1. not-pharmacological periopera0ve prolaxys

2. general methods mobiliza(on hydra(on mechanical prophylaxis elas(c compression caval lters pneuma(c compression Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care 3. moderate risk high risk very high risk Preven&on and management of venous thromboembolism in the surgical pa&ent: op&ons by surgery type and individual pa&ent risk factors, The American Journal of Surgery, Vol 199, Jan 2010 Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care 4. INJURED PATIENT High Risk Factors (Odds ra0o for VTE = 2 3) Very High Risk Factors (Odds ra0o for VTE = 4 - 10) Age 40 Major opera0ve procedure Pelvic fx Lower extremity fx Venous injury Ven0lator days > 3 Shock 2 or more high risk factors Spinal cord injury Head Injury (AIS 3) Does the pa0ent have contraindica0ons for Heparin? Does the pa0ent have contraindica0ons for Heparin? No Yes Yes No LMWH* and Mechanical Compression Mechanical and serial CFDI Mechanical LMWH* Compression OR Compression Temporary IVC lter * Prophylac0c dose Knudson Ann Surg 2004; 240:490-498 Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care 5. We recommend that mechanical methods of thromboprophylaxis be used primarily in pa0ents at high risk for bleeding (Grade 1A), or possibly as an adjunct to an0coagulant based thromboprophylaxis (Grade 2A). For pa0ents receiving mechanical methods of thromboprophylaxis, we recommend that careful a_en0on be directed toward ensuring the proper use of, and op0mal adherence with, these methods (Grade 1A). Kearon et al. AnJthromboJc Therapy for Venous Thromboembolic Disease: American College of Chest Physicians Evidence-Based Clinical PracJce Guidelines (8th EdiJon). Chest 2008; 133; 454-545 Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care 6. For general surgery pa0ents with mul0ple risk factors for VTE who are thought to be at par0cularly high risk, we recommend that a pharmacologic method be Rimozione quotidiana per ispezione cute se riduzione significativa mobilit,integrit della cute compromessa e ridotta sensibilit 2-3 volte giorno specie combined with the op0mal use of a mechanical method talloni e prominenze ossee. (ie, re-measured and anti-embolism stockings refitted. swelling have theirEnsure that patients who develop oedema or postoperative [GCS] and/or legs graduated compression stockings IPC) (Grade 1C). Use anti-embolism stockings that provide graduated compression and produce acalf pressure of 1415 mmHg. Se collaborante coinvolgere il paziente ad indossarle in modo corretto mopnitorando la coinvolgere il paziente ad indossarle in modo correttoSe collaborante comprensionemopnitorando la comprensioneFor general surgery pa0ents with a high risk of bleeding, we recommend the op0mal use of mechanical thromboprophylaxis with properly _ed GCS or IPC (Grade 1A). When bleeding risk decreases, we recommend that pharmacologic prophylaxis be s u b s 0 t u t e d f o r o r a d d e d t o m e c h a n i c a l prophylaxis (Grade 1C). Kearon et al. AnJthromboJc Therapy for Venous Thromboembolic Disease: American College of Chest Physicians Evidence-Based Clinical PracJce Guidelines (8th EdiJon). Chest 2008; 133; 454-545 Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care 7. foot FP impulse devices SCD sequen0al SCDcompression devices Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care 8. G C S graduated compression stockings SCD AES Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care 9. controindicazioni SCD DVT anamnesis/suspect conges0ve heart failure/pulmonary edema Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care 10. fasci0s, gangrene not treated - infected sores controindicazioni AES/SCD recent sutures edema edema bone lesions foot pumps ! arterial bypass graging skin gag obesity vasculopathies neuropathies malforma0ons Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care 11. Oer VTE prophylaxis to pa0ents undergoing gastrointes0nal surgery who are assessed to be at increased risk of VTE or pa0ents undergoing bariatric surgery S t a r t a t a d m i s s i o n , con0nue un0l pa0ent n o l o n g e r h a s signicantly reduced mobility. Choose any one of: AES, foot impulse devices, IPC Base choice on individual factors including clinical condi0on, surgical procedure and pa0ent preference. Add pharmacological prophylaxis if low risk of major bleeding Venous thromboembolism reducing the risk, NICE guidelines 2007 Velia Marta Antonini, Parma University Hospital - I Department of Anesthesia and Intensive Care