Evidence_Based_Practice

Critique of a research article related to area of clinical practice Area – Ward 75 Orthopaedics (ACH) Research Article – “A meta-analysis of bed rest versus early ambulation in the management of pulmonary embolism, deep vein thrombosis, or both.” The background of this study is that bed rest is often recommended as part of the management of DVT and PE but this recommendation is to not be clearly evidence-based. This topic has been brought up because there are a lot of debates going on whether to bed rest or ambulate is recommended because of the concern of clot dislodgement by ambulation, causing a potentially fatal PE. But on the other side, it is said on the article that bed rest can be deleterious to the patient by promoting blood stasis and propagation of the thrombus and lengthens the duration of hospitalization. From the study, among 4011 patients presenting with acute venous thromboembolism found immobility to be an important risk factor of lower extremity DVT. According to the results from the 5 studies that were retained in this analysis which included a total of 3048 patients, early ambulation was not associated with a higher incidence of a new PE when compared to bed rest. Also, early ambulation was associated with a trend toward a lower incidence of new PE and overall mortality. Furthermore, the results indicate that initial bed rest is not really recommended based on evidence and that is should no longer be a part of the management or teaching of thromboembolic disorders and should recommend that early ambulation should be considered in these patients soon after the level of effective anticoagulation has been reached. As an audience of this article, I would support continuing the current practice related to the intervention which is early ambulation for patients with DVT as studies have shown and proven that early ambulation for patients DVT are safe for the patients and does not raise the risk of developing PE. Mobilizing the patients soon after surgery has been considered one of the main nursing interventions for DVT prophylaxis/treatment and has been supported by evidence bed practice. Also, this is what normally I see in practice and this is what I think is right for the patient although I had to clarify these and looked up on evidence based articles to support this intervention as I was not too sure whether ambulation can really increase the risk of PE. Furthermore, from what I have learned, early ambulation promotes circulation and decreases leg swelling. Lastly, immobilization for patient can only increase the chance of blood stasis and propagation of the thrombus therefore it is important for the patients to ambulate as early as possible to avoid these complications from developing.