44 year-old woman with DVT dies of PE--- ???

Nurses General Nursing

Published

I took care of a patient over the weekend for 1 12-hour shift. I saw her the next morning on my rounds and she was perfectly fine. 1 hour later she was dead. Massive PE, the docs think as her admitting Dx: DVT. She was admitted 2 days prior. MY QUESTION: She asked me about TED hose application. I told her that this was a good question for the doctor because I didn't know if TED hose were contraindicated if someone already HAS a DVT. I know they are good for PREVENTION. I did ask a doc (after she passed away) what he thought. He said that he didn't think it was a good idea to constrict, possibly, blood flow if someone already HAS a DVT. I heard the family complaining, "WHY DIDN'T SHE HAVE ON TED HOSE!?" It's just haunting me a bit, you know? Wondered if any other nurses have ever encountered this dilemma. Thanks in advance. Personally, I'm upset that the doctor told her/wrote an order that she could increase ambulation only 1 day after she was admitted, INR not therapeutic yet, but on a hefty dose of Lovenox. Sighhhhhh... :( :confused:

Specializes in LTC, Hospice, Case Management.
What does a DVT feel like? Just wondering.

My calf had no redness, no edema... sore the first day (like a pulled muscle), hurt considerably worse by day 2, on day 3.. felt like someone was cutting the muscle away from the bone with a REALLY SHARP knife - hurt like he!!, could barely walk and had to go up/down stairs on my rump to get my toddler out of his crib. That's when I decided the pulled muscle probably wasn't a pulled muscle!

Up Vote Up Vote ×
Specializes in ICU.
Really? Instead of a heparin gtt?

Yes, the dosing schedule goes to 1mg/kg instead of 40mg (or 30mg with reduced CrCl). Still usually given SQ, although there is a dosing approved for IV in ACS. Lovenox has the benefit of no PTT monitoring required, and decreased risk of HIT.

Back to the original question, TED in DVT. My guess is that it wouldn't hurt but it certainly wouldn't help. Remember, TED hose is meant to squeeze the veins together to allow the incompetent valves to work better and prevent blood backflow/stagnation. Once a clot is formed, that pressure would be meaningless. SCDs are certainly contraindicated.

In reality TED hose are a waste of time. A Greenfeld filter is the only thing that could have prevented the PE.

Up Vote Up Vote ×
Specializes in RN CRRN.

our hospital is thinking about doing away with TEDS I heard. They help with edema, but research they said doesn't show they prevent DVTs. The best prevention is SCDS. We have many pts who cannot be on hep, lovenox or coumadin, due to head bleeds or brain surgery and don't want to risk more bleeding. Problem is the docs usually order them for bedtime which may be okay for most patients but those not on anticoagulants ( or even if they ARE, but not therapeutic yet can still be a risk for DVT) and I have seen pts who don't have them on till bedtime can end up with massive bilateral leg DVTs, and we are surprised? I am not anymore....but again if they already have a DVT then you can't use the SCDS obviously....then again sometimes it is a freak thing....no one can see it coming...

Up Vote Up Vote ×
Specializes in Oncology, Triage, Tele, Med-Surg.

We recently had a woman admitted with DVT. The E.R. doc had ordered TEDs to be applied bilaterally. The nurse who had the patient asked me for my opinion and I wasn't comfortable sharing b/c it's always been a controversial issue. Plus, we're not supposed to manipulate the affected leg, or even bend it like with a Homan's check with a known DVT and sometimes pulling on TEDS is really quite a job & we worried about breaking the clot loose. We decided it was best to call the admitting doc to clarify. Admitting doc said - "No, don't put it on-probably not a good idea."

I saw an autopsy from a young woman in her 30's who died from a PE and vividly recall how profoundly it affected me b/c it's such a sudden and tragic death that, frankly - could happen to anyone. I wrote it as an article here: https://allnurses.com/forums/f300/lessons-autopsy-warning-graphic-289490.html but you have enough images in your head already with the code and knowing your sweet lady... so you may want to skip it.

I am a stickler for prevention trying to get my patients up and moving to prevent a DVT, and teaching early warning signs and making sure the patient knows not to ignore things - "When in doubt, check it out immediately." Once a DVT is in place, well ... I'm terrified, I've seen what can happen and it's just so scary.

Anyway... I'm sorry it happened to your patient... and to you.

Gentle hugs,

:redbeathe

Up Vote Up Vote ×
Specializes in Cardiac.
our hospital is thinking about doing away with TEDS I heard.

We don't even have ted hose in our hospital. Our prophylaxis is either hep sq+scds or just scds if the hep is contraindicated.

Up Vote Up Vote ×
Specializes in CNA, Surgical, Pediatrics, SDS, ER.

I thought teds were contraindicated w/ DVT's? I would suppose it depends on the doc.?

I also know that awhile ago we had a pt in ER w/ a DVT & we asked about starting a Heparin gtt, the doc said that the prefered tx now is Lovenox inj. w/ warfarin therapy.

As to the OP I'm sorry for your situation-just know that you did what you were supposed to do and this is not your fault. Take care and God bless.

Up Vote Up Vote ×

Loving Nurse,

What a GREAT article you wrote! I HAD to read it. All of the responses people have given to be in the past day have helped me tremendously feel less... haunted about it all. I will never forget this woman, her family, or what happened to her. I, too, in nursing school, attended an autopsy or two. The doctor performing 1 of the autopsies I witnessed found a blood clot in the lung, as well. He pulled it out and said, "I believe this was our problem." It reminded me of a big black leach or something. It was fascinating and sad at the same time. I have never forgotten that either, after all these years. Thank you SO much for providing the link to your article. You have a wonderful writing ability! Again... all of this information has really, really helped me feel as though there really WAS nothing I could have done for this poor lady... Interesting, also, that so many doctors feel that TED hose are a contraindication when someone does have a blood clot already present. I honestly did not know the answer to that prior to yesterday. Thank you! :)

Up Vote Up Vote ×
+ Add a Comment