Knowledge of best practices for VTE prophylaxis and fluid resuscitation
| Survey question | % (N) | |||
| Overall n=259 | Physicians/NPs 48.3% (n=125) | Nurses 42.5% (n=110) | Pharmacists 9.3% (n=24) | |
| What form(s) of prophylaxis is/are most effective at preventing deep vein thrombosis?* | ||||
| LMWH only | 59.1 (153) | 63.2 (79) | 51.8 (57) | 70.8 (17) |
| UFH only | 4.3 (11) | 2.4 (3) | 7.3 (8) | 0.0 (0) |
| LMWH & UFH | 16.2 (42) | 24.0 (30) | 5.5 (6) | 25.0 (6) |
| Mechanical only | 1.9 (5) | 0.0 (0) | 4.6 (5) | 0.0 (0) |
| (LMWH or UFH) and Mechanical | 15.1 (39) | 8.0 (10) | 25.5 (28) | 4.2 (1) |
| Unsure only | 3.5 (9) | 2.4 (3) | 5.5 (6) | 0.0 (0) |
| What form(s) of prophylaxis is/are most effective at preventing pulmonary embolism?* | ||||
| LMWH only | 56.8 (147) | 72.0 (90) | 33.6 (37) | 83.3 (20) |
| UFH only | 18.2 (47) | 1.6 (2) | 40.9 (45) | 0.0 (0) |
| LMWH & UFH | 12.7 (33) | 20.8 (26) | 3.6 (4) | 12.5 (3) |
| Mechanical only | 0.4 (1) | 0.0 (0) | 0.9 (1) | 0.0 (0) |
| (LMWH or UFH) & mechanical | 8.5 (22) | 3.2 (4) | 15.5 (17) | 4.2 (1) |
| Unsure only | 3.5 (9) | 2.4 (3) | 5.5 (6) | 0.0 (0) |
| Which form(s) of prophylaxis is/are most cost effective?* | ||||
| LMWH only | 51.0 (132) | 70.4 (88) | 22.7 (25) | 79.2 (19) |
| UFH only | 15.4 (40) | 12.8 (16) | 20.0 (22) | 8.3 (2) |
| LMWH & UFH | 4.3 (11) | 5.6 (7) | 0.9 (1) | 12.5 (3) |
| Mechanical only | 10.0 (26) | 4.8 (6) | 18.2 (20) | 0.0 (0) |
| (LMWH or UFH) & Mechanical | 2.7 (7) | 0.0 (0) | 6.4 (7) | 0.0 (0) |
| Unsure only | 16.6 (43) | 6.4 (8) | 31.8 (35) | 0.0 (0) |
| Which form(s) of pharmacological prophylaxis has/have the lowest risk of bleeding?† | ||||
| LMWH only | 57.5 (149) | 47.2 (59) | 69.1 (76) | 58.3 (14) |
| UFH only | 24.7 (64) | 32.8 (41) | 18.2 (20) | 12.5 (3) |
| LMWH & UFH | 5.0 (13) | 6.4 (8) | 0.0 (0) | 20.8 (5) |
| Unsure only | 12.7 (33) | 13.6 (17) | 12.7 (14) | 8.3 (2) |
| Which form(s) of pharmacological prophylaxis has/have the lowest risk of heparin induced thrombocytopenia?* | ||||
| LMWH only | 86.1 (223) | 94.4 (118) | 74.6 (82) | 95.8 (23) |
| UFH only | 6.6 (17) | 3.2 (4) | 11.8 (13) | 0.0 (0) |
| LMWH & UFH | 0.4 (1) | 0.0 (0) | 0.0 (0) | 4.2 (1) |
| Unsure only | 7.0 (18) | 2.4 (3) | 13.6 (15) | 0.0 (0) |
| To what extent do you think best practices are followed for preventing DVT/PE in your ICU? 0=never and 7=always, median (IQR) | ||||
| 6 (5–6) | 6 (5–6) | 6 (6–7) | 6 (5–6) | |
| Survey question | Overall n=259 | Physicians/NPs 48.3% (n=125) | Nurses 42.5% (n=110) | Pharmacists 9.3% (n=24) |
| What form(s) of intravenous fluids is/are most effective for fluid resuscitation?‡ | ||||
| Albumin only | 3.5 (9) | 2.4 (3) | 5.5 (6) | 0.0 (0) |
| Crystalloids only | 84.2 (218) | 83.2 (104) | 82.7 (91) | 95.8 (23) |
| Albumin & crystalloids | 8.5 (22) | 9.6 (12) | 9.1 (10) | 0.0 (0) |
| Unsure only | 3.9 (10) | 4.8 (6) | 2.7 (3) | 4.2 (1) |
| Which form(s) of intravenous resuscitation fluids are most cost effective?‡ | ||||
| Albumin only | 0.4 (1) | 0.0 (0) | 0.9 (1) | 0.0 (0) |
| Crystalloids only | 94.6 (245) | 94.4 (118) | 95.5 (105) | 91.7 (22) |
| Albumin & crystalloids | 0.4 (1) | 0.8 (1) | 0.0 (0) | 0.0 (0) |
| Unsure only | 4.6 (12) | 4.8 (6) | 3.6 (4) | 8.3 (2) |
| Which form(s) of intravenous resuscitation fluids has the lowest risk of fluid overload?* | ||||
| Albumin only | 47.1 (122) | 32.8 (41) | 69.1 (76) | 20.8 (5) |
| Crystalloids only | 29.7 (77) | 36.8 (46) | 23.6 (26) | 20.8 (5) |
| Albumin & crystalloids | 1.9 (5) | 3.2 (4) | 0.0 (0) | 4.2 (1) |
| Unsure only | 21.2 (55) | 27.2 (34) | 7.3 (8) | 54.2 (13) |
| Which form(s) of intravenous resuscitation fluids has the lowest risk of infectious disease?‡ | ||||
| Albumin only | 2.7 (7) | 1.6 (2) | 4.6 (5) | 0.0 (0) |
| Crystalloids only | 86.5 (224) | 87.2 (109) | 87.3 (96) | 79.2 (19) |
| Albumin & crystalloids | 0.8 (2) | 0.8 (1) | 0.9 (1) | 0.0 (0) |
| Unsure only | 10.0 (26) | 10.4 (13) | 7.3 (8) | 20.8 (5) |
| To what extent do you think best practices are followed for prescribing fluid boluses in your ICU? 0=never and 7=always; median (IQR) | ||||
| 6 (5–6) | 5 (5–6) | 6 (5–6) | 5 (5–6) | |
1The order of the survey items are as presented in this table.
2Evidence suggests the efficacy of LMWH for deep vein thrombosis is similar to or better than UFH.18 19 45 46 Evidence suggests that LMWH is more efficacious than UFH for preventing pulmonary embolism, has a lower incidence of heparin induced thrombocytopenia, and a similar or lower risk of bleeding.18 19 45 46
3Evidence suggests that LMWH is more cost effective than UFH.18
4Evidence suggests that albumin and crystalloids are similarly effective for fluid resuscitation.21 24–26 Evidence suggests that albumin has a higher risk of infectious disease transmission than crystalloids and is less cost effective than crystalloids.
*Responses varied by professional group (P<0.001),
†Responses varied by professional group (P=0.01),
‡Responses did not vary by professional group (P>0.05)
DVT, deep vein thrombosis; ICU, intensive care unit; IQR, interquartile range (p25 - p75); LMWH, low molecular weight heparin; n, number; NP, nurse practitioner; PE, pulmonary embolism; UFH, unfractionated heparin.