|Title:||Implantation and Retrieval of Inferior Vena Cava Filters|
|Document ID:||Operational Directive OD 0418/13|
|Date of issue:||Thursday, 31 January 2013|
|Description:||This Operational Directive sets out patient follow-up and related annual reporting requirements for clinicians performing inferior vena cava filter implantation.|
|Legal requirements:||Not issued under any specific instrument.
|Applicable to:||Clinicians who refer patients for inferior vena cava (IVC) filter implantation, and Departments and clinicians performing IVC filter implantation in WA public hospitals.|
|Period of effect:||from 1 January 2013 to 1 January 2018|
|Review date:||1 January 2018|
|Authorised by:||Dr David Russell-Weisz, Director General, Department of Health, 15-Oct-2015|
|Print version:||View print version|
Implantation and Retrieval of Inferior Vena Cava Filters
Compliance with this Operational Directive is mandatory for all public hospitals and those private healthcare facilities contracted to provide services to public patients.
This Operational Directive describes the minimum policy and procedural requirements to be followed by Western Australian healthcare facilities for patients implanted with an inferior vena cava filter.
Rationale for retrieval of IVC filters
Inferior vena cava (IVC) filters are small cage-like filtration devices that are placed percutaneously, or less commonly, surgically, in the inferior vena cava to provide protection from pulmonary embolism. IVC filter placement is commonly indicated for patients with existing venous thromboembolism (VTE) for whom anticoagulant therapy has been ineffective or is contraindicated. Filters may also be placed to prevent pulmonary embolism in trauma patients, or in patients with a high risk of VTE from an existing medical condition or surgery.
IVC filters can be permanent devices. However, the use of a retrievable IVC filter allows a device to be placed as a permanent or temporary measure. For temporary devices, retrieval is generally recommended once the indication for insertion has subsided and the risk of pulmonary embolism is considered acceptably low.
Complications associated with IVC filters, albeit rare, include device migration, embolisation of device components, perforation of the IVC, and filter fracture . An increased rate of deep vein thrombosis after long term insertion of IVC filters has also been reported. There is international recognition that further studies and systematic follow up of IVC patients are necessary to conclusively determine the long-term safety and efficacy of IVC filters . For this reason, the following requirements will apply to the use of inferior vena cava implants for Western Australian public patients.
Requirements for patient follow up:
As set out in the Operational Directive 0398/12 and the related Policy for the Release of Human Tissue and Explanted Medical Devices, it is strongly recommended that explanted IVC filters are sent to the Biomaterials and Implant Technology Section of the Bioengineering Division, Royal Perth Hospital, for examination and where required, failure analysis.
*Individual clinical departments may wish to delegate this responsibility to specific individuals.
Cochrane Database Syst Rev. 2007;(4):CD006212. PubMed 17943896
Dr David Russell-Weisz
This circular last updated: Wednesday, 28 October 2015 at 10:52am