (16 studies), as a stratification variable before randomization (1 study), in ongoing patient assessment (1 study), in treatment decisions (5 studies), as part of the study intervention (2 studies), as standard of care (2 studies), and in the results, discussion or conclusions (12 studies).Conclusions: There is a marked lack of consistency in how the concept of immobility is defined and utilized in RCTs of thromboprophylaxis in medical inpatients. This circumstance may contribute to the underutilization of thromboprophylaxis in clinical practice with medical inpatients.

Erythromelalgia: A rare microvascular disease

Victoria Latessa — 2010-06-01

Erythromelalgia (EM) is a rare condition of unknown etiology that results in intense, burning pain and redness primarily of the feet, and, even more rarely, in the hands. Most cases are idiopathic (primary EM); others occur secondary to medical conditions, such as autoimmune diseases, and neurological or hematological disorders. Symptoms are episodic and can result in severe disability. Triggers, such as exposure to warmth, pressure or exercise, become apparent to those afflicted with this condition; however, triggers may be unavoidable during the course of daily living. There are no diagnostic tests for EM. Diagnosis is based on history, physical examination during symptomatic episode and the exclusion of other probable causes for the syndrome. Early recognition of the signs and symptoms as well as early treatment offer patients the best hope of remissions and improved quality of life.

Health-related quality of life in patients with peripheral arterial disease undergoing percutaneous transluminal angioplasty: A prospective one-year follow-up

Louise Egberg, Anne-Cathrine Mattiasson, Karl-Gösta Ljungström, Johan Styrud — 2010-06-01

Measuring Health Related Quality of Life has become more and more important in evaluating patients with peripheral arterial disease. This prospective longitudinal survey aimed to investigate health related quality of life over time in patients with peripheral arterial disease (PAD) undergoing percutaneous transluminal angioplasty (PTA) between December 2005 and June 2008. Health Related Quality of life was assessed using the Claudication Scale (CLAU-S) and EQ5D and the Sense of Coherence Scale was used to estimate the patients' sense of coherence. The findings of this study shows that the total CLAU-S score was improved both at one-month follow-up (p < 0.0001) and one-year follow-up (p < 0.0001) compared to baseline. There were significant differences regarding all five dimensions: every day life, pain, social life, illness-specific fears and psychological wellbeing. The EQ5D computed by index improved significantly both at one-month follow-up (p = 0.0006) and one-year follow-up (p = 0.0019) compared to baseline. Differences were found between the groups with low and moderate sense of coherence (p = 0.0169) as well as between the groups with low and high sense of coherence (p = 0.0208) regarding health related quality of life (HRQoL). This study showed that PTA improves HRQoL among individuals suffering from PAD and that the effect is sustainable over time. For more accurate results, a disease-specific instrument should be used to evaluate HRQoL.

Vascular access for hemodialysis: Thrills and thrombosis

Victoria Gilpin, W. Kirt Nichols — 2010-06-01

Hemodialysis is a life saving treatment for Americans with end stage renal disease. In the last decade, liberal selection of patients treated by hemodialysis has resulted in patients who are substantially older, diabetics, who have higher co-morbidities including extensive atherosclerotic vascular disease. Many of these patients start hemodialysis treatments with a synthetic graft access rather than with their own native vessels. Grafts are appropriate for patients with inadequate vessels for construction of an arterio-venous (A-V) fistulas.The National Kidney Foundation published the Dialysis Outcome Quality Initiative (DOQI) guidelines in 1997, a set of evidenced based guidelines regarding the optimal management of vascular access. One important guideline had been to increase the number of patient dialyzing with Arterio-Venous (A-V) fistulas rather than A-V grafts which are prone to frequent stenosis, thrombosis, and thus are more costly and labor intensive.The prevalence of patient dialyzing with fistulas depends on several factors; timing of the referral, anatomy and adequacy of the patients vessels, type of fistula placed, fistula maturation, minimal accepted dialysis blood flow and patency of the fistula.The management of a vascular access for hemodialysis is a challenging area of practice for those who care for the hemodialysis patient population. The multidisciplinary approach to management of patients with hemodialysis access includes support, education, collaboration and ongoing communication with the multidisciplinary team, patients, and their family members.

Review of an Article: Dabigatran versus warfarin in the treatment of acute venous thromboembolism (2009). Schulman S, Kearon C, Kakkar A, et al., N Engl J Med 361;2342-2352.

Janice D. Nunnelee — 2010-06-01

This was a randomized, double-blind, double-dummy study in patients with clinically documented acute venous thromboembolism (DVT). Patients were initially placed on parenteral anticoagulation and started on either oral dabigatran (150 mg twice daily) or warfarin, which was adjusted to obtain an INR of 2.0-3.0. They were also given a placebo that mimicked the alternate drug. The purpose was to determine whether there is a difference in recurrent, symptomatic, confirmed DVT or a related death at 6 months, found as a result of treatment with dabigatran or warfarin. Researchers also monitored bleeding events, coronary problems, liver-function tests and other adverse events. The study took place in 29 countries in Europe and in the United States. In all, 78.5% of the study participants were from Europe or North America. There were no significant differences between groups in baseline characteristics.

Using the Ankle-Brachial Index as a tool to reduce complications in total knee arthroplasty

Glenda Lawson, D. Russ Greene — 2010-06-01

Although arterial complications after Total Knee Arthroplasty (TKA) are rare, results can be devastating for patients, because infection and possibility of amputation are common. Not only can pre-existing peripheral artery disease (PAD) lead to poor healing and increased risk of infection, use of the tourniquet during surgery has been implicated in subsequent arterial complications. Because many of the patients who develop these complications have pre-existing PAD, identifying those at risk should be an integral part of the initial orthopedic patient assessment. Nurses are in a unique position to assess risk factors for PAD in potential candidates for TKA and to decrease risk of postoperative complications by performing the Ankle-Brachial Index (ABI). The test is quick and simple, can be performed in the office and results can be shared immediately with the orthopedic surgeon if follow-up with a vascular surgeon is necessitated.

2010-06-01

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2010-06-01

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2010-06-01

Journal of Vascular Nursing

From the Editor's Perspective…

Definition of immobility in studies of thromboprophylaxis in hospitalized medical patients: A systematic review

Erythromelalgia: A rare microvascular disease

Health-related quality of life in patients with peripheral arterial disease undergoing percutaneous transluminal angioplasty: A prospective one-year follow-up

Vascular access for hemodialysis: Thrills and thrombosis

Review of an Article: Dabigatran versus warfarin in the treatment of acute venous thromboembolism (2009). Schulman S, Kearon C, Kakkar A, et al., N Engl J Med 361;2342-2352.

Using the Ankle-Brachial Index as a tool to reduce complications in total knee arthroplasty

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