Dvt resulting in amputation

What about other forms of VTE prophylaxis? anti thrombotic stockings? SCDs? Low dose anticoagulant.

It seems strange that a pt with a hx of DVT had nothing...

It's dual responsibility as far as I'm concerned- the medical officer for not completing that assessment and ordering something and the nurse for not questioning why the patient wasn't on something.

I agree with the previous poster, especially the nurse, because a proper assessment was not completed. If I am not mistaken, a dvt clinically manifest as "red hot calf" first so considering patient's history he should have been assessed more frequently and also preventative measures such as the compression stockings should have been implemented.

Unfortunately for the patient, he now has to cope with an amputation something I bet he was not planning to at all.

No pulse sounds more like an arterial thrombus- not a DVT.

What about other forms of VTE prophylaxis? anti thrombotic stockings? SCDs? Low dose anticoagulant.

It seems strange that a pt with a hx of DVT had nothing...

It's dual responsibility as far as I'm concerned- the medical officer for not completing that assessment and ordering something and the nurse for not questioning why the patient wasn't on something.

no scd? ambulation?

Thanks for the responses! This is something my clinical instructor brought up in post conference, a situation that took place on the unit we were on for clinical. This is how my instructor described it, I am not sure of any more details! I asked what we could of done to prevent it and they didn't really answer and it got me thinking, so I came here!

I agree, after doing some more research on dvt and arterial thrombus, it does sound more like arterial thrombus.

If someone was to have a history of clots, how much more frequently would you assess to try and prevent/ catch early the clot? Every four hours?

No pulse sounds more like an arterial thrombus- not a DVT.

That was what I was thinking as soon as I read the title/OP.

Let's for now just say it was a DVT. Why was the patient in the hospital? Were they able to walk? Did they ambulate regularly/were they given assistance to help them ambulate? If no, why not? Why were other methods of DVT prophylaxis used? If not, why not? Did the nurse contact the doc? If so why did he/she not institute anything? Was such a conversation charted?

To change gears, I don't think there is anyway to prevent an arterial thrombus other than systemic anticoagulation (I am not 100% sure of this--any insight from other nurses appreciated). Either way, this does sound like the more likely (medical) diagnosis.

If someone was to have a history of clots, how much more frequently would you assess to try and prevent/ catch early the clot? Every four hours?

It depends on the unit standard. I would not necessarily check more often then that, but I would educate the patient about the S/S of a "new" clot.

Since this clot sounds arterial, my guess is that lack of mobility and/or lack of DVT prophylaxis did not play a role in the clot's formation. Possibilities for formation of the clot include A fib (if they were in A fib and not being anticoagulated I would call the doctor and find out what, it anything, he/she wants), a clotting disorder (Factor V Leiden, hyperhomocysteinemia), or some type of physical manipulation to that artery.

As for the last of those options: did he have some type of a recent arterial graft (fem-pop bypass)? Did he have catheterization of that leg for angiogram or angioplasty? If some type of a procedure was done, the performing physician would probably write for more frequent assessment of the site/leg/foot to chest for color, cap refill, pulses. For the first few hours after the procedure, those checks can be a frequent as q15 minutes.

I am extermely interested for you to go to school and get the details about this patient for your own learning...and come here and let us know...I'm curious now.

I will do just that, thank you! Thursday/Friday I'll be back with more details! I definitely know more about dvt/ arterial thrombosis just from the information discussed here

As for the last of those options: did he have some type of a recent arterial graft (fem-pop bypass)? Did he have catheterization of that leg for angiogram or angioplasty? If some type of a procedure was done, the performing physician would probably write for more frequent assessment of the site/leg/foot to chest for color, cap refill, pulses. For the first few hours after the procedure, those checks can be a frequent as q15 minutes.

I am going to be looking more into the details, but I don't think he had some type of arterial graft or catheterization of that leg for angiogram/angioplasty. Thanks for all the info, I'm going to get some more background information and discuss further with my instructor!