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Nordic Business Report, March 31, 2006

NORDIC BUSINESS REPORT-31 March 2006-Thule AB acquires snow chains supplier Pewag Schneeketten Group(C)1994-2006 M2 COMMUNICATIONS LTD http://www.m2.com

The Swedish sports utility transportation systems provider Thule AB said on Friday (31 March) that it has agreed to acquire Austrian snow chains supplier Pewag Schneeketten Group.

Pewag Schneeketten supplies snow chains for passenger cars and commercial and industrial vehicles. It has 325 employees and annual sales of EUR48m. The group has production and sales operations at seven sites in Europe and North America.

“The acquisition more than doubles the size of our current snow chains portfolio with the help of Pewag’s strong market positions for example in Austria,” said Anders Pettersson, president and CEO of Thule.

The financial details of the acquisition were not disclosed.

One euro (EUR) is worth approximately 0.69 British pounds (GBP).

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AORN Journal, Jan, 2007 by Byron L. Burlingame

QUESTION: Currently, we are in the process of developing a protocol for deep venous thrombosis (DVT) prevention. When should antiembolism (ie, thromboembolic disease [TED]) stockings or sequential compression devices (SCDs) be used in the surgical setting, and what are a nurse’s responsibilities when using them?

ANSWER: The decision to use TED stockings or SCDs is a medical decision, which should be based on the patient’s risk factors for developing DVT. Risk factors can be divided into three categories: the patient’s age (ie, older than 40 years); (1) admitting diagnosis; and past medical history. Examples of admitting diagnoses classified as risk factors include, but are not limited to,

* burns; (2)

* planned surgical or interventional procedures that will last longer than 30 to 45 minutes;

* procedures during which a vessel may be constricted related to positioning or use of equipment (eg, a tourniquet); (1,3) and

* trauma, especially injuries involving orthopedic fractures of the lower extremities. (2)

Traits or past medical history of conditions that may increase the risk of DVT include, but are not limited to,

* cardiac conditions (eg, recent myocardial infarction, congestive heart failure, atrial fibrillation);

* chronic obstructive pulmonary disease;

* dehydration or hypovolemia;

* estrogen or hormone therapy;

* ethnicity (ie, there is greater risk for Caucasians and African-Americans);

* history of cancer (ie, malignancy with or without treatment);

* family history of blood clots, blood-clotting disorders, coagulopathy, DVT, pulmonary embolism (PE), stroke, or thrombosis;

* immobility (eg, related to casts, braces, or splints);

* infection or sepsis;

* inflammatory bowel disease;

* nephrotic syndrome;

* obesity;

* pregnancy or less than one month postpartum;

* presence of a central venous catheter;

* recent surgery, especially orthopedic, abdominal, or thoracic;

* smoking; and

* varicosities or leg swelling. (1,2)

Perioperative RNs should assess the patient for risk factors preoperatively and then work collaboratively with the surgeon and the anesthesia care provider to implement a plan for the prevention of venous stasis. If TED stockings are ordered, the RN should measure the patient for proper fit before application. (1) If SCDs are the selected prevention method, the RN should apply the devices according to manufacturer’s recommendations. The TED stockings and SCDs should be applied as soon as possible after the patient arrives in the preoperative area.

The circulating nurse should visually confirm that the TED stockings have not rolled down during transfer to the OR bed or during positioning. (3) If SCDs are ordered, the circulating nurse should confirm correct placement and proper functioning before induction of general anesthesia has begun or before regional anesthesia has been administered. (1,3,4)

When positioning the patient, the circulating nurse should be aware that extreme degrees of flexion and internal rotation of the hip and knee and the reverse Trendelenburg position should be avoided, if possible, because they are precipitating factors for DVT. A 10-degree reverse Trendelenburg position decreases blood flow by 53%, whereas a 10-degree Trendelenburg position increases blood flow by 30%. (5) When using a tourniquet, unnecessarily high pressures and prolonged periods of inflation should be avoided. (3)

Phase I and II postanesthesia care unit (PACU) nurses also should monitor SCDs for proper functioning. The SCDs should be worn continuously except during assessments, physical therapy, or ambulation