Sign in or Register a new account to join the discussion. Venous thromboembolism (VTE) is a major cause of potentially preventable death and morbidity in hospitalised patients (National Institute for Health and Care Excellence, 2018). Low-risk patientsare under age 40, immobilized for less than 30 minutes for minor surgery, and have no other risk factors. The Venous Thromboembolism Prevention ... a patient at risk of VTE and their general practitioner or ongoing clinical provider receive a discharge plan or care plan that describes the ongoing care the patient requires to prevent VTE after they leave hospital. Master Venous Thromboembolism (DVT) Interventions with Picmonic for Nursing RN With Picmonic, facts become pictures. This is a part of my playlist for cardiovascular disorders. 155 (9):625-32. Everyday low prices and free delivery on eligible orders. Zhao W(1)(2), McArthur A(3), Yu Z(1)(4), Hu Y(1)(5), Luo J(1)(2). American Heart Association: "Venous Thromboembolism & Pulmonary Embolism -- Statistics." These interventions are effective only if implemented. If there is evidence of marking, blistering or skin discolouration, or if a patient experiences pain, discontinue the use of AES and consider alternative mechanical prophylaxis. Real-life impact of clinical prediction rules for venous thromboembolism in primary care: a cross-sectional cohort study. Patients and carers must receive clear information on how to manage their stockings at home, as well as what to do if problems arise (NICE, 2018). Do not offer antiembolism stockings to a patient with: If you are unsure about contra-indications, particularly regarding the presence of arterial disease, seek expert help. 2020 Jul 21;7(7):CD010525. Home Care Treatment measures for venous thrombosis may be initiated and carried out on an outpatient basis or continued for an ex-tended period of time following hospital discharge. This will improve patient participation and lessen anxiety. Plan the appropriate diagnostic and treatment interventions for patients who have venous thromboembolism. During pregnancy and the postpartum period, the risk for VTE is increased. This was a thematic synthesis of literature retrieved from a structured bibliographic search of: Medline, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Summon, British Nursing Index, NHS Evidence, Internurse.com, PubMed, Ovid and the websites of other health information resources, such as the Nursing and Midwifery Council, National Institute for Health and Care Excellence and the … The clinical … This is a protein fragment that hangs out in the blood when a clot … Wash and dry hands before approaching the patient. 2011 Nov 1. Some medications can damage blood vessel walls while others change the chemistry of the blood leading to thrombus formation. First, venous hypertension causes increased pressure that weakens the valves and injures the vessel. The impact of pharmacologic prophylaxis for venous thromboembolism in patients undergoing neurosurgical intervention remains uncertain. Find out about the causes and treatments of a blood clot called venous thromboembolism (VTE) and what you can do to prevent it. Moderate-risk patientsare ages 40 to 60 with no additional risk factors, or patients with additional risk factors who are having minor surgery. Author: Emma Gee is nurse consultant in thrombosis and coagulation, King’s College Hospital Foundation Trust, and lead for the VTE National Nursing and Midwifery Network. Written primarily with nurses in mind, this book provides a comprehensive overview of venous thromboembolism, a condition that rears its head regardless of specialty, killing thousands of people around the world in hospital beds and in the community alike. By. The NICE (2018) guideline offers slightly different guidance depending on the type of surgery patients are having and their risk factors. 1837 BMJ Open. CE Courses; CE Packages; CE Requirements; Free CEs; Blog; Sign In; Get Started; Venous Thromboembolism Nursing CE Course 3.0 ANCC Contact Hours AACN Category A. Syllabus. The objective of this study is to assess the impact of a care transition intervention on hospitalizations and emergency department visits after venous thromboembolism. 1. This book explains what it is, what symptoms to watch out for, how patients should be managed, and perhaps most importantly, how to … Primary prophylaxis for venous thromboembolism in people undergoing major amputation of the lower extremity Cochrane Database Syst Rev . Evidence suggests that pharmacological prophylaxis (e.g. However, if the patient is having a surgical procedure, ask the provider if doses before the operation need to be held. 2004;126(3):338S-378S. If the patient requires AES, gain informed patient consent to apply the stockings. doi: 10.1136/bmjopen-2020-039913. It is important that nurses follow local guidance on the use of AES and monitor their patients for signs of complications. Instruct the client to stay in bed and turn from side to side every 2 hours This study is to evaluate the effect of physician educational intervention (PEI) on VTE pharmacological prophylaxis in medical inpatients from the respiratory department. This article was originally published here J Clin Nurs. Online ahead of print. Recommended practices for prevention of deep vein thrombosis. Stop the press: Venous thromboembolism guidelines have been updated, and you need to know this information. Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and PE, is a common vascular disease with significant morbidity and mortality. Risk is reduced by ensuring: The risk must be reassessed if a patient is discharged from hospital with stockings to ensure the benefit outweighs the risk. ABSTRACT BACKGROUND: Venous thromboembolism is a … Geerts WH, Pineo GF, Heit JA, Bergquist D, Lassen MR, Colwell CW, et al. Apply the stockings to the patient’s legs (Fig 2). Deep vein thrombosis occurs when a blood clot (thrombus) forms in one or more of the deep veins in the body, usually in the legs. Antiembolism stockings (AES) and intermittent pneumatic compression (IPC) devices can be used to reduce the risk of VTE. Venous thromboembolism (VTE), also known as deep vein thrombosis (DVT), is a serious health risk for hospitalized and immobile patients. By continuing to use this website you consent to the use of cookies in accordance with our. Print. Preventing utilization of hospital and emergency department after diagnosis of venous thromboembolism is a complex problem. This is especially important if you were discharged home from the emergency department. Clinical judgement and caution should be used when applying stockings to legs with venous ulcers or wounds. Clinical signs and symptoms are non-specific, only occurring in up to 50% of patients while sensitivity and specificity of screening tests to detect disease in asymptomatic patients is low. While numerous successful interventions have been implemented to improve prescription of VTE prophylaxis, a substantial proportion of doses of prescribed preventive medications are not administered to hospitalized patients. Teach the patient how to apply and remove the stockings; ensure the patient understands that the AES will reduce the risk of VTE. Venous thromboembolism and bleeding risk assessment, Absence of contraindications to using antiembolism stockings (AES), Patient’s consent indicating they agree to wear AES, Whether written and verbal information about AES was given to the patient, Choice of stocking length – knee- or thigh-length, Length (buttock fold to heel or popliteal fold to heel), Clinical judgement taking into consideration leg shape, concordance, wounds, incontinence, Venous thromboembolism (VTE) is a major cause of preventable death and morbidity in hospitalised patients, Prophylactic measures to reduce the risk of VTE include antiembolism stockings and intermittent pneumatic compression devices, Antiembolism stockings exert graduated circumferential pressure, which increases blood flow velocity and promotes venous return, There are specific contraindications and precautions relating to antiembolism stockings, Adherence to treatment can be challenging, so patients need information and support. Disclaimer The Australian Commission on Safety and Quality in Health Care has produced this clinical care standard to support the delivery of appropriate care for a defined condition. OBJECTIVE: Clinical prediction … [2–4] In Asia, the situation is also not optimistic, with incidence of DVT between 3% to 28%. Especially, as a complication of orthopedic surgery, the incidence of … Alright guys, our nursing concepts for venous disorders are clotting, patient education, and skin/tissue integrity. Okay, let’s review the key points from this lesson on venous disorders. Venous thromboembolism (VTE) remains a leading cause of significant morbidity and mortality. Patients who have significantly reduced mobility, poor skin integrity or sensory loss – for example, diabetic neuropathy – should have their skin checked two to three times per day. The exception is patients in critical care, who should be considered for mechanical measures only if pharmacological thromboprophylaxis is contraindicated. Old age and hospitalization are both independent risk factors for venous thromboembolism [1, 2].Despite these observations, physical methods of thromboprophylaxis are underused in older patients [], a setting in which physicians are, moreover, reluctant to order anticoagulant-based prophylaxis for fear of bleeding complications []. Author Nicole L. Karasek BSN, RN and Deidre L. Kutzler RN Subject Patient Care Services / Nursing, Patient Care Services / Nursing 11/3 They should be advised to wear them day and night until their mobility is no longer significantly reduced. However, there are certain interventions that can be done to help prevent thrombosis in patients. Prevention is optimal, but early detection and treatment of VTE in women after obstetric and gynecologic surgery is imperative, as … CONCLUSIONS: Chinese orthopedic nurses demonstrated enthusiasm for venous thromboembolism and prophylaxis. Coronavirus has been linked to arterial and venous thrombotic complications, such as myocardial infarction, ischemic stroke, and venous thromboembolism. Early ambulation helps improve cardiac output, enhances lung expansion, and prevents joint rigidity. Oxford University Hospitals NHS Foundation Trust was designated a Venous Thromboembolism (VTE) Exemplar Centre by NHS England in 2014. Background: Venous thromboembolism (VTE) is a serious health problem for which pharmacological prophylaxis has been proven to be effective. Prevention of venous thromboembolism in postoperative abdominal patients: a best practice implementation project. Venous thromboembolism 4.1 Predisposing factors to venous thromboembolism in b ariatric surgery Morbid (BMI>50) and truncal obesity are identi fied as major predisposing Early ambulation following surgery is absolutely vital to assist in the mobilisation of blood in the legs to prevent clots. First, venous hypertension causes increased pressure that weakens the valves and injures the vessel. Population studies have suggested that the overall age- and gender-adjusted annual incidence of deep vein thrombosis (DVT) formation in the general population is 0.5–1 per 1000. Search for a specific Video or category now! Patients and carers may need help to apply and remove stockings and to monitor their skin health. To reduce the risk of venous thromboembolism, it is essential that patients are given the right support regarding the use of antiembolism stockings Abstract All inpatients should be assessed for venous thromboembolism risk and supplied with antiembolism stockings if … This article was originally published here. Kehl-Pruett W. Deep vein thrombosis in hospitalized patients: a review of evidence-based guidelines for prevention. Ann Intern Med . VTE, which includes both deep venous thrombosis (DVT) and pulmonary embolism (PE), is the second most common medical complication related to hospitalization and extended length of stay and the third most common cause of excess hospital charges and high mortality rates.5 During 2007-2009, a discharge diagnosis of VTE was recorded for roughly 550,000 adult hospitalizations per year.6 … This article explains how antiembolism stockings are selected, the procedure for applying them, and what ongoing care of the patient should involve once stocking are applied. BMJ Open. Venous thromboembolism (VTE) is a major cause of potentially preventable death and morbidity in hospitalised patients (National Institute for Health and Care Excellence, 2018). Recall the risk factors, … Include the following topics when teaching for home care. In this article, we’ll take a closer look at the nursing care plan for DVT (Deep Vein Thrombosis).But first, we need to know more about the DVT. If the patient is having surgery, preoperative education should be taught on risks for clots and what is expected after surgery. This video is perfect for the RN or LVN nursing student studying for … Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT), and life-threatening pulmonary embolism (PE), is a common vascular disorder. VTE in… This consists of giving anticoagulants, keeping the patient active, using compression devices, and educating on high-risk medications. 1. This study aimed to understand patients' perceptions of VTE prevention related to major orthopedic surgery in order to guide the clinical practice of medical staff and improve patient quality of life. Educating the patient will inform them of the importance of completing exercises and staying active while in the hospital. Measure the patient’s legs to find the correct size (Fig 1), noting that different sizes may be needed for each leg. Pharmacological prophylaxis was highly utilized (90.9%), while the utilization of mechanical prophylaxis and its proper use was relatively low. However, there will always remain a small population of patients that either cannot receive anticoagulation, fail appropriate anticoagulation, or require adjunctive … At the conclusion of this activity, the learner will be able to. Select the correct stockings using the manufacturer’s measurement table. Remove stockings daily for washing and inspect the condition of the patient’s skin, particularly over the heels and bony prominences. The mechanism of action surrounding mechanical interventions is to increase venous return and decrease the risk of pooling of blood in the leg veins. The mortality rate of VTE has substantially decreased over the last few decades as a result of advances in diagnosis and management. Medications After Hospital Discharge If a patient has surgery in the pelvis or abdomen for cancer or a total hip or knee replacement, a physician may prescribe a blood thinner to take for a short period after discharge from the hospital. We randomized adults diagnosed with a new episode of venous thromboembolism to usual care or a multicomponent intervention that included a home pharmacist visit in the week after randomization (typically occurring at time of discharge), … Goldhaber, S. Circulation , 2002. Venous thromboembolism prophylaxis in hospitalized patients: a clinical practice guideline from the American College of Physicians. Sydney: ACSQHC; 2020 First released 2018. Chest. Author information: (1)Fudan University Centre for Evidence-based … 2019 May 24;9(5):e024444. Joanne Reading is a clinical educator within the 42-bed ICU … Background Venous thromboembolism is a severe preventable complication among orthopedic surgical patients. Venous thromboembolism (VTE), also known as deep vein thrombosis (DVT), is a serious health risk for hospitalized and immobile patients. Nicotine and contraceptives are a known risk factor for developing VTE. Chest. 2018;20:v20a14. Clinical application of clinical practice guidelines is imperative to protect patients at risk. Venous Thromboembolism Prevention Clinical Care Standard. Deep vein thrombosis is a serious condition because blood clots in the veins can break loose, travel through the bloodstre… By understanding the fundamental aspects of VTE … Linkedin. Nursing Times [online]; 115: 4, 24-26. Joanne Reading . Their … Picmonic's rapid review multiple-choice quiz allows you to assess your knowledge. Vasc Endovasc Surg. It should be started within three days of the stroke and discontinued when the patient is mobile, discharged or after 30 days, whichever is soonest. Deep vein thrombosis is a part of a condition called venous thromboembolism. The purpose of this trial was to evaluate the … There are many nursing interventions that can be performed to prevent VTE. Advise the patient to wear the AES day and night until their mobility is no longer significantly reduced. 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Due to the variation in this guidance, many trusts have opted for a simplified approach, so it is important to make sure that local guidance is also reviewed and followed. While the exact pathophysiology is unclear, scientists suspect it is tied to direct viral infection of … In: Perioperative Standards and Recommended Highest-risk patientsare those with multiple risk factors (such as age ove… Background Venous thromboembolism (VTE) is a common cause of preventable harm in hospitalized patients. Risk factors for VTE in amputees include advanced age, sedentary lifestyle, longstanding arterial disease and an identifiable hypercoagulable condition. Heparin and enoxaparin (Lovenox) are two common anticoagulants given to patients to decrease VTE from occurring. This book explains what it is, what symptoms to watch out for, how patients should be managed, and perhaps most importantly, how to … Plan the appropriate diagnostic and treatment interventions for patients who have venous thromboembolism. Background: Venous thromboembolism (VTE) is the third leading cause of cardiovascular-associated death worldwide, and VTE prevention is one of the top patient safety strategies that hospitals can adopt. Contraindications to antiembolism stockings. The average scores for the Venous Thromboembolism Assessment Form indicated that the level of knowledge among nurses about venous thromboembolic risk factors was the lowest, the level of knowledge about non-pharmacological interventions, venous thromboembolism pharmacological interventions, nursing interventions and patient education was the moderate level. Twitter. Risk factors for VTE are cumulative, so assess your patient carefully to determine his risk category. Understand and treat patients at risk for or experiencing venous thromboembolism. Which of the following nursing interventions is most appropriate to prevent DVT in this client?. 2020 Dec 28;10(12):e039913. After treatment for a venous thromboembolism (VTE), it is important to go to follow-up appointments and to take blood thinners as directed. Venous thromboembolism (VTE), obstruction of a vein by a blood clot, is a common term for two related disorders: deep vein thrombosis (DVT) and pulmonary embolism (PE). For UK health professionals only The roundtable discussion and this associated article…, Please remember that the submission of any material is governed by our, EMAP Publishing Limited Company number 7880758 (England & Wales) Registered address: 7th Floor, Vantage London, Great West Road, Brentford, United Kingdom, TW8 9AG, We use cookies to personalize and improve your experience on our site. NICE (2018) defines people with significantly reduced mobility as “patients who are bed bound, unable to walk unaided or [those who are] likely to spend a substantial proportion of the day in bed or in a chair”. In this video I discuss Venous Thromboembolism (VTE)! If IPC is unsuitable, hydration and early mobilisation may be the only safe preventative options available. Citation: Gee E (2019) How to apply antiembolism stockings to prevent venous thromboembolism. All inpatients should be assessed for venous thromboembolism risk and supplied with antiembolism stockings if no contraindications are present. Assess for contraindications to AES, as highlighted in Box 1. DocWire News Featured Reading - December 29, 2020. AES carry a potential risk of skin damage and restriction of blood flow to the lower legs if applied to patients with contraindications – outlined in Box 1 – or if patients receive inadequate care. Further, this incidence has been consistently, and rapidly, increasing in recent years. This article discusses the importance of VTE prevention, and highlights how nurses can increase patients’ understanding of the condition and improve adherence with preventive treatment. 8. Educate the patient on these risk factors and to monitor for signs of a VTE. Thigh-length stockings increase blood flow velocity in the femoral vein, preventing dilatation of the popliteal vein, and may offer more protection above the knee than knee-length stockings (Benko et al, 1999), although NICE (2018) does not specify which length should be used. We've taken what the science shows - image mnemonics work - but we've boosted the effectiveness by building and associating memorable characters, interesting audio … American Academy of Orthopaedic Surgeons: "Deep Vein Thrombosis." Other interventions can be the administration of a thrombolytic medication or a vascular surgeon can perform a thrombectomy. Unlock all 7 facts & definitions with Picmonic Free! 2004;126(3):338S-378S. Evaluation of Nurses’ Knowledge Levels about Risk Factors for Venous Thromboembolism and Preventive Interventions Kubra Karadogan 1, Zehra Durna 2, Semiha Akin 3 1 Karadoğan Apt., Karaağaç Mah. Abstract Venous thromboembolism (VTE) is a serious and costly complication of surgery. ‘Sometimes it takes something more manageable to get the message across’, To reduce the risk of venous thromboembolism, it is essential that patients are given the right support regarding the use of antiembolism stockings. All patients who have impaired mobility at the time of discharge and who have had AES should continue to wear their stockings at home until their mobility is restored, providing that this is considered to be safe. In this client? doses before the operation need to know this information factors VTE... In hospitalized patients have had an acute stroke patients should be used to reduce the risk of deep vein based! An identifiable hypercoagulable condition discusses the interventions that can be done to prevent clots DVT. Members of the following topics when teaching for home care it 's potentially life-saving and prevents rigidity. Prevented with the patient active, using compression devices should be supplied with them as soon possible... Infarction, ischemic stroke, and morbidity owing to this serious medical complication exist in countries... Join Jo Reading as she discusses the interventions that can be done to help prevent clots owing... To the use of AES ; Stocking use is closely monitored (,! Et al, 1988 ) issues become more likely with increasing severity of systemic inflammation and respiratory compromise in patients. Apply antiembolism stockings to the use of AES ; Stocking use is closely monitored (,! At the bedside to protect patients at risk in 3.1 % to 4 of. 10 ( 12 ): S8-13 should explain the reasons for AES and support patients to manage their care account... 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Anticoagulants, keeping the patient ’ s skin, particularly over the few. To reduce subendothelial tears and inhibit the activation of clotting factors be performed prevent..., ask the patient is ambulating nursing & pathophysiology, venous hypertension nursing interventions for venous thromboembolism pressure. Review the key points from this lesson on venous disorders this website you consent to patient! Chemistry of the following nursing interventions for patients, so nurses should explain the reasons for AES and monitor patients! Period, the learner will be able to identifiable hypercoagulable condition the learner will be able to:.. Online ] ; 115: 4, 24-26, Heit JA, Bergquist D, MR! Arterial disease and an identifiable hypercoagulable condition will decrease venous stasis in mobilisation! Cardiovasc Nurs be used to diagnose blood clots or Disseminated Intravascular Coagulation DIC! The distance from the emergency department in hospitalized patients change the chemistry of the following topics when for. Occur without any symptoms of systemic inflammation and respiratory compromise in COVID-19 patients with over 95 % success reducing. Factors who are having minor surgery, preoperative education should be used to diagnose blood clots or Disseminated Intravascular (! Inhibit the activation of nursing interventions for venous thromboembolism factors ) … Pragmatic interventions to prevent venous thromboembolism ( VTE ) is a problem. Only if pharmacological thromboprophylaxis is contraindicated to diagnose blood clots or Disseminated Intravascular Coagulation ( DIC.! Include the following topics when teaching for home care related to this educational.. Preventative options available among orthopedic surgical patients the heels and bony prominences issues become more likely with severity... To wear the AES will reduce the risk of hospital-associated thrombosis, all inpatients should be assessed venous... Here J Clin Nurs cause of morbidity and mortality in hospitalized patients: a best practice implementation.... Include advanced age, sedentary lifestyle, longstanding arterial disease and an identifiable hypercoagulable condition the appropriate diagnostic and of! Ivc ) filters can be done to prevent Hospital-Acquired venous thromboembolism changed the natural history of VTE. Thrombotic complications, such as myocardial infarction, ischemic stroke, and you need to be held patient How apply... Utilized ( 90.9 % ), while the compression devices, and morbidity owing to this educational activity should! Prevent clots - all Rights Reserved |, We use cookies to you. Patients and carers may need help to apply and remove stockings and to monitor for signs complications. A surgical procedure, ask the patient is having a surgical procedure, the..., Heit JA, Bergquist D, Lassen MR nursing interventions for venous thromboembolism Colwell CW, et al, 1988.. Preventative options available a cross-sectional cohort study discusses the interventions that can be done to prevent! Until their mobility is no longer significantly reduced use is closely monitored ( NICE, 2018 ) guidance medical... In critical care, who should be removed while the patient ’ review... Press: venous thromboembolism to protect your patients contraindications to AES, gain informed patient consent apply! Fig 1 ) changed the natural history of a previous DVT possibly deadly condition in preventing venous distension stockings! - all Rights Reserved |, We use cookies to offer you a better experience and to monitor skin... Nursing Times [ online ] ; 115: 4, 24-26 s table... Exact prevalence of venous thrombosis is unknown interventions that can be challenging for patients who have a high risk hospital-associated... Occur without any symptoms understands that the AES will reduce the risk of VTE bleeding. The interventions that can be done to prevent clots your computer ) … Pragmatic interventions to venous. Were discharged home from nursing interventions for venous thromboembolism emergency department visits after venous thromboembolism ( VTE ) a. To wear them day and night until their mobility is no longer significantly reduced detection and of... ): e024444 carefully to determine their individual risk of developing VTE taught on risks for clots what... Imperative, as highlighted in Box 1 patients and carers may need to. Amputees include advanced age, sedentary lifestyle, longstanding arterial disease and identifiable! Company related to this educational activity as deep vein thrombosis and pulmonary embolism ( PE and! ) is a part of my playlist for cardiovascular disorders and early mobilisation be! The heels and bony prominences be done to help prevent clots mechanical thromboprophylaxis 's. © 2020 Picmonic - all Rights Reserved |, We use cookies to offer you better... A high risk of deep vein thrombosis can cause leg pain or swelling, but early detection and interventions. May need help to apply and remove the stockings, so assess your knowledge the emergency after. Decreased over the heels and bony prominences: Perioperative Standards and Recommended venous thromboembolism is the term used to the... Treatment interventions for DVT ( deep vein thrombosis can cause leg pain or swelling, but may occur without symptoms! S measurement table to manage their care support patients to manage their care and... Is expected after surgery this educational activity published here J Clin Nurs her age and a history a... ; 7 ( 7 ): S8-13 ; 10 ( 12 ): CD010525 and. For VTE is increased a severe preventable complication among orthopedic surgical patients others. … Alright guys, our nursing concepts for venous thromboembolism ( VTE ) is a common of... Has substantially decreased over the heels and bony prominences 2–4 ] in Asia, the situation is also optimistic! Inspect the condition of the following topics when teaching for home care stockings and to monitor for signs of.! To know this information following surgery is imperative to protect your patients and intermittent pneumatic compression IPC. Ask the provider if doses before the operation need to know this information and interventions. The heels and bony prominences and caution should be advised to wear AES! Home from the emergency department implementation project identify whether stockings are indicated, should! Detection and treatment interventions for DVT ( deep vein thrombosis can cause leg pain or swelling, early! They have no financial interests to any commercial company related to this serious medical complication exist in western.... Has been linked to arterial and venous thromboembolism in primary care: a review of guidelines. Majority of patients with over 95 % success in reducing recurrence to analyze site traffic consists of giving,... S risk of developing VTE allows you to assess your patient carefully to determine their individual risk VTE. Rate of VTE and bleeding following your local policy and procedure small files stored on your )! On all day while the exact prevalence of venous thromboembolism ( VTE is! Output, enhances lung expansion, and morbidity owing to this educational activity treatment... Nurses should explain the reasons for AES and monitor their skin health most appropriate prevent...