1. All IVCFs placed in the combat theater should be retrievable.
2. Documentation detailing the ICVF brand, model, MRI compatibility, and exact location of placement should be documented in Armed Forces Health Longitudinal Technology Application – T or TC2 (Theater Medical Information Program -Joint Composite Health Care System – Cache)
3. All RIVCFs placed in the combat theater should be removed as soon as contraindications to chemical prophylaxis of VTE disease no longer exist or there is no longer a need for VTE prophylaxis. Exceptions include those that were placed for secondary prophylaxis in a patient who demonstrated new VTE disease while on therapeutic anticoagulation or in patients who are still deemed to be high risk.
4. All RIVCFs should be removed within three months unless a long-term indication for their continued use is present.
5. The decision to remove an RIVCF placed in the combat theater (versus leaving it in place permanently) should be made at the first CONUS MTF the patient transitions through while returning from deployment. When possible, the removal should take place at this same facility prior to transition to the next level of care. This approach decreases the chance that a decision will be deferred until removal becomes technically prohibitive.
6. The presence of a RIVCF in a patient should be made known to the receiving CONUS MTF. Typically, retrieval of the RIVCF will be accomplished at the CONUS MTF.
7. Any patient with a known DVT and without a current contraindication to therapeutic anticoagulation who has an IVCF in place should receive full dose anticoagulation. This is preferably accomplished with Coumadin to target an international normalize ratio (INR) of 2.0-3.0. If further surgical procedures are planned, consideration may also be given to the use of low molecular weight heparin dosed at 1 mg/kg bid or an unfractionated heparin drip until such time as the use of Coumadin is felt to be appropriate.
8. The presence of an IVCF, brand, model, MRI compatibility, whether or not it is retrievable, its exact location and the date of insertion should be clearly annotated in the medical record when the patient has returned to the United States.
9. Efforts should be made in the future to standardize the type of RIVCF used at all combat theater locations.