Inpatient Clinical Pathway for
VTE Prevention in Children

Goals and Metrics
Provider Resources
Patient is admitted
to an inpatient unit
Excluded: COVID-19 and MIS-C
Perioperative/
Procedural VTE Prevention Pathway
VTE Prophylaxis on the SDU Job Aid
< 12 years
Any age
≥ 12 years
Does not meet routine criteria for prophylaxis. May receive if determined to be high risk after discussion with Hematology

If history of central line clot with current central line (See Problem List and/or Past Medical History), consider therapeutic enoxaparin dosing
(goal anti-Xa 0.5-1.0 IU/mL) unless contraindicated

Monitor for s/s of bleeding
Assess and document
current VTE risk level in EPIC
  • RN: at admission and daily
  • FLC: at admission and transfer
    •  
Low Risk
Baseline mobility,
no VTE risk factors
Moderate Risk
Altered mobility, no VTE risk factors OR
Baseline mobility, ≥ 1 VTE risk factor
High Risk
Altered mobility and
≥ 1 VTE risk factor
Encourage highest degree of mobility for the patient ≥ 3 times a day
AND mechanical prophylaxis when in bed
with Pneumatic Sequential Compression Device (SCD)
if NO contraindications exist
AND Mechanical Prophylaxis When in Bed
with Pneumatic Sequential Compression Device (SCD)
if NO contraindications exist
AND pharmacologic prophylaxis
if NO contraindications exist
Recommend for: ≥ 18 years
Strongly consider for 12 to 18 years
PHARMACOLOGIC PROPHYLAXIS
Enoxaparin
< 60 kg: 0.5 mg/kg Sub-Q q12 hours
  • ≥ 60 kg:
  • 40 mg q24 hours (medical patients)
  • or
  • 30 mg q12 hours (high-risk orthopedic surgery)
Dose adjustment is required for renal insufficiency.
Enoxaparin should be held for procedures.
Monitor for signs and symptoms of bleeding
On-going monitoring for signs and symptoms of VTE
VTE risk assessment continues until patient is discharged
Mobility Status
  • Baseline Mobility: Usual state of ambulation
  • Altered Mobility: A temporary inability to ambulate freely, i.e., bathroom privileges only, pivot to chair only, etc...

VTE Risk Factors

  • Acute Conditions
    • Active cancer
    • Burns: > 50% total body surface area
    • Critically ill (currently in an intensive care unit)
    • Major trauma
    • Pregnancy
    • Severe dehydration
    • Severe systemic infection
    • Spinal cord injury
    • Surgery within past 30 days
  • Chronic Medical Conditions
    • Estrogen containing medications
    • Inflammatory disorders: IBD, SLE, chronic extensive GVHD, etc.
    • Known acquired or inherited thrombophilia
    • Obesity
      • < 18 years: BMI ≥ 95 percentile
      • ≥ 18 years: BMI ≥ 30
    • Protein losing disorders: nephrotic syndrome, PLE, draining chylous effusion
    • Sickle Cell Disease
  • Historical Factors
    • Previous history of clots (DVT/PE)
    • Family history of VTE in 1st degree relative < 40 years old
Posted: February 2017
Revised: June 2021
Authors: C. Witmer, MD; D. Davis, MD; L. Raffini, MD; H. Hlela, MSN