Verify the doctor’s orders.

Confirm the patient’s identity using at least two patient identifiers according to your facility’s policy.¹

Explain all procedures to the patient.

Perform hand hygiene.²,³,⁴

Check vital signs every ten minutes until stable, every 30 minutes twice, then every 2 to 4 hours, and then routinely thereafter, according to facility policy. Report any changes in vital signs because they may indicate infection, hemorrhage, or postoperative complications.

Encourage the patient to perform deep-breathing and coughing exercises. Assist with incentive spirometry to prevent postprocedure pneumonia.

Perform bilateral neurovascular assessments every 2 hours for the first 48 hours and then every 4 hours for signs of complications. Check the affected leg for color, temperature, toe movement, sensation, edema, capillary filling, and pedal pulse. Investigate any complaints of pain, burning, numbness, or tingling.

Apply the compression stocking or sequential compression device, if ordered, to promote venous return and prevent venous thromboembolism. Once every 8 hours, remove the stockings or compression device; inspect the legs, especially the heel, for pressure ulcers; and then reapply the stocking or device.

Assess the patient’s pain and then administer pain medications, as ordered, following safe medication administration practices. Perform a follow-up assessment and notify the doctor if pain isn’t adequately controlled.⁵

Administer anticoagulant therapy, as ordered, to minimize the risk of venous thromboembolism.

Make sure baseline coagulation studies have been obtained and are documented in the patient’s medical record. (International Normalized Ratio [INR] should be monitored if the patient is receiving warfarin [Coumadin].) If a continuous infusion of heparin is prescribed, administer it using a programmable pump (preferably a smart pump with dose-range alerts) to provide consistent and accurate dosing.⁶

Observe for bleeding and for signs and symptoms of phlebitis, such as warmth, swelling, tenderness, and redness. Monitor laboratory results, including complete blood count, prothrombin time, partial thromboplastin time, and INR.

Check the dressings for excessive bleeding. Circle any drainage on the dressing and mark it with your initials, the date, and the time. As needed, apply more sterile dressings, using hypoallergenic tape. Report excessive bleeding to the doctor.