PICO Worksheet and Search Strategy 
(Worth 30pts)

Define your question using PICO: Population, Intervention, Comparison, and Outcome. 

Population: immobile patients

Intervention: wearing sequential compression devices (SCD)

Comparison: not wearing sequential compression devices

Outcome: prevention of deep vein thrombosis DVT     

Write out your question (7pts): 
Does wearing sequential compression devices lower the chance of DVT in immobile patients?

 List the main topics and terms from your question that you can use to search.
DVT, prevention, compression devices

Check any limit that may pertain to your search:
 _NA_Age    English_Language   2006-2012_Year of publication 
 
Type of study/publication you want to include in your search: 
  _X_  Systematic Review or Meta-Analysis
 _X_   Clinical Practice Guidelines  
 _X_  Critically Appraised Research Studies
_X _   Individual Research Studies 
___   Electronic Textbooks

Check the databases you searched: 
__X_ Cochrane
  _    AHRQ Evidence Reports 
__ Evidence-Based Journals 
__X_ CINAHL  
_X_ PubMed Clinical Queries
__ Other: Provena United Samaritans Search Database 

 What information did you find to help answer your question?(7pts)  
	Deep vein thrombosis (DVT) is a major concern for immobile patients. Virchow’s triad (stasis of blood, endothelial injury and hypercoagulability of blood) in the venous system often leads to deep vein thrombosis (Stewart, Zalamea, Waxman, Schuster & BOZUK, 2006).  
DVTs may occlude the venous return from the legs which can lead to pain and swelling.  If the DVT becomes an embolus it can lodge in the lungs (pulmonary embolism) causing death.  Prophylaxis treatment of DVT usually involves Heparin (Lovenox).  Sequential compression devices are used in conjunction with medications to help prevent DVTs.  According to Sachdeva, Dalton, Amaragiri & Lees (2010) patients using compression stockings developed a DVT 13% of the time compared to the control group of 26%.  A review by He, Xiao, Lei, Li, Wu & Liao, (2012),   found “the incidence of DVT or venous thromboembolism was not clearly different in the CPM (continuous passive motion) group compared with the control group of participants.”  This indicates that the passive movement of the legs is not enough to reduce the risk of DVT.

Cite at least three sources and summarize data related to your question. (10pts)
Sachdeva et al., finds that compression stockings do lower the risk of developing a DVT in immobile patients.  Stewart et al, emphasizes the risk that immobile patients have of developing DVTs and addresses the problem of compliance of patients and nurses.  Stewart et al, finds that noncompliant nurses and patients do not appreciate the impact that SCD make in reducing DVT.  He et al, finds that CPM is not very effective in preventing DVT.    

Reflect on your findings(5pts)  
DVT is a serious problem effecting immobile hospital patients.  SCD, along with medications, are proven to help reduce the risk of DVT.  Noncompliance is an issue that needs to be addressed by educating the nursing staff and the patients about the importance of SCD. 

References 
He, M., Xiao, Z., Lei, M., Li, T., Wu, H., & Liao, J. (2012). Continuous passive motion for preventing venous thromboembolism after total knee arthroplasty (review). The cochrane review, (2), Retrieved from http://www.thecochranelibrary.com
Sachdeva, A., Dalton, M., Amaragiri, S., & Lees, T. (2010). Elastic compression stockings for prevention of deep vein thrombosis (review). The cochrane review, (7), Retrieved from http://www.thecochranelibrary.com
Stewart, D., Zalamea, N., Waxman, K., Schuster, R., & BOZUK, M. (2006). A prospective study of nurse and patient education on compliance with sequential compression devices. The american surgeon, 72,