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To Bleed or not to Bleed: Current Anticoagulation Therapy and Implications for Practice
Vol. XXXIV No. 2
JOURNAL OF VASCULAR NURSING www.jvascnurs.net
our patients with lower extremity amputations, an Amputee Support Group has been implemented on the Vascular Care Unit at Florida Hospital Orlando. In addition to presenting empirical research related to the financial, emotional and social impact of lower extremity amputations, we will discuss the impact that the Amputee Support Group has had on promoting the positive adjustment of patients with lower extremity amputations.
Abstract 8 To Bleed or not to Bleed: Current Anticoagulation Therapy and Implications for Practice Kristen Alix, RN, MS, APRN-BC, CVN, University of Colorado Division of Vascular Surgery and Endovascular Therapy, Denver, Co Background: Anticoagulants and anti platelets agents are commonplace in any vascular practice. In 2014, over 30 million people were taking Warfarin for indications including atrial fibrillation and venous thromboembolism. Yearly, over 2 million people are started a Vitamin K antagonist, Novel oral anticoagulant (NOAC) or a heparin substrate. Additionally, in 2014, there were over 5.5 million prescriptions written for new antiplatelet agents. Vascular nurses are well versed with the care of the patient with a deep vein thrombosis or pulmonary emboli as there are over 600,000 VTE events diagnosed annually. Many nurses can readily educate patients regarding usual medications of Coumadin, Aspirin, and Low Molecular Weight Heparins. So with the advent of multiple new blood thinning medications, do we really understand what is being prescribed and their implications for practice? Purpose: Vascular Nurses and Nurse Practitioners should understand the basics of the clotting cascade and platelet activation, as this is essential for using any Heparins, NOACs, Vitamin K Antagonists, XA Inhibitors, Direct Thrombin Inhibitors, Aspirin or Thienopyridines. Additionally, one should understand the drug’s mechanism of action, half-life, indications, reversal agents, and laboratory testing for overdose identification for each of these drug types. Holding these medications in the perioperative period is also critically important to understand. Methods: Goal of talk is to present vascular nurses with information on each class of drug. Also to be discussed are the guidelines for reversal of the drugs, and holding around surgeries or procedures. Conclusions:Vascular nurses receive questions from patient’s daily regarding the use of these medications. One should understand all of these medications are high-risk regardless of agent being utilized. The vascular nurses comprehension of these medications adds to the success and safety for vascular patients.
Abstract 9 The PAD PRAIRIE Initiative: The First Year Diane Treat-Jacobson, PhD, RN, University of Minnesota School of Nursing, Minneapolis, MN Peripheral Artery Disease (PAD) has a devastating effect on the lives of older adults, limiting function, quality of life, and the likelihood of being able to live independently. Its impact, the cycle of disability that ensues as the disease progresses, the lack of public and provider awareness of this condition’s importance, the under-
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diagnosis and treatment, and the lack of referral for effective interventions for PAD are well documented. This may be especially true in rural communities. The PAD Initiative: PRomoting Healthy Aging and Mobility In Rural MInnEsota (PRAIRIE) is an innovative three-year project designed to create partnerships in with health care providers in rural Minnesota communities to improve the care and outcomes for patients with PAD. During the course of this initiative, in partnership with physician and nurse champions and community leaders at each site, we aim to increase awareness of the importance of PAD among the public and to promote increased detection through cost-effective, non-invasive measurement of the ankle-brachial index. We will educate a group of primary care providers who will evaluate patients at risk for PAD and offer appropriate therapies to reduce cardiovascular risk in those confirmed to have PAD. We will establish both supervised and independent PAD therapeutic exercise interventions through cardiac rehabilitation, wellness centers, and/or independent senior housing. Each of these program elements will contribute to improved outcomes for older adults with PAD. Finally, we will measure change in PAD awareness, detection, risk factor management, referral for therapeutic exercise interventions, and long-term functional and quality of life outcomes in each community to demonstrate program effectiveness, increasing likelihood of future third party reimbursement. The objective of this presentation is to describe our experiences during the first year of implementation of the PAD PRAIRIE Initiative, strategies used to fostering development of community partnerships, lessons learned, evolving program structure and implementation, and progress to date.
Abstract 10 An Integrative Review to Develop a Better Understanding of the Experience of Chronic Critical Limb Ischaemia Sue Monaro, RN, B.App.Sc. (Nursing), MN, Concord Hospital, New South Wales, Sydney, Australia Chronic Lower Limb Ischaemia (CCLI) presents a highly individualised set of personal and health circumstances. Consideration of therapeutic options involves processing information about a complex clinical situation often by people with significant disease-related physical, psychological and emotional impairment. In addition to the technical aspects and predicted outcomes of interventions, the quality of life (QoL) of these patients and the concerns of the patient and their family requires serious consideration during the decision-making process. Focus: This review aims to uncover and synthesize current knowledge about the QoL and patient and carer concerns in CCLI. Anchor: Seven peripheral arterial disease (PAD) specific health related QoL domains previously identified are used as a framework for an integrative review of literature located through a systematic search of keywords in a range of electronic databases. Report: The reviewed articles expanded and extended the framework to provide a better understanding of QoL and the issues for patients and families associated with CCLI. Argue: Whilst CCLI is a highly individualised situation there is a need to develop an understanding of the experience on which appropriate language can be used in discussions with patients and families. This could be extended to develop a CCLI specific
JOURNAL OF VASCULAR NURSING www.jvascnurs.net
our patients with lower extremity amputations, an Amputee Support Group has been implemented on the Vascular Care Unit at Florida Hospital Orlando. In addition to presenting empirical research related to the financial, emotional and social impact of lower extremity amputations, we will discuss the impact that the Amputee Support Group has had on promoting the positive adjustment of patients with lower extremity amputations.
Abstract 8 To Bleed or not to Bleed: Current Anticoagulation Therapy and Implications for Practice Kristen Alix, RN, MS, APRN-BC, CVN, University of Colorado Division of Vascular Surgery and Endovascular Therapy, Denver, Co Background: Anticoagulants and anti platelets agents are commonplace in any vascular practice. In 2014, over 30 million people were taking Warfarin for indications including atrial fibrillation and venous thromboembolism. Yearly, over 2 million people are started a Vitamin K antagonist, Novel oral anticoagulant (NOAC) or a heparin substrate. Additionally, in 2014, there were over 5.5 million prescriptions written for new antiplatelet agents. Vascular nurses are well versed with the care of the patient with a deep vein thrombosis or pulmonary emboli as there are over 600,000 VTE events diagnosed annually. Many nurses can readily educate patients regarding usual medications of Coumadin, Aspirin, and Low Molecular Weight Heparins. So with the advent of multiple new blood thinning medications, do we really understand what is being prescribed and their implications for practice? Purpose: Vascular Nurses and Nurse Practitioners should understand the basics of the clotting cascade and platelet activation, as this is essential for using any Heparins, NOACs, Vitamin K Antagonists, XA Inhibitors, Direct Thrombin Inhibitors, Aspirin or Thienopyridines. Additionally, one should understand the drug’s mechanism of action, half-life, indications, reversal agents, and laboratory testing for overdose identification for each of these drug types. Holding these medications in the perioperative period is also critically important to understand. Methods: Goal of talk is to present vascular nurses with information on each class of drug. Also to be discussed are the guidelines for reversal of the drugs, and holding around surgeries or procedures. Conclusions:Vascular nurses receive questions from patient’s daily regarding the use of these medications. One should understand all of these medications are high-risk regardless of agent being utilized. The vascular nurses comprehension of these medications adds to the success and safety for vascular patients.
Abstract 9 The PAD PRAIRIE Initiative: The First Year Diane Treat-Jacobson, PhD, RN, University of Minnesota School of Nursing, Minneapolis, MN Peripheral Artery Disease (PAD) has a devastating effect on the lives of older adults, limiting function, quality of life, and the likelihood of being able to live independently. Its impact, the cycle of disability that ensues as the disease progresses, the lack of public and provider awareness of this condition’s importance, the under-
PAGE 65
diagnosis and treatment, and the lack of referral for effective interventions for PAD are well documented. This may be especially true in rural communities. The PAD Initiative: PRomoting Healthy Aging and Mobility In Rural MInnEsota (PRAIRIE) is an innovative three-year project designed to create partnerships in with health care providers in rural Minnesota communities to improve the care and outcomes for patients with PAD. During the course of this initiative, in partnership with physician and nurse champions and community leaders at each site, we aim to increase awareness of the importance of PAD among the public and to promote increased detection through cost-effective, non-invasive measurement of the ankle-brachial index. We will educate a group of primary care providers who will evaluate patients at risk for PAD and offer appropriate therapies to reduce cardiovascular risk in those confirmed to have PAD. We will establish both supervised and independent PAD therapeutic exercise interventions through cardiac rehabilitation, wellness centers, and/or independent senior housing. Each of these program elements will contribute to improved outcomes for older adults with PAD. Finally, we will measure change in PAD awareness, detection, risk factor management, referral for therapeutic exercise interventions, and long-term functional and quality of life outcomes in each community to demonstrate program effectiveness, increasing likelihood of future third party reimbursement. The objective of this presentation is to describe our experiences during the first year of implementation of the PAD PRAIRIE Initiative, strategies used to fostering development of community partnerships, lessons learned, evolving program structure and implementation, and progress to date.
Abstract 10 An Integrative Review to Develop a Better Understanding of the Experience of Chronic Critical Limb Ischaemia Sue Monaro, RN, B.App.Sc. (Nursing), MN, Concord Hospital, New South Wales, Sydney, Australia Chronic Lower Limb Ischaemia (CCLI) presents a highly individualised set of personal and health circumstances. Consideration of therapeutic options involves processing information about a complex clinical situation often by people with significant disease-related physical, psychological and emotional impairment. In addition to the technical aspects and predicted outcomes of interventions, the quality of life (QoL) of these patients and the concerns of the patient and their family requires serious consideration during the decision-making process. Focus: This review aims to uncover and synthesize current knowledge about the QoL and patient and carer concerns in CCLI. Anchor: Seven peripheral arterial disease (PAD) specific health related QoL domains previously identified are used as a framework for an integrative review of literature located through a systematic search of keywords in a range of electronic databases. Report: The reviewed articles expanded and extended the framework to provide a better understanding of QoL and the issues for patients and families associated with CCLI. Argue: Whilst CCLI is a highly individualised situation there is a need to develop an understanding of the experience on which appropriate language can be used in discussions with patients and families. This could be extended to develop a CCLI specific