Inpatient Clinical Pathway for VTE Prevention in Children

Goals and Metrics
Provider Resources
Related Pathway
Child on Inpatient Unit
Exclusions: COVID-19, MIS-C
History of Central Venous Catheter (CVC) Clot with Current CVC
< 12 yrs
≥ 12 yrs
  • Does not meet criteria for VTE risk assessment or routine prophylaxis.
  • Contact Hematology if concerned
    for VTE risk
  • Assess and document current
    VTE risk level in EHR
    • RN: Admission and daily
    • Provider: Admission and transfer
Low Risk
Baseline mobility
and
No VTE risk factors
Moderate Risk
Altered mobility and no VTE Risk factors
or
Baseline mobility and ≥ 1 VTE risk factor
High Risk
Altered mobility
and
≥ 1 VTE risk factor
All children ≥ 12 yrs, regardless of risk, should ambulate ≥ 50 ft at least 3xday
For children confined to room, view Get Up and Move for strategies to meet ambulation goal
Mechanical Prophylaxis
Pharmacologic Prophylaxis
  • Enoxaparin
    • < 60 kg
      • 0.5 mg/kg q12hr
    • ≥ 60 kg
      • High-risk ortho surgery 30 mg q12hr
    • All Other Medical
      • 40 mg q24hr
  • Dose adjustment is required for
    renal insufficiency
  • Hold Enoxaparin for procedures
Monitor for Signs and Symptoms of Bleeding
Ongoing monitoring for signs and symptoms of VTE
Risk assessment continues until discharge
Mobility Status
  • Baseline Mobility
    Ambulatory at baseline and meeting goals of ≥ 50 ft, 3x/day
  • Altered Mobility
    Ambulatory at baseline and unable to meet goal of ≥ 50 ft, 3x/day
  • Examples of 50 ft distance:
    • Length of semi-truck trailer
    • 5 story building
VTE Risk Factors
  • Acute Conditions
    • Active cancer
    • Burns:
      50% total body surface area
    • Critically ill (currently in an ICU)
    • 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
    • Known acquired or inherited thrombophilia
    • Obesity
      • < 18 yrs: BMI ≥ 95 percentile
      • ≥ 18 yrs: 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 yrs old
Posted: February 2017
Revised: April 2024
Editors: Clinical Pathways Team