Nursing Assignment | GCS and Post Operative Patients

GCS AND POST OPERATIVE PATIENTS 1
Systematic Review; Research Proposal
Name
Nam of the Class
Instructor
Institution
City and State
Date

GCS AND POST OPERATIVE PATIENTS 2
Research proposal: Graduated Compression Stockings (GCS) to Prevent Deep Vein Thrombosis
(DVT) in Post Operative Patients
Background
Deep vein/venous thrombosis is a situation where the blood clot forms in the deep veins
of the body, especially in the legs. The state can cause swelling of legs or pain, and can also
occur without any symptoms (Baldwin et al. 2013). It can also develop if a person has specific
medical conditions that affect the rate at which blood clots. Else way, the state can occur for
people who cannot move for a long time like after an accident, surgery, or when a person is
confined to bed. Diagnosis of the condition is difficult since the patients/clients history cannot be
specific. Also, the symptoms can vary from one person to the other. The sequelae of the
condition can change from a full clot resolution with no ill impact via death because of the P.E,
pulmonary embolism.
In earlier past, the incidence of deep vein thrombosis at the community level was almost
negligible while about 24 percent of those in hospitals contracted the condition (Caprini 2010).
However, recent data from regulatory arms of RCTs show that the prevalence of deep vein
thrombosis in surgical clients was 28 percent contrary to 23 percent to those in the medical
clients. Also, the incidence of symptomatic pulmonary embolism was three and one percent
respectively.
Data from the Britain cohort study pointed out that women going through inpatients
surgical procedures had a higher probability compared to those who did not performed the
procedure to be admitted having developed venous thromboembolism within the first one month
after surgery; Also, those going through the day case process had higher chances of being

GCS AND POST OPERATIVE PATIENTS 3
admitted. According to CLOTS (2013), the risks which were left increased seven to twelve
weeks after surgery, where the pattern of risk was the same to that of pulmonary embolism and
deep vein thrombosis. Ideally, the risks varied significantly due to surgery type. However it is
approximated that over 20, 000 people in England are at risk of dying each year due to
potentially preventable venous thromboembolism developed while in healthcare centres.
Surgical patients are however at high risk of venous thromboembolism if they can
achieve the following guidelines. First, is the surgical procedure having a complete anaesthetic
as well as a surgical period of more than 1.5 hours or 1 hour if the process involves the lower
limb or the pelvis (De et al. 2010). Second is acute surgical admission with intra-abdominal
condition or inflammatory, obesity, dehydration, critical care admission, active cancer/ cancer
treatment, and known thrombophilias to mention just a few.
As of late, there have been shifts in some of the factors that influence the risk of post-
surgery deep vein thrombosis. De et al. (2010) postulates that, surgical practices have changed to
the extent at which the time of general anaesthetic becomes short; the operation is done using a
local anaesthetic. However, the time at which the client stays in the healthcare unit is very short
with lots of procedures being done on a daily basis. Therefore, patients are mobilised
immediately while those discharged home get help from physiotherapists in the community.
Moreover, modern anticoagulants like rivaroxaban can be used for an extended period providing
long protection to clients. For example, in 2010, the health department developed a risk
assessment for VTT or venous thromboembolism tool for use in people in healthcare units
(CLOTS 2013). It’s also the NICE quality standards that every person on admission to healthcare
unit gets an assessment of the personal risk of venous thromboembolism as well as bleeding
using clinical risk evaluation criterion which is described in the tool mentioned above.

GCS AND POST OPERATIVE PATIENTS 4
Irrespective of such efforts to prevent postoperative deep vein thrombosis, other aspects like the
increasing number of aged clients undergoing surgery as well as proportion overweight plus
morbidly obese clients, puts more pressure on the postoperative DVT population risk.
The rate of a disease due to deep vein thrombosis entails post-thrombotic syndrome
abbreviated as (PTS) that comprises of chronic-venous hypertension (CVH) leading to pain in
the limbs, swelling, hyper-pigmentation, skin inflammation commonly known as dermatitis,
ulcers as well as the skin becoming hard which may lead to a brown/red pigmentation which is
usually associated with wasting of fat. Most importantly, data from different cohort studies
showed that 42% of people with symptomatic deep vein thrombosis develop features of PTS,
post-thrombotic syndrome at two years follow up.
Mortality linked with deep vein thrombosis is higher in the first one month, at three to six
percent, also the risk of death is always high at a long-term follow-up (Goldhaber &
Bounameaux, 2012). According to different reports, 29 % to 42 % of people with deep vein
thrombosis subsequently developed pulmonary embolism, which is directly connected with a rise
in the risk of thirty-day mortality to about 12%. However, those at the risk of contracting deep
vein thrombosis is classified into three distinct categories; low, medium, as well as higher risk as
per the international consensus statement abbreviated as (ICS) as well as thromboembolism risk
factor consensus group guideline. According to Caprinini (2010), the principles on prophylaxis
of VT or venous thromboembolism from the Scottish intercollegiate guideline framework as well
as National Institute of Health and Care Excellence do not group people either into low, medium
or high risk subsets. Besides, such frameworks consider the risk factors for improving deep vein
thrombosis in hospitalised clients especially on a personal level.