Finding Evidence on Venous Thromboembolism Project Comprehensive Nursing Essay Example

Finding Evidence on Venous Thromboembolism Project Comprehensive Nursing Essay Example

Introduction

Health professionals’ reliance on passive diffusion is bound to fail as the world healthcare environment witnesses the publication of more than two million articles on medical issues every year. Increasing interest in implementation of research findings in practice stems from the fact that there is a growing awareness of the gap between research findings and clinical practice. Additionally, there is also a need to show that public investment in research studies leads to benefits for patients. In order to promote and improve the uptake of research findings, it is paramount for an investigator to identify potential hindrances to implementation and overcome them. Suffice it to say that specific interventions can be used to develop strategies for organizational change, communicate research findings to patients, and promote the use of clinical guidelines, use of protocols and care bundles, and development of educational programs on specific and pertinent clinical questions regarding healthcare issues and practices. Interest on how to best promote the absorption of research findings is premised several factors that include but are not limited to disparities between clinical practice and research evidence of effective interventions. Some of these interventions address the management of homeostasis disturbance in kidney transplant patients, the risk of thromboembolism, and the prevalence of venous thromboembolism (VTEs) in KTPs as well as its effect on graft survival. Consequently, this essay purposes to locate three original research articles whose content address VTE treatment and care plan with a specific bias to adult KTPs. To achieve the objective, each of the retrieved article is summarized within the context of its participants, independent and dependent variables, the methods used, and the study results .Further, the essay delves into determining why the selected articles are suitable for inclusion for VTE prevalence among KTPs research topic.(Finding Evidence on Venous Thromboembolism Project Comprehensive Nursing Essay Example)

Abualhassan, N., Aljiffry, M., Thalib, L., Coussa, R., Metrakos, P., & Hassanain, M. (2015). Post-transplant venous thromboembolic events and their effect on graft survival. Saudi Journal of Kidney Diseases and Transplantation26(1), 1.(Finding Evidence on Venous Thromboembolism Project Comprehensive Nursing Essay Example)

Finding Evidence on Venous Thromboembolism Project Comprehensive Nursing Essay Example
Finding Evidence on Venous Thromboembolism Project Comprehensive Nursing Essay Example

URL;

https://www.sjkdt.org/article.asp?issn=1319-2442;year=2015;volume=26;issue=1;spage=1;epage=5;aulast=Abualhassan

Introduction

The introductory segment of this essay has established that finding relevant evidence helps the investigator to gain an understanding of the existing research and debates relevant to one’s selected topic or area of study, keep abreast of new knowledge, and support the implementation of knowledge gained. According to Abdulhassan et al (2015) VTEs which comprise of pulmonary embolism and deep vein thrombosis are a leading cause of post- operative morbidity and mortality. The researchers observe majority of VTEs happen due to failure prophylaxis instead of failure of prophylaxis per se. As such most of deaths from pulmonary embolism (a type of VTE) can largely be prevented through provision of adequate prophylaxis. Current recommendation for post- operative prophylaxis groups the VTEs risk into three categories namely low, moderate or high. The risk stratification is pegged on the degree of prophylaxis whereby early ambulation and graduated compression stocks are recommended for low risk patients. For those found to be in the medium risk group, use of low dose unfractionated heparin (LDUH) or low molecular weight heparin (LMWH) is recommended while for the high risk group LDUH 5 000 U three times a day or LMWH of more than 3 400 U daily reinforced with the use of GCS and/ or intermittent pneumatic compression (IPC) for between 7 and ten days is recommended.(Finding Evidence on Venous Thromboembolism Project Comprehensive Nursing Essay Example)

Participants

The researchers used collected data of 1596 KTPs who are the subjects of this study. (Finding Evidence on Venous Thromboembolism Project Comprehensive Nursing Essay Example)The setting was McGill University Multi-organ Transplant Database where KTPs diagnosed with VTEs from 1985 to 2010 were identified. Kidney transplants were performed using the standard technique and the diagnosis of DVT was made based on clinical suspicion and confirmed radiologically using Doppler Ultrasound.(Finding Evidence on Venous Thromboembolism Project Comprehensive Nursing Essay Example)

Independent Variables

The independent variables were the recommended prophylaxis post-operative intervention based on the risk stratification of either low, medium or high. This means the administration of early ambulation in low risk group, use of LDUH or LMWH for the medium group and LDUH 5000 U three times a day or LMWH more than 3400 daily combined with the use of GCS and or IPC for a minimum of 7 to 10 days. In some high risk patients, extended prophylaxis with LMWH is advised for between 28 and 45 days.(Finding Evidence on Venous Thromboembolism Project Comprehensive Nursing Essay Example)

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Dependent Variables

The dependent variables were increase or decrease of perioperative VTE events among KTPs. Prevalence of post –operative VTEs and graft survival were determined. The relative risk of developing a VTE was estimated using Cox regression and Hazard Ratio. A P-value of less than 0.05 was deemed significant. Other prognostic confounders were also collected and accounted for. These consisted of age, gender and cold ischemia time. Summary statistics for categorical variables like gender were expressed as frequency while continuous variables like age were expressed as a median, range or mean and standard deviation(Finding Evidence on Venous Thromboembolism Project Comprehensive Nursing Essay Example)

Methods

The method used in the study is retrospective analysis of perioperative VTEs in KTPs. As such, VTEs more than 90 days after transplantation and patients who had undergone multiple grafts were excluded.(Finding Evidence on Venous Thromboembolism Project Comprehensive Nursing Essay Example)

Results

A total of 1596 KTPs were analyzed.1114 of the patients or (64%) were mean with a median age of 47 years while 582 (or 36%) were women with a median age of 45 years). The youngest partiparticipant18 while the oldest was 74 years. 25 patients (or 1.6%) developed VTEs where three of these had PE and twenty two with DVT. The mean graft survival in patients without a VTE was 20.5 years while that of patients who developed VTEs was 12.3 years. The overall five year graft survival of the whole group was 78.3%. With P = 0.447, this effect was not statistically significant(Finding Evidence on Venous Thromboembolism Project Comprehensive Nursing Essay Example)

Why the Article is Suitable for Inclusion in Literature Review for My Topic on VTE in Adult Kidney Transplant Patients

        This article meets the inclusion criteria for a literature review on VTE among adult KTPs because VTEs increase the risk of graft failure in this patient population. (Finding Evidence on Venous Thromboembolism Project Comprehensive Nursing Essay Example)While the effects of this study were not statistically significant the impact of VTEs on graft and patient survival once determined by largescale studies would emphasize the fact that thrombo prophylaxis in KTPs still has clinical significance as they remain a high risk group.(Finding Evidence on Venous Thromboembolism Project Comprehensive Nursing Essay Example)

Ng, J. C. Y., Leung, M., & Landsberg, D. (2016). Evaluation of Heparin Anticoagulation Protocols in Post–Renal Transplant Recipients (EHAP-PoRT Study). The Canadian journal of hospital pharmacy69(2), 114. (Finding Evidence on Venous Thromboembolism Project Comprehensive Nursing Essay Example)https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4853178/

Introduction

        Homeostasis disturbances in KTPs is a common event. Patients who require a kidney transplant are those with end- stage renal disease as they have a pre-existing blood coagulation abnormalities related to chronic kidney disease. While bleeding has been reported in up to a half of patients with kidney failure, the process of a kidney transplant in and of itself present a significant for thrombosis. After a kidney transplant, the incidence of VTE falls between 6% and 18% while that of PE stands at between 2 and 14%. Moreover, renal artery or vein thrombosis contributes to 45% of early kidney graft losses. Guided by the fact that the risk of VTE and graft loss standard postoperative heparin prophylaxis has been implemented by many hospitals and some studies evaluated its use.(Finding Evidence on Venous Thromboembolism Project Comprehensive Nursing Essay Example)

Participants

        In the current study, the subjects were patients aged 19 years and above who had undergone a kidney transplant at St. Paul’s hospital between January 1, 2008 and July 31st, 2013. The Patient Records and Outcome Management Information System (PROMIS) database of BC Renal Agency was used to identify eligible patients. Similarly, patients who received either no heparin, prophylactic heparin or therapeutic heparin anticoagulation were identified using Centricity Pharmacy software. A sample size of 580 patients were included where they were categorized in their respective heparin cohorts.(Finding Evidence on Venous Thromboembolism Project Comprehensive Nursing Essay Example)

Independent variables

        The independent variables in this study were the three types of heparin prophylaxis intervention mentioned above namely, patients that had no heparin administered on them, those who received  prophylactic heparin or those that received therapeutic heparin anticoagulation in the early post- operative period( herein defined as 0-7 days after the kidney transplant operation.(Finding Evidence on Venous Thromboembolism Project Comprehensive Nursing Essay Example)

Dependent variables

        The dependent variables were the primary and secondary outcome variables. The primary objective outcome was the incidence of major bleeding and of thrombosis in early post-operative period. (Finding Evidence on Venous Thromboembolism Project Comprehensive Nursing Essay Example)Major bleeding was considered to be hematoma necessitating a surgical evacuation with retroperitoneal bleeding, intracranial bleeding required two or more units of packed red blood cells and documented bleeding taken to be a drop in hemoglobin level of 20g/L or more. On the other hand, thromboses were defined from documentation connected to both arterial and VTEs Secondary dependent variables were risk factors assessment in comparing patients with major bleeding and no bleeding.(Finding Evidence on Venous Thromboembolism Project Comprehensive Nursing Essay Example)

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Methods

        The researchers in this study selected retrospective cohort study as their research design for patients who had kidney transplant surgeries at St Paul’s Hospital whereby the study was approved by the University of British Columbia Providence Health Care Research Ethics Board and the Fraser Health Research Ethic Board.(Finding Evidence on Venous Thromboembolism Project Comprehensive Nursing Essay Example)

Results

The total KTPs population comprised of 547 patients of whom 268 had no heparin in the early post-operative period, 266 received prophylactic heparin, and 13 had therapeutic heparin. Of the 266 receiving prophylactic heparin, 91% or( 242) received 5000 units  SC of heparin twice every day, 6.4%( or 17) received dalteparin 5 000 units SC daily and 2.6% ( or 7) received heparin at a non- standard  dosage of between 7 500 units q8h  or 5 000 units qh8). For the 13 who received therapeutic heparin, 4 received a second course of heparin where all the 17 courses were administered intravenoustly.65% of 11 of the 17 courses used a low- target protocol (meaning 50- 85 s) while the other six courses (35%) used a standard target protocol 60-120 s)24 KTPs (or 4.4) experienced a total of 27 episodes of major bleeding or thrombosis. At secondary outcome level, the onset of major bleeding occurred a mean of 2.3(S.D 1.8) days after the initiation of anticoagulation and the mean drop in hemoglobin associated with major bleeding was 40. (SD 8.4) g/L.(Finding Evidence on Venous Thromboembolism Project Comprehensive Nursing Essay Example)

Why the Article is Suitable for Inclusion in Literature Review for My Topic on VTE in Adult Kidney Transplant Patients

            The results, findings and conclusion of this study make it suitable for inclusion in my proposed research topic because therapeutic use of heparin supports the continued use prophylactic heparin. (Finding Evidence on Venous Thromboembolism Project Comprehensive Nursing Essay Example)Both heparin administration play a significant role in the prevention VTE which is the main target of my study.(Finding Evidence on Venous Thromboembolism Project Comprehensive Nursing Essay Example)

Nieuwenhuijs-Moeke, G. J., van den Berg, T. A., Bakker, S. J., van den Heuvel, M. C., Struys, M. M., Lisman, T., & Pol, R. A. (2018). Preemptively and non-preemptively transplanted patients show a comparable hypercoagulable state prior to kidney transplantation compared to living kidney donors. PloS one13(7), e0200537 (Finding Evidence on Venous Thromboembolism Project Comprehensive Nursing Essay Example)https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0200537

Introduction

        Renal artery or vein thrombosis remains one of the most dangerous complications after undergoing a kidney transplantation. The incidence artery thrombosis after a kidney transplant falls between 0.2 % and 7.5% while vein thrombosis ranges between 0.1% and 8.2% and combined the two are responsible for 45% of early graft loss. Sudden anuria is a clinical manifestation of graft thrombosis while vein thrombosis manifests with pain and or swelling in the iliac fossa. Although early recognition and surgical intervention can save the graft it usually leads graft loss yet the absence of international guidelines means different intra- and post-operative antithrombotic strategies are used in different hospitals. Some of the healthcare facilities use no- anticoagulation therapy while others use unfractionated heparin therapy for many days for KTPs categorized as belonging to high risk group.(Finding Evidence on Venous Thromboembolism Project Comprehensive Nursing Essay Example)

Participants

        In this study conducted at the University Medical Center of Groningen, stored citrated plasma samples of donors and recipients taking part in the Volatile- Anesthetic Protection of Renal Transplants(VAPOR—1 trial were used. Sixty donors and recipient couples met the inclusion criteria and gave their written informed consent. But three were later excluded so that 57 patients had their results analyzed.(Finding Evidence on Venous Thromboembolism Project Comprehensive Nursing Essay Example)

Independent variables

        The independent variables were the dialysis, anesthesia and surgery performed. Last dialysis was performed a day before the scheduled surgery in case of hemodialysis (HD)or until one hour before surgery in case of peritoneal dialysis(PD) (Finding Evidence on Venous Thromboembolism Project Comprehensive Nursing Essay Example)Kidney donation was performed through hand assisted laparoscopy  while kidney transplantation was performed as per the local protocol. The choice of anesthetic agent (propofol or sevoflurane) was based on randomization whereby. In all patients analgesia was managed with remifentanil where target controlled infusion was used. Patients transplanted preemptively had 5 000 IU of UFH administered before the external iliac artery was clamped according to local protocol.(Finding Evidence on Venous Thromboembolism Project Comprehensive Nursing Essay Example)

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Dependent variables

            The dependent variables were the hemostatic state between preemptively and non-preemptively transplanted patients. These included elevated levels of platelet factor (indication platelet activation) and prothrombin fragment (indicating coagulation activation) and Von Willebrand Factor (indicating endothelia activation) and all these were compared to those of donors.

Methods

            A prospective randomized control trial examining the effects of two different anesthetic agents’ propofol versus sevoflurane on renal outcome in living donor kidney transplantation (LDKT). Sixty donors and recipient couples met the inclusion criteria and gave their written informed consent. Three of the participants were later excluded for violating the surgical or immunosuppressive protocol leaving a total of 57 subjects for the final analysis. Of the 57 participants 28 patients were transplanted preemptively ( preemptive group PG) and 29 patients were transplanted non- pre-emptive dialysis group-DG) To determine the reference values  for the various test groups performed 37 patients were selected to function as the control group.(Finding Evidence on Venous Thromboembolism Project Comprehensive Nursing Essay Example)

Results

            Baseline characteristics and relevant intraoperative parameters like age, BMI and gender were listed and compared. Charlson Comorbidity Index (CCI) was scored for both donors and recipients and as expected donors showed a lower CCI compared to recipients. The recipients CCI was comparable. None of the donors was administered with platelet aggregation inhibitors or erythropoietin analogs. The use of these medications was comparable in preemptive and non- preemptive recipients. The estimated glomerular filtration rate (eGFR) of preemptively transplanted patients was higher than the eGFR of no preemptively transplanted patients. Of the non-preemptively transplanted patients, 21 (72%) patients were on HD, and 8 (28%) on PD. Duration of the laparoscopic donor nephrectomy was longer than the kidney transplantation procedure. Ischemia times were comparable between recipients and the amount of fluid given intraoperatively was comparable between all groups. None of the recipients experienced graft thrombosis, 1 patient in the non-preemptive group experienced a postoperative bleeding complication warranting surgical exploration.(Finding Evidence on Venous Thromboembolism Project Comprehensive Nursing Essay Example)

Why the Article is Suitable for Inclusion in Literature Review for My Topic on VTE in Adult Kidney Transplant Patients

                    The article results, findings and conclusion are relevant to my research topic in that CKD has been determined to be an independent risk factor for VTE. One cannot fail to note that impaired kidney function is itself an independent risk factor for VTE whereby the risk increases with decreasing eGFR and the presence of other VTE risk factors like surgery and immobilization. (Finding Evidence on Venous Thromboembolism Project Comprehensive Nursing Essay Example)Therefore, the discussion and subsequent conclusion if integrated into my proposed intervention would significantly help to develop a VTE risk assessment and prophylaxis KTP care bundle after undergoing kidney transplant surgery.(Finding Evidence on Venous Thromboembolism Project Comprehensive Nursing Essay Example)

Conclusion

In conclusion, the current essay has established that locating relevant evidence is bound to help investigators to plan for rapid changes in knowledge. These changes encompass diagnostic techniques, pharmacological and behavioral l interventions, and surgical procedures all of which impact the organization and delivery of health services. Moreover, the changes significantly inform health policy development. This is because research findings are bound to influence decision making at several levels ranging from care accorded to individual patients, development of practice guidelines and commissioning of healthcare. Most importantly, one must at all times remember that successful formulation of educational programs, performance of clinical audits, development of  strategies that promote health and prevent diseases will only become effective if the healthcare professionals know how to translate knowledge into action.(Finding Evidence on Venous Thromboembolism Project Comprehensive Nursing Essay Example)

Finding Evidence on Venous Thromboembolism Project Comprehensive Nursing Essay Example
Finding Evidence on Venous Thromboembolism Project Comprehensive Nursing Essay Example 1

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