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Abdominal Aortic Aneurysms: Promoting Awareness, Screenings, and Patient Support
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JOURNAL OF VASCULAR NURSING www.jvascnurs.net
JUNE 2016
patient reported outcomes tool (PROT) to help guide patient and family-centred decision-making particularly in relation to therapeutic options and advanced care planning. Keywords: Peripheral vascular disease, chronic critical limb ischaemia, quality of life and patient/family concerns.
Abstract 13
Abstract 11
The goal of every vascular intervention whether surgical or medical, is to improve the flow of blood from and to the heart. Consideration is made for each person on an individual basis to promote blood flow in the safest, most effective manner. Often blood flow is enhanced by the use of oral anticoagulants. Oral anticoagulation options for the vascular patient have traditionally been limited to warfarin which, while effective, has many limitations. Newer options include selective inhibitors of FXa and direct thrombin inhibitors. Each of these products has their own set of risks and advantages and disadvantages for use. This is a very competitive market and advances in product indications and safety profiles have been changing. The aim of this presentation is to provide an up to date summary of the uses, side effects and precautions for each product to better prepare the vascular nurse in educating patients on their use and to increase the comfort of advance practice nurses in prescribing these products. The presentation will also include the perspective of Society for Vascular Nursing members through a member survey on the clinical perspectives of using each product. The future of oral anticoagulation options will also be reviewed.
Abdominal Aortic Aneurysms: Promoting Awareness, Screenings, and Patient Support Ken Tillman, PhD, RN, East Tennessee State University College of Nursing, Johnson City, TN Thousands of individuals die each year from a ruptured Abdominal Aortic Aneurysm (AAA). These deaths can be prevented by promoting awareness of AAA disease and encouraging individuals who are at risk to have a simple ultrasound screening. Fortunately, many AAAs are discovered accidently during tests for other reasons. Depending on the size of aortic dilation corrective surgery may or may not be performed. Individuals diagnosed with an AAA have many questions and need education about the disease process and treatment protocols. This is especially true for individuals with an AAA who do not require immediate surgical repair. These individuals may experience stress, anxiety and feel like they are ‘‘living with a time bomb’’ internally. Nurses are in key positions to promote awareness of AAA disease, advocate for screening of at risk individuals, and provide education and support to individuals diagnosed with an AAA. The SVN has a collaborative relationship with AAAneurysm Outreach (AO), a national non-profit organization dedicated to promoting awareness of AAA disease and screenings for at risk individuals. Through these organizations individual nurses and SVN Chapters have access to a variety of resources to help create awareness about AAA disease and provide education and support to patients diagnosed with an AAA.
Abstract 12 Enchanted Tales in Home Health Care...It Doesn’t Have to be a Nightmare! Dewey Moulton, MAN, RN, Mayo Clinic, Rochester, MN As healthcare costs continue to rise, the vascular patient, with multiple comorbidities is faced with enduring an ever growing number of medical/surgical interventions which can now be performed as an outpatient or with a shortened length of hospitalization. In an effort to transition home, many of these patients will require the assistance of their families, but also home health care services. As health care providers, we must identify those patients who will benefit from home health care services, determine their needs, and develop an affordable care plan which will promote patient success. Frequently, Medicare (and other insurances), will assist with the cost of many of these services, when properly initiated. Health care providers who understand eligibility requirements will have another option to effectively manage patients in their home, with fewer return appointments and hospitalizations. Options and benefits for home health care will be presented using a series of short stories, each building upon the former one.
Oral Anticoagulation in the Vascular Patient Cindi Christensen, MSN, CVN, ARNP-BC, Mobile Medical Professionals, Polk City, IA
Abstract 14 The Evolution of Inferior Vena Cava Filters Patty Bozeman, APRN, CVN, Hartford Healthcare Medical Group, Hartford, CT Inferior vena cava (IVC) filters are devices which are placed in the IVC for the purpose of preventing life threatening pulmonary embolism (PE). Venous thromboembolism (VTE) which is comprised of deep vein thrombosis and/or pulmonary embolism continues to cause significant morbidity and mortality. Medical management of VTE remains first line treatment, however in a subgroup of patients, anticoagulation may be contraindicated. In this group of patients endovascular treatment with IVC filter placement may be indicated. Early reports indicate that ligation of the infrarenal inferior vena cava provided a mechanism to block the final common path to the pulmonary circulation. Ligation, as a means to prevent PE, was performed up until the late 1960’s. Complications and unacceptable outcomes from this procedure led to its discontinuation. Subsequent to this, vena caval suturing, staple plication, and applications of clips provided limited flow through the IVC. However outcomes proved to be less than acceptable. Transverse interruption of the inferior vena cava by the umbrella filter was first performed by MobinUddin in 1968. The IVC filter has evolved markedly over the past 50 years. Types of IVC filters include permanent, retrievable, and the newest generation of a bioconvertible filter. The purported use of these filters is to reduce the risk of PE thus reducing morbidity of VTE. Indications for placement of an IVC filter are, contraindication for systemic anticoagulation, recurrent VTE despite adequate anticoagulation, and, although more controversial, prophylaxis from PE during high risk surgical
JOURNAL OF VASCULAR NURSING www.jvascnurs.net
JUNE 2016
patient reported outcomes tool (PROT) to help guide patient and family-centred decision-making particularly in relation to therapeutic options and advanced care planning. Keywords: Peripheral vascular disease, chronic critical limb ischaemia, quality of life and patient/family concerns.
Abstract 13
Abstract 11
The goal of every vascular intervention whether surgical or medical, is to improve the flow of blood from and to the heart. Consideration is made for each person on an individual basis to promote blood flow in the safest, most effective manner. Often blood flow is enhanced by the use of oral anticoagulants. Oral anticoagulation options for the vascular patient have traditionally been limited to warfarin which, while effective, has many limitations. Newer options include selective inhibitors of FXa and direct thrombin inhibitors. Each of these products has their own set of risks and advantages and disadvantages for use. This is a very competitive market and advances in product indications and safety profiles have been changing. The aim of this presentation is to provide an up to date summary of the uses, side effects and precautions for each product to better prepare the vascular nurse in educating patients on their use and to increase the comfort of advance practice nurses in prescribing these products. The presentation will also include the perspective of Society for Vascular Nursing members through a member survey on the clinical perspectives of using each product. The future of oral anticoagulation options will also be reviewed.
Abdominal Aortic Aneurysms: Promoting Awareness, Screenings, and Patient Support Ken Tillman, PhD, RN, East Tennessee State University College of Nursing, Johnson City, TN Thousands of individuals die each year from a ruptured Abdominal Aortic Aneurysm (AAA). These deaths can be prevented by promoting awareness of AAA disease and encouraging individuals who are at risk to have a simple ultrasound screening. Fortunately, many AAAs are discovered accidently during tests for other reasons. Depending on the size of aortic dilation corrective surgery may or may not be performed. Individuals diagnosed with an AAA have many questions and need education about the disease process and treatment protocols. This is especially true for individuals with an AAA who do not require immediate surgical repair. These individuals may experience stress, anxiety and feel like they are ‘‘living with a time bomb’’ internally. Nurses are in key positions to promote awareness of AAA disease, advocate for screening of at risk individuals, and provide education and support to individuals diagnosed with an AAA. The SVN has a collaborative relationship with AAAneurysm Outreach (AO), a national non-profit organization dedicated to promoting awareness of AAA disease and screenings for at risk individuals. Through these organizations individual nurses and SVN Chapters have access to a variety of resources to help create awareness about AAA disease and provide education and support to patients diagnosed with an AAA.
Abstract 12 Enchanted Tales in Home Health Care...It Doesn’t Have to be a Nightmare! Dewey Moulton, MAN, RN, Mayo Clinic, Rochester, MN As healthcare costs continue to rise, the vascular patient, with multiple comorbidities is faced with enduring an ever growing number of medical/surgical interventions which can now be performed as an outpatient or with a shortened length of hospitalization. In an effort to transition home, many of these patients will require the assistance of their families, but also home health care services. As health care providers, we must identify those patients who will benefit from home health care services, determine their needs, and develop an affordable care plan which will promote patient success. Frequently, Medicare (and other insurances), will assist with the cost of many of these services, when properly initiated. Health care providers who understand eligibility requirements will have another option to effectively manage patients in their home, with fewer return appointments and hospitalizations. Options and benefits for home health care will be presented using a series of short stories, each building upon the former one.
Oral Anticoagulation in the Vascular Patient Cindi Christensen, MSN, CVN, ARNP-BC, Mobile Medical Professionals, Polk City, IA
Abstract 14 The Evolution of Inferior Vena Cava Filters Patty Bozeman, APRN, CVN, Hartford Healthcare Medical Group, Hartford, CT Inferior vena cava (IVC) filters are devices which are placed in the IVC for the purpose of preventing life threatening pulmonary embolism (PE). Venous thromboembolism (VTE) which is comprised of deep vein thrombosis and/or pulmonary embolism continues to cause significant morbidity and mortality. Medical management of VTE remains first line treatment, however in a subgroup of patients, anticoagulation may be contraindicated. In this group of patients endovascular treatment with IVC filter placement may be indicated. Early reports indicate that ligation of the infrarenal inferior vena cava provided a mechanism to block the final common path to the pulmonary circulation. Ligation, as a means to prevent PE, was performed up until the late 1960’s. Complications and unacceptable outcomes from this procedure led to its discontinuation. Subsequent to this, vena caval suturing, staple plication, and applications of clips provided limited flow through the IVC. However outcomes proved to be less than acceptable. Transverse interruption of the inferior vena cava by the umbrella filter was first performed by MobinUddin in 1968. The IVC filter has evolved markedly over the past 50 years. Types of IVC filters include permanent, retrievable, and the newest generation of a bioconvertible filter. The purported use of these filters is to reduce the risk of PE thus reducing morbidity of VTE. Indications for placement of an IVC filter are, contraindication for systemic anticoagulation, recurrent VTE despite adequate anticoagulation, and, although more controversial, prophylaxis from PE during high risk surgical