Patients with Indwelling Epidural and/or Paravertebral Catheters
Patients who require an epidural catheter increasingly have interruptions in pharmacologic prophylaxis, such that epidural catheter placement is now associated with an increased VTE rate, whereas previously this was not the case. 45,46,47,48 Please refer to the JTS Pain, Anxiety, and Delirium CPG for further detail.
1. The timing of administration for chemical VTE prophylaxis may need to be modified to accommodate the placement and/or removal of an epidural.43
2. Avoid missing doses of VTE prophylaxis for epidural placement, if possible.
3. In the combat casualty requiring an epidural pain catheter, modification of enoxaparin dosing to 40mg daily does not increase the incidence of venous thromboembolism.28