The Role of Prophylaxıs for Preventıng Venous Thromboembolısm in Major Urologıcal Surgery and Nursıng Management

Year 2025, Volume: 20 Issue: 1, 51 - 63, 27.02.2025

Senem Güneş Kara

https://doi.org/10.33719/nju1503620

Abstract

Venous thromboembolism (VTE), which includes both pulmonary embolism (PE) and deep vein thrombosis (DVT), is a common complication in major urological oncology surgery and is one of the significant causes of mortality and morbidity. Effective and quality nursing care and practices at every stage of the perioperative process, from the patient's initial clinical admission to post-discharge home care, can prevent potential complications. The most effective and easiest way to prevent VTE is to perform a proper risk assessment. Nurses providing care to patients undergoing major urological surgery should conduct a risk assessment through an effective nursing anamnesis in the preoperative period and take necessary precautions for individuals at risk for VTE. These precautions should be planned to encompass the intraoperative and postoperative periods as well. The primary reasons that increase susceptibility to VTE include the pelvic region being the focus of urological surgeries, the majority of patients being elderly, surgeries typically being performed in the lithotomy position, and the relatively extended period of postoperative immobilization. Risk classification, according to national and international guidelines, is categorized as 'high' or 'very high' risk, with prophylaxis post-discharge considered only for a subset of patients at 'very high risk.' VTE prevention is generally achieved through two main approaches: pharmacological and non-pharmacological prophylaxis. Pharmacological prophylaxis reduces the likelihood of VTE, but it is crucial to balance the risk of bleeding with the patient's experience. Therefore, this review aims to evaluate the role of prophylaxis and nursing management in preventing VTE in major urological surgical procedures.

Keywords

Major urological surgery, venous thromboembolism, nursing management.

MAJÖR ÜROLOJİK CERRAHİ GİRİŞİMLERDE VENÖZ TROMBOEMBOLİYİ ÖNLEMEDE PROFİLAKSİNİN ROLÜ VE HEMŞİRELİK YÖNETİMİ

Abstract

Venöz tromboembolizm (VTE), hem pulmoner emboli (PE) hem de derin ven trombozu (DVT) dahil olmak üzere, büyük ürolojik onkoloji cerrahisinde yaygın bir komplikasyon olup, mortalite ve morbiditenin önemli nedenlerinden biridir. Hastanın ilk klinik başvurusundan taburculuk sonrası ev bakımına kadar perioperatif sürecin her aşamasında etkili ve kaliteli hemşirelik bakımı ve uygulamaları, olası komplikasyonları önleyebilir. VTE'yi önlemenin en etkili ve en kolay yolu, doğru bir risk değerlendirmesi yapmaktır. Büyük ürolojik cerrahi geçiren hastalara bakım veren hemşireler, preoperatif dönemde etkili bir hemşirelik anamnezi yoluyla risk değerlendirmesi yapmalı ve VTE riski taşıyan bireyler için gerekli önlemleri almalıdır. Bu önlemler, intraoperatif ve postoperatif dönemleri de kapsayacak şekilde planlanmalıdır. VTE'ye yatkınlığı artıran başlıca nedenler arasında, ürolojik cerrahilerin pelvis bölgesinde odaklanması, hastaların çoğunluğunun yaşlı olması, cerrahilerin genellikle litotomi pozisyonunda gerçekleştirilmesi ve postoperatif immobilizasyon süresinin nispeten uzun olması yer almaktadır. Ulusal ve uluslararası rehberlere göre risk sınıflandırması, 'yüksek' veya 'çok yüksek' risk olarak kategorize edilmekte olup, taburculuk sonrası profilaksi yalnızca 'çok yüksek risk' grubundaki hastaların bir alt kümesi için düşünülmektedir. VTE önlenmesi genellikle iki ana yaklaşımla sağlanır: farmakolojik ve farmakolojik olmayan profilaksi. Farmakolojik profilaksi VTE olasılığını azaltır, ancak kanama riski ile hastanın deneyimi arasında bir denge kurmak önemlidir. Bu nedenle, bu derlemenin amacı, büyük ürolojik cerrahi prosedürlerde VTE'yi önlemede profilaksi ve hemşirelik yönetiminin rolünü değerlendirmektir.

Keywords

Büyük ürolojik cerrahi, venöz tromboembolizm, hemşirelik yönetimi.

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