Position (HELP), which allows for better movement of the patient's
chest to get air in and out and also helps your anesthesia providers
manage the airway. "It makes it easier for me to mask the patient,
because I'm not fighting the weight of the abdominal contents," says
Dr. Sinha.
• DVT. Patients with a BMI above 30 are more likely than patients
with BMIs in normal range to get a blood clot in a deep vein or suffer
deep vein thrombosis (DVT), so take extra measures to prevent this
dangerous and potentially fatal complication.
The Caprini DVT Risk Assess-ment, which generates a total clotting
risk score ("Caprini Score") based on a patient's health history and
comorbidities, can help (osmag.net/6cywtg). Another tactic is simply
encouraging patients to stay active.
"Ask them to get up and moving, even on the day of surgery," says
John Magaña Morton, MD, MPH, MHA, FACS, FASMBS, ABOM, the
vice chair of quality and the division chief of bariatric & minimally inva-
sive surgery at the Yale School of Medicine and the Yale New Haven
(Conn.) Health System. "Even a few steps help. Keeping blood flowing
to the lower extremities is important."
Of course, you may need to rely on medical interventions to prevent
clots from forming. "All of our bariatric patients get Lovenox for DVT
prophylaxis, but patients undergoing other procedures may just get
heparin," says Ms. Pate.
Dr. Morton says surgeons may differ on their opinions of which anti-
clotting agent is best — he thinks many surgeons use heparin because
it's effective and a lot less expensive than Lovenox — but most under-
stand that using any agent is better than using none.
• Starting IVs. Locating veins for IV access is another common chal-
lenge with high-BMI patients, but there are commonsense solutions.
For example, heating the skin at the intended stick site to increase
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