| Summary: | 碩士 === 長庚科技大學 === 護理系碩士在職專班 === 105 === Background: Surgical intensive care patients are easy to occur extremities’ deep vein and/or pulmonary embolism without obvious symptoms due to iatrogenic interventions that result in unclear consciousness or limited expressive ability, restraint, and immobility. If deep vein thrombosis is not diagnosed in time that may threaten patients’ life and become a chronic disease. Therefore, early diagnosis of venous thrombosis is very important; this issue must be globally confronted patients’ safety and medical burden. Likewise, Taiwan’s nursing staffs of intensive care units less concern about venous thrombosis and rare evidence-based literature is related to risk factors of legs’ deep venous thrombosis in surgical intensive care units.
Purposes: (1) compare difference in incidence of deep venous thrombosis on lower extremities among surgical intensive care unit by Wells score and Doppler ultrasound; (2) compare physiological factors, risk factors, and symptoms of deep venous thrombosis with or without deep vein thrombosis; (3) determine factors associated with legs’ deep venous thrombosis among surgical intensive care patients.
Methods: This was a prospective, observational study. A convenience sample was recruited from a surgical intensive care unit in a southern medical center. A self-design structured questionnaire was used to collect physiological, clinical, and situational data among surgical intensive care patients merging with modified Wells score and color Doppler ultrasound for assessing possibility of deep vein thrombosis occurrence. Data were analyzed by descriptive statistic, Chi-square test, unpaired test, and logistic regression.
Results: The majority of moderately likely patients with clinical deep venous thrombosis (69.9%) and likely deep venous thrombosis (99.5%) using Modified Wells score. The incidence of bilateral lower extremities deep vein thrombosis scan using Color Doppler was 24.0%. Bivariate logistic regression analyses revealed that gender, the presence or absence of femoral vein catheter replacement at the first time assessment, smoking versus non-smoking, and greater versus less or equal seven days’ hospitalization days of intensive care unit were statistically significant associated factors. However, multivariate logistic regression showed that age, body mass index at the first time assessment, and the presence or absence of femoral vein catheter replacement at the first time assessment were the statistically significant associated factor.
Conclusions: The incidence of deep vein thrombosis in medical-surgical intensive care patients was nearly one of fourth. Age, body mass index, and femoral vein catheter replacement were the significant associated factors. The occurrence of deep vein thrombosis is related to multiple risk factors. The clinical front line of medical care team members should have the professional knowledge of identifying deep vein thrombosis symptoms, the use of appropriate and reliable assessment tools, establishment of domestic deep vein thrombosis care standards, multiple screening high risk patients, correction of precipitate factors timely for preventing deep vein thrombosis occurrence and reducing patients’ life threat, and thereby improving the quality of medical care.
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