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VTE prophylaxis

Risk	Criteria	Recommendation
Low	Minor surgery + Age < 40yo + No other risk factors	Early ambulation
Moderate	Minor surgery + other risk factors 40-60yo without other risk factors	Heparin 5000U TID Enoxaparin 40mg daily (30mg if CrCL < 30)
High	Age > 60yo 40-60yo with other risk factors
Highest	Multiple risk factors	Enoxaparin 40mg daily (30mg if CrCL < 30) + SCD Heparin 5000U TID + SCD

Non-pharmacologic DVT prophylaxis options

• Compression stockings: decrease DVT risk in low risk patients, need to be proper fit, contraindicated if PVD, pulmonary edema, peripheral neuropathy, leg deformity
• Pneumatic compression: prevent venous stasis and stimulate fibrinolytic activity, reduces risk of DVT by 50%, use at all times unless ambulating, contraindicated if DVT, PVD, pulmonary edema, or leg deformity

Wound care

• Closed incision: keep dressing for 48hr (can change if leakage), consider antimicrobial or negative pressure dressings if wound high risk for breakdown
• Open incision: debride dead tissue, clean with dressing changes, pack wound, consider negative presure dressing
• Ostomy care: empty prior to being full, change pouch first thing in AM (reduces leakage), measure size appropriately (avoid excoriation/breakdown), consider drainage bag for nighttime
• Passive drainage: can use Penrose to assess for bleeding/infection, avoid rapid abscess closure