The Effect of a VTE Prevention Care Bundle in Total Hip Arthroplasty Patients

Background and Rationale Venous thromboembolism (VTE), which encompasses deep vein thrombosis (DVT) and pulmonary embolism (PE), remains a critical and potentially life-threatening complication following total hip arthroplasty (THA). Despite the routine administration of standard medical prophylaxis, the incidence of VTE can still be significant. This highlights a crucial gap that can be addressed through comprehensive and structured nursing interventions. The implementation of a "care bundle"-a targeted, structured set of evidence-based practices performed collectively and reliably-has been shown to improve patient safety, optimize clinical outcomes, and minimize complications in various high-risk clinical settings.

Study Workflow and Patient Journey This non-randomized controlled clinical trial evaluates the efficacy of a specialized VTE Prevention Care Bundle tailored for patients undergoing total hip arthroplasty. The patient journey begins at the preoperative stage. Candidates are initially screened using the Autar DVT Risk Assessment Scale, which serves strictly as an objective filtering tool to ensure patients meet the precise inclusion criteria regarding their baseline VTE risk.

Eligible participants are then systematically assigned to either the control or intervention phase of the study.

In the control phase, patients receive the standard, routine orthopedic nursing care provided by the hospital ward, alongside the standard pharmacological prophylaxis prescribed by their attending physicians.

In the intervention phase, patients receive the structured VTE Prevention Care Bundle administered by the research team. This bundle is integrated into the daily nursing workflow and focuses on five core pillars: proactive preoperative education (both verbal and written), structured early mobilization, scheduled in-bed ankle-pumping exercises, strict fluid management and hydration tracking, and the continuous monitoring of mechanical prophylaxis (elastic compression stockings).

Data Collection and Longitudinal Follow-Up To accurately capture the impact of the care bundle, the study employs a rigorous 90-day longitudinal follow-up design. Data collection begins with a Descriptive Data Form to capture baseline demographics and clinical characteristics. During the inpatient period, a researcher-developed Clinical Follow-up Chart is utilized to monitor daily physiological parameters, including leg circumference, Homan's sign, localized edema, erythema, vital signs, and International Normalized Ratio (INR) levels for coagulation tracking.

The psychosocial and functional recovery of the patients is also a major focus. Validated tools, including a Postoperative Comfort Scale, a Fear of Falling Scale, and the Newcastle Satisfaction with Nursing Care Scale, are administered to comprehensively assess the patient experience during the mobilization and recovery process.

Following hospital discharge, the monitoring continues seamlessly for 3 months. A specialized Post-Discharge 90-Day Follow-up Chart is used to track the patients in their home environment. This ensures that any hospital admissions or readmissions due to suspected VTE symptoms (such as sudden leg swelling, acute pain, or shortness of breath) are accurately recorded and analyzed.

Funding Status A grant application to support the logistical and material requirements of this clinical research has been submitted to The Scientific and Technological Research Council of Türkiye (TUBITAK) and is currently under official evaluation.

Inclusion criteria

• Patients aged 18 years and older.
• Scheduled for elective primary total hip replacement surgery.
• Conscious, oriented, and able to communicate effectively to complete questionnaires and understand education.
• Volunteering to participate in the study and able to provide written informed consent.
• Physically capable of participating in early mobilization and bed exercises postoperatively.

Exclusion criteria

• Previous history of Deep Vein Thrombosis (DVT) or Pulmonary Embolism (PE).
• Known bleeding disorders or coagulation abnormalities (e.g., thrombophilia).
• Contraindications to the use of mechanical prophylaxis/compression stockings (e.g., severe peripheral arterial disease, severe skin lesions, or leg ulcers).
• Severe cognitive impairment, dementia, or psychiatric disorders that prevent cooperation with the study protocol and care bundle.
• Bedridden prior to surgery or having severe neurological/musculoskeletal conditions completely preventing mobilization.