Ana Luisa Barajas, DNP, MSN, ACNP-BC

Abstract:

Background: Retrievable inferior vena cava (IVC) filters were developed for the transient prevention of pulmonary embolisms. Despite indications for removal, many filters are unintentionally left in place indefinitely. Adverse events associated with chronic indwelling retrievable filters have generated increased interest in improving their retrieval rates. Objective: This DNP scholarly project aimed to determine if a collaborative IVC filter retrieval protocol developed by the researcher and adopted by the Interventional Radiology (IR) clinical team, increased filter retrieval rates and decreased loss to follow-up of patients who had undergone temporary IVC filter placement. Methods: Seven-step IVC filter retrieval protocol was created and implemented. Following a quasi-experimental comparative design the pilot-study prospectively included all consecutive adult patients who underwent insertion of a retrievable IVC filter for a period of four months. Data collected included patient demographics, filter outcomes, and documented follow-up. Same data variables were collected using a retrospective review of similar patients who had undergone retrievable IVC filters placement 24-months prior to initiation of the new protocol. Chi-square statistical analysis was performed for all variables. Results: Total of 101 IVC filters (97 retrievable, 4 permanent) were inserted during the 28-month pilot-study period. Of the 97 retrieval filters placed (85 retrospective, 12 prospective), the retrieval rates of eligible filters increased from 64.15% to 100% and patients lost to follow-up decreased from 35.85% to 0% following implementation of the new protocol (p= 0.3, both outcomes). However, there was a statistically significant positive correlation between IVC filter conversion to permanent status and malignancy (r(26) = 0.32; p <0.01). As a consequence, this led to an increase in the number of permanent IVC filters placed in the prospective cohort (1.2% vs. 20%; p <0.01). Conclusion: Although not statistically significant, adoption of a collaborative IR led process for the management of IVC filters led to improved IVC filter retrieval rates and decreased patient loss to follow-up. Additionally, pre-insertion discussion of type of filter needed, as outlined in the new protocol, helped identify the right filter for the right patient, demonstrating a statically significant change in practice that ultimately transformed the IR department’s common practice into best practice. 

Click here to see the full manuscript.