Hekim ve Hemşirelerin Derin Ven Trombozu Profilaksisinde Mekanik Yöntem Kullanımları ve Belirleyicileri

Yıl 2023, Cilt: 26 Sayı: 4, 253 - 259, 29.12.2023

Süleyman Altun Elif Akyüz

https://doi.org/10.5152/JANHS.2023.23446

Öz

Amaç: Bu çalışma, hekim ve hemşirelerin derin ven trombozu profilaksisinde mekanik yöntem kullanımlarını ve belirleyici faktörleri saptamak amacıyla yapılmıştır.

Yöntemler: Çalışma Aralık 2020-Şubat 2021 tarihleri arasında gerçekleştirildi. Bu çalışmanın katılımcılarını Türkiye’de bir üniversite hastanesinin cerrahi ve dahiliye klinikleri ile yoğun bakım ünitelerinde çalışan 234 hekim ve 303 hemşire oluşturdu. Veriler araştırmacılar tarafından geliştirilen formlar kullanılarak toplandı ve tanımlayıcı istatistik olarak ortalama ve standart sapma, sayı ve yüzde dağılımları kullanılarak analiz edildi.

Bulgular: Hekim ve hemşirelerin en çok kullandığı mekanik yöntem antiembolik çoraplardı. Mekanik yöntemlerin kullanımını belirleyen faktörler klinikteki rutin uygulamalar, uygulama kolaylığı, hastanın kullanımına uygunluğu, klinikte cihaz/malzeme varlığı ve hekim tercihi idi. Hemşirelerin bir kısmı (%39,3) mekanik yöntemleri kullanırken güçlük yaşadıklarını bildirdi. Hemşirelerin yaşadıkları güçlükler; hastaların mekanik yöntem kullanımına bağlı uyum sorunları (%38,9), mekanik yöntemleri doğru uygulayamama (%27,9), değerlendirememe/izleyememe (%20,0) ve hastane prosedürlerinde sorun yaşama (%13,2) olarak belirlendi. Hekimler, mekanik yöntemlerin yanlış/eksik kullanıldığını fark ettiklerini bildirdi (%57,7). Bu yanlış/eksik kullanımlar mekanik yöntemlerin yanlış uygulanması (%54,1) ve hastalara doğru mekanik yöntemin seçilememesiydi (%22,5).

Sonuç: Kliniklerde kılavuzlar dikkate alınarak hastaya uygun etkili ve güvenli mekanik yöntemler kullanılmalıdır. Bakımı standardize etmek için mekanik yöntemlerin kullanımına yönelik bakım protokolleri geliştirilmeli, kaliteli bakım sağlamak için sağlık profesyonellerine bu doğrultuda eğitim verilmelidir.

Physicians’ and Nurses’ Use and Determinants of Mechanical Methods for Prophylaxis of Deep-Vein Thrombosis

Öz

Objective: This study was conducted to determine the use of mechanical methods and determining factors of prophylaxis of deep-vein thrombosis by physicians and nurses.

Methods: The study was conducted between December 2020 and February 2021. The participants of this study consisted of 234 physicians and 303 nurses working in surgical and internal medicine clinics/intensive care units of a university hospital in Turkey. Data were collected using forms developed by the researchers and analyzed using mean and standard deviation, number and percentage distributions as descriptive statistics.

Results: The mechanical method most used by the physicians and nurses was anti-embolism stockings. Factors determining the use of mechanical methods were routine practices in the clinic, ease of application, suitability for the patient use, presence of devices/materials in the clinics, and preference of the physician. Some of the nurses reported that they had difficulties using mechanical methods (39.3%). These difficulties were as follows: patients’ compliance problems related to the use of mechanical methods (38.9%), inability to apply mechanical methods correctly (27.9%), inability to evaluate/monitor it (20.0%), and having trouble with hospital procedures (13.2%). Physicians noticed the wrong/missing use of mechanical methods (57.7%). These were improper application of the mechanical methods (54.1%) and failure to choose the right mechanical method for the patients (22.5%).

Conclusion: Considering the guidelines, effective and safe mechanical methods suitable for the patient should be used in clinics. Care protocols should be developed for the use of mechanical methods to standardize care, and health professionals should be trained to provide quality care.

Anahtar Kelimeler

Deep-vein thrombosis, mechanical methods, prophylaxis, physician, nurse

Kaynakça

• 1. Badireddy M, Mudipalli VR. Deep venous thrombosis prophylaxis. Available at: https ://ww w.ncb i.nlm .nih.gov/b ooks/ NBK53 4865/ Accessed May 03, 2023.
• 2. Palamone J, Brunovsky S, Groth M, Morris L, Kwasny M. ‘‘Tap and Twist’’: preventing deep vein thrombosis in neuroscience patients through foot and ankle range-of-motion Exercises. J Neurosci Nurs. 2011;43(6):308-14; quiz 315. [CrossRef]
• 3. Beckman MG, Hooper WC, Critchley SE, ortel TL. Venous thromboembolism. A public health concern. Am J Prev Med. 2010;38(4)(suppl):S495-S501. [CrossRef]
• 4. Hajibandeh S, Hajibandeh S, Antoniou GA, Scurr JRH, Torella F. Neuromuscular electrical stimulation for the prevention of venous thromboembolism [protocol]. Cochrane Database Syst Rev. 2015;6.[CrossRef]
• 5. Stone J, Hangge P, Albadawi H, et al. Deep vein thrombosis: pathogenesis, diagnosis, and medical management. Cardiovasc Diagn Ther. 2017;7(suppl 3):S276-S284. [CrossRef]
• 6. Centers for Disease Control and Prevention. Impact of blood clots on the United States. 2022. Available at: https ://ww w.cdc .gov/ncbddd/dvt /info graph ic-im pact. html. Accessed April 20, 2023.
• 7. Favaloro EJ, Lippi G. Maintaining hemostasis and preventing thrombosis in CoVID-19—Part I. Semin Thromb Hemost. 2020;46(7):757- 762. [CrossRef]
• 8. Akyüz E, Tunçbilek Z. Anti-embolism stocking care protocol to prevent associated skin problems: A quasi-experimental study. J Tissue Viability. 2021;30(1):89-94. [CrossRef]
• 9. Lippi G, Favaloro EJ, Cervellin G. Prevention of venous thromboembolism: focus on mechanical prophylaxis. Semin Thromb Hemost. 2011;37(3):237-251. [CrossRef]
• 10. National Institute for Health, Exellence C. Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism. Available at: https ://ww w.ncb i.nlm .nih.gov/b ooks/ NBK56 1646/; 2019. Accessed April 20, 2023
• 11. ortel TL, Neumann I, Ageno W, et al. American Society of Hematology 2020 guidelines for management of venous thromboembolism: treatment of deep vein thrombosis and pulmonary embolism. Blood Adv. 2020;4(19):4693-4738. [CrossRef]
• 12. Caprini JA. Mechanical methods for thrombosis prophylaxis. Clin Appl Thromb Hemost. 2010;16(6):668-673. [CrossRef]
• 13. Froimson MI, Murray TG, Fazekas AF. Venous thromboembolic disease reduction with a portable pneumatic compression device. J Arthroplasty. 2009;24(2):310-316. [CrossRef]
• 14. Hill J, Treasure T. Reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in inpatients having surgery: summary of NICE guidance. BMJ. 2007;334(7602):1053-1054. [CrossRef]
• 15. Tamowicz B, Mikstacki A, Urbanek T, Zawilska K. Mechanical methods of venous thromboembolism prevention: from guidelines to clinical practice. Pol Arch Intern Med. 2019;129(5):335-341. [CrossRef]
• 16. Field TS, Hill MD. Prevention of deep vein thrombosis and pulmonary embolism in patients with stroke. Clin Appl Thromb Hemost. 2012;18(1):5-19. [CrossRef]
• 17. Barp M, Carneiro VSM, Amaral KVA, Pagotto V, Malaquias SG. Nursing care in the prevention of venous thromboembolism: an integrative review. Rev Eletr Enf. 2018;20:v20a14. [CrossRef]
• 18. Cohen AT, Tapson VF, Bergmann JF, et al. Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDoRSE study): a multinational cross-sectional study. Lancet. 2008;371(9610): 387-394. [CrossRef]
• 19. Winslow EH, Brosz DL. Graduated compression stockings in hospitalized postoperative patients: correctness of usage and size. Am J Nurs. 2008;108(9):40-50; quiz 50. [CrossRef]
• 20. Moran PS, Teljeur C, Harrington P, Ryan M. A systematic review of intermittent pneumatic compression for critical limb ischemia. Vasc Med. 2015;20(1):41-50. [CrossRef]
• 21. Akyüz E, Tunçbilek Z. Nurses role and responsibilities on management of antiembolism stockings: antiembolism stocking care protocol. Turk J CardioVasc Nurs. 2018;9(20):96-104. [CrossRef]
• 22. Fontela PC, Forgiarini LAJr, Friedman G. Clinical attitudes and perceived barriers to early mobilization of critically ill patients in adult intensive care units. Rev Bras Ter Intensiva. 2018;30(2):187-194.[CrossRef]
• 23. Stolldorf DP, Dietrich MS, Chidume T, McIntosh M, Maxwell CA. Nurse-initiated mobilization practices in 2 community intensive care units: A pilot study. Dimens Crit Care Nurs. 2018;37(6):318-323. [CrossRef]
• 24. Hayes JM, Lehman CA, Castonguay P. Graduated compression stockings: updating practice, improving compliance. Medsurg Nurs. 2002;11(4):163-6. quiz 167.
• 25. Cayley WE. Preventing deep vein thrombosis in hospital inpatients. BMJ. 2007;335(7611):147-151. [CrossRef]