Welcome and Introduction to Conference

The Clotting Cascade Made Easy – Understanding Coagulation

Coagulation is a very complex process that under normal circumstances results in the blood clotting. But, how does this happen and why is it so important? This opening interactive session will help you to understand the series of events that are fundamental to the body’s ability to clot. It includes:

• How does the blood clot?
• What do the all the different factors do?
• How does this relate to the actions of common anticoagulant agents?

Recognising a Clot – Nursing Signs and Symptoms

A blood clot is a serious, potentially life-threatening clinical condition that must be immediately recognised and assessed if patient outcomes are to be satisfactory. Although there is a widespread awareness of the risk that blood clots may develop, this may not actually translate to being familiar with their exact signs and symptoms. This session will go back to basics to help you understand how to perform a detailed assessment for DVT and PE so that you can recognise them when they develop. It includes:

• What physical signs may indicate a DVT or PE?
• Diagnosing deadly clots – ultrasounds, CTPA and VQ scans – what are we looking for and why?
• What pathology changes may indicate a clot?
• What changes in clinical observations should make you immediately suspicious of a PE?
• What comes after assessment? A look at common interventions

Ischaemic Stroke – Catastrophic Clotting?

An ischaemic stroke occurs as a result of a blood clot or obstruction to the flow of blood to the vessels that supply the brain. It is estimated that ischaemic stroke accounts for 80% of all cases of stroke, which is much more than haemorrhagic stroke. Due to the huge potential for disability and death as a result of a stroke, and the impact that early recognition plays to improve outcomes, this session is dedicated to improving your understanding of:

• Ischaemic stroke – what is happening in the brain?
• Common presentations – who are most at risk?
• Recognising stroke FAST – what are the other signs and symptoms?
• What makes a difference to recovery?

The Risk of Non-Reversible Anticoagulation and Injuries in the Community

Non-vitamin K oral anticoagulants (NOAC), such as apixaban, rivaroxaban and dabigatran, are known to be effective agents in certain circumstances. However, unlike warfarin, which is considered to be more easily reversed, reversing the actions of these newer agents is less straightforward. Does this place people in the community at a higher risk of injury? This session looks at:

• What are the indications for apixaban, rivaroxaban, and dabigatran?
• What range of bleeding events and their severity result from these agents?
• What signs and symptoms should patients and clinicians be monitoring for?
• What options for reversing exist?
• When would reversal of these agents be considered?
• How do these compare with warfarin?
• How can we reduce the risk of bleeding in patients on NOACs?

2018 Update – Management of Acute Coronary Syndrome

In a patient, acute coronary syndrome (ACS) is the term used to describe symptoms of ischaemia that results from a clot/occlusion in the coronary arteries. The prevalence of coronary artery disease, and its potential to manifest as ischaemic symptoms, demands that all nurses, regardless of speciality, are up-to-date on ACS. As such, this session will bring you up to speed on:

• What is the initial management of chest pain?
• What has changed with regards to oxygen supplementation and the use of aspirin?
• What are the current recommendations for the pharmacological treatment of ACS?

Platelet-Rich Plasma Injections in Arthritis

The most identifiable function of platelets is their involvement in coagulation. However, due to other properties, a range of other uses continue to be identified. Platelet-rich plasma (PRP) injections represent one example. It’s thought that platelets may support the repair of damaged cartilage, tendons, ligaments, and muscles. This session will review the evidence for PRP injections in the management of arthritis. It includes:

• What are PRP injections?
• Do they stimulate “natural healing”?
• What evidence underpins their use in the management of arthritis?
• What will the current trial investigating their use be looking at?

Central Venous Access Devices – Preventing Thrombosis, Occlusion, and Other Complications

Central Venous Access Devices (CVADS) are essential for management of many complex health conditions and their use in the community is becoming more common. The type of CVAD, their placement, and management are essential to reduce the risk of complications, such as thrombosis, as well as to promote device longevity. This session reviews the key considerations for the management of CVADs including the prevention of thrombosis and occlusion and includes:

• A review of devices
• Catheter selection – choosing appropriate devices
• Complications – during and following insertion with a focus on preventing thrombosis and occlusion
• Management principles – blood sampling, flushing, medication/fluid administration, and dressing and line changes
• Common troubleshooting tips

The Science of Stem Cells

Stem cell science represents an area of medicine that is promising and may be revolutionary in terms of its outcomes. However, despite much interest and attention, a number of unproven and unregulated therapies exist even though there is a lack of evidence. Whilst their curing properties may be revealed in the future, at present stem cells isolated from bone marrow and transplanted in the context of certain haematological malignancies remain one of the few recognised uses of stem cells. As such, this session will reveal:

• What is a stem cell?
• What are the current recognised stem cell therapies?
• How are stem cells isolated from bone marrow?
• Which haematological malignancies may benefit from bone marrow transplant?
• What are the non-malignant disease indications for transplant?
• What are the nursing considerations of a person pre- and post-bone marrow transplant?

Variceal Bleeding and Advanced Liver Disease

It is an inevitable and worrying reality for many people with liver dysfunction that advanced liver disease (cirrhosis of the liver) can develop. Oesophageal or gastric varices are a complication associated with advanced liver disease. Not every person with varices will bleed. However, it can be frightening to experience as bleeding may be compounded by poor clotting function. This session reviews:

• What causes varices to develop?
• What are the signs and symptoms of varices?
• How is primary prophylaxis achieved and why is this essential?
• What are the current treatments for active variceal bleeding?

Cutting out the Confusion – Gold Standards for VTE Prevention

For any hospitalised patient, the risk of VTE is elevated. Nurses are at the forefront of VTE prevention throughout the patient’s journey. This session will provide an evidence-based update on the rationales and the correct use for the prevention of VTE. It includes:

• Risk factors for developing clots and how to assess
• Application in practice of NHMRC – NICS Clinical Practice Guidelines for the Prevention of Venous Thromboembolism
• Practice guidelines for mechanical VTE prophylaxis: e.g. antiembolism stockings and sequential compression devices
• Correct use of compression stockings

“HIT Back Post-Operatively” – Recognising Heparin-Induced Thrombocytopenia

Heparin is the most commonly used anticoagulant used in a hospital setting when treating and preventing thromboembolic disorders. While it often works in the patient’s favour, it can also go wrong. This session looks at:

• Why use heparin postoperatively?
• Who is susceptible to HIT?
• HIT-ing the mark – how do we manage HIT?

Gene Therapy for Haemophilia – the Beginning of the End?

Christmas disease is a genetic disorder that impacts an individual’s ability to produce clotting factor IX. This session will further explore what “Christmas disease” is and how revolutionary changes are occurring. It includes:

• What is “Christmas disease” and how does it affect someone?
• What is the factor IX Padua gene therapy trial?
• What is the underlining pathophysiology of haemophilia and the gene therapy?
• What does this mean for the future treatment of haemophilia B?