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Out of Sight, out of Mind? An Audit Which Proposes a Follow-Up and Management Pathway for Inferior Vena Cava Filters


Affiliations
1 National Center for Hereditary Coagulation Disorders, St. James's Hospital, Dublin 8, Ireland
 

Insertion of an IVC filter can be a safe and effective way to avoid PE in thrombosis patients who cannot be anticoagulated. If temporary filters are not promptly removed they can become difficult to remove, causing avoidable complications and often requiring lifelong warfarin. In this study, two sequential audits of retrieval of temporary IVC filters were conducted before and after the implementation of a coordinated management strategy for IVC filter follow-up. 33 filter placements were examined over a 15-month period (Group A). Following implementation of the strategy a comparable 15-month period in which 33 IVC filters were placed was audited (Group B). Following implementation, failed retrievals dropped from15% to 9%. The number successfully retrieved did not change at 45%. The number made permanent from the outset following expert discussion increased from 12% to 39%. The number of filters with no attempted retrieval and no consultation about retrieval decreased from 27% to 9% (these patients were lost to follow-up with multiple contact attempts made). In Group B 100% of placed IVC filters were followed up appropriately. The proposed model is an easily implemented plan to avoid patient morbidity caused by temporary IVC filters made unintentionally permanent by loss to follow-up.
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  • Out of Sight, out of Mind? An Audit Which Proposes a Follow-Up and Management Pathway for Inferior Vena Cava Filters

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Authors

Caitriona Logan
National Center for Hereditary Coagulation Disorders, St. James's Hospital, Dublin 8, Ireland
Niamh O'Connell
National Center for Hereditary Coagulation Disorders, St. James's Hospital, Dublin 8, Ireland
John Kavanagh
National Center for Hereditary Coagulation Disorders, St. James's Hospital, Dublin 8, Ireland
Niall McEniff
National Center for Hereditary Coagulation Disorders, St. James's Hospital, Dublin 8, Ireland
Mark Ryan
National Center for Hereditary Coagulation Disorders, St. James's Hospital, Dublin 8, Ireland
Michael Guiney
National Center for Hereditary Coagulation Disorders, St. James's Hospital, Dublin 8, Ireland
Orla Seery
National Center for Hereditary Coagulation Disorders, St. James's Hospital, Dublin 8, Ireland
James O'Donnell
National Center for Hereditary Coagulation Disorders, St. James's Hospital, Dublin 8, Ireland
Kevin Ryan
National Center for Hereditary Coagulation Disorders, St. James's Hospital, Dublin 8, Ireland
Barry White
National Center for Hereditary Coagulation Disorders, St. James's Hospital, Dublin 8, Ireland

Abstract


Insertion of an IVC filter can be a safe and effective way to avoid PE in thrombosis patients who cannot be anticoagulated. If temporary filters are not promptly removed they can become difficult to remove, causing avoidable complications and often requiring lifelong warfarin. In this study, two sequential audits of retrieval of temporary IVC filters were conducted before and after the implementation of a coordinated management strategy for IVC filter follow-up. 33 filter placements were examined over a 15-month period (Group A). Following implementation of the strategy a comparable 15-month period in which 33 IVC filters were placed was audited (Group B). Following implementation, failed retrievals dropped from15% to 9%. The number successfully retrieved did not change at 45%. The number made permanent from the outset following expert discussion increased from 12% to 39%. The number of filters with no attempted retrieval and no consultation about retrieval decreased from 27% to 9% (these patients were lost to follow-up with multiple contact attempts made). In Group B 100% of placed IVC filters were followed up appropriately. The proposed model is an easily implemented plan to avoid patient morbidity caused by temporary IVC filters made unintentionally permanent by loss to follow-up.