Venous thromboembolism prophylaxis

Venous thromboembolism in a patient who has not yet clotted is prevented rather than awaited, so every admitted patient is assessed for the three conditions that let blood clot in a vein — stasis from immobility, surgery or a paralysed limb, injury to the vein wall from surgery, trauma or a central line, and hypercoagulability from cancer, estrogen, dehydration, obesity, pregnancy or a previous clot — and the nurse matches the prophylaxis to that risk and to the bleeding risk that competes with it: getting the patient walking and doing leg exercises from the first hours, keeping them hydrated, applying graduated compression stockings and intermittent pneumatic compression so that they fit, stay on and are never put on a limb that is already thrombosed or arterially insufficient, giving the prescribed subcutaneous heparin or low-molecular-weight heparin with the technique that spares the tissue and the checks that catch bleeding and a falling platelet count, and treating a prophylaxis that was ordered but not delivered — a device left off, a dose missed or refused, a risk that rose during the stay without reassessment — as the same absence of protection as one never prescribed.