Progress of Comprehensive Nursing on the Prevention of Postoperative DVT of Gynecologic Tumor

Deep vein thrombosis (DVT) is the second reason of death due to tumor. In order to find more effective methods for prevention of DVT due to gynecologic tumor, the advances of study and practice in this aspect should be summarized. As an important and effective measure for prevention of DVT, the comprehensive nursing is to be analyzed carefully. Lots of practices show that proper nursing measures can prevent effectively the occurrence of postoperative DVT. Virchow thought that DVT is caused by three factors: injury of venous wall, slowed blood flow and hypercoagulability. Thus, the prevention measures are presented on the factors such as application of sequential decompression elastic socks, intraoperative intervention etc. Clinical nursing pathway is shown to be very effective method recently. More effective measures and related facilities for prevention of DVT should be built in the future. Physical and psychological methods should be combined in the nursing of DVT.


Mechanism of Occurrence
In the middle of 19 century, Virchow presented a theory that DVT is caused by three factors: injury of venous wall, slowed blood flow and hypercoagulability [4]. The occurrence of DVT is sketched in Figure 1. This theory has been validated after near 100 years clinical application. It is thought that the possibility occurring DVT of tumor patients is 4 -7 times of general population. Gynecological tumor patients have higher danger of DVT because of the special physiological and anatomical structure and surgical treatment [5].
The factors and mechanism related with the occurrence of DVT are mainly as follows: 1) factor of tumor, malignant tumor cells can secrete cell factor to reduce anticoagulant material and increase coagulant, which provides the pathological basis of local thrombus [6] [7]; 2) surgical factors, for example, the radical hysterectomy is the main operation mode of endometrial cancer and cervical cancer. Patients must be preoperative fasting and drinking, so the organism is easy to dehydrate and the blood is easy to concentrate. In addition, the affected range of radical hysterectomy is large because the pelvic lymphadenectomy is often pelvic are dense. The vein wall is thin and has not valve, which make women easier to form venous blood stasis [11]. 4) chemotherapy: If the patients adapt chemotherapy as the successive treatment after radical hysterectomy, the possibility of occurring DVT is 2 -6 times of the general population. The reason is that chemotherapy increases the content of procoagulant protein and the platelet activation, meanwhile restrain the fibrinolysis process [12].

Application of Sequential Decompression Elastic Socks
The effects are obvious for the prevention of DVT by applying sequential decompression elastic socks and air wave pressure treatment system.
The theory of the sequential decompression elastic socks is to form progressively declining pressure by putting the stocks with elastic pressure on the foot, ankle and shank. The pressure at the ankle is about 18 mmHg, 14 mmHg at the middle leg. The declined pressure can force the blood return and relief the pain of lower limbs.
The treatment system of air wave pressure inflates and bleeds periodically to the multicavity bags of pressure leg cover. The pressure squeezes the legs uniformly and regularly from distal to proximal. The pressure can excite the deep muscles, blood vessel and lymph gland of lower limbs to increase the oxygen carrying capacity of blood and improve microcirculation, which can effectively decrease the pain of lower limbs and prevent DVT [13].

Intraoperative Intervention
Try best to succeed at the first time of establishing venous access before opera-

Clinical Nursing Pathway
Clinical nursing pathway (CNP) can provide a series of regular and standardized nursing interventions to reduce DVT.
CNP is a kind of nursing mode made for the patients according to the standard nursing plan of a special disease or operation. Every conventional nursing plan is listed out in figures or tables, which can help nursing staff to carry out effectively [29].
Hua Lu's study shows that CNP can effectively reduce the risk of DVT after radical hysterectomy. CNP can optimize the nursing procedure, reduce the hos-