Dvt resulting in amputation

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At clinical a patient woke up and called the nurse because his left leg felt numb, the nurse looked at the leg and it was grey and cool to touch. They checked vitals, all normal. Couldn't find a pedal pulse in left foot, but could in right. Couldn't find pedal pulse with Doppler even. Called physician. The patient has a dvt and now they have to amputate the leg. He had a previous hx of dvt, but admitted for bleeding ulcer, so I don't think they had him on anticoagulants because of the bleeding ulcer. Could this have been prevented (caught before the leg got to the point of needing amputation)? Would that be a mistake of the nurse?

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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.

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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:

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Specializes in NICU, ICU, PICU, Academia.

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

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Specializes in Hematology/Oncology.
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?

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

I agree with MMJ...no pulse? What would cause a leg to have NO PULSE? I am thinking it isn't a deep VEIN thrombus.

Couldn't find a pedal pulse in left foot, but could in right. Couldn't find pedal pulse with Doppler even. Called physician.
Amputation for a DVT I don't think so.

Is this for school?

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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!

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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?

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Specializes in Emergency, Telemetry, Transplant.
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.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
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?

I am still confused...But it might be one of those days. Arterial occlusion/obstruction by clot isn't something you "monitor" for per say. If a patient has something in the artery, usually they are in critical care with special monitoring equipment or have had an invasive cardiac procedure. You monitor the pulses every one to two hours depending on the patient. A sudden occlusion of the artery causes extreme pain to the limb and loss of color/temperature to the extremity. The "cure" for this is the removal replacement of the special lines in the arteries.

A patient with chronic peripheral artery disease have intermittent pain to the extremity that has blockages especially with activity. These patients do experience sudden occlusion and pain but it is seldom these days that the patients only option is amputation of the limb.

Venous occlusion can occur for many reasons....patient in chronic atrial fibrillation, on bedrest, long flights...cn shower blood clots/emboli but the biggest immediate danger to these is the showering emboli to the heart/lungs that can cause cardiac death...rarely, if ever, do they cause the amputation of a limb.

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.

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Specializes in Emergency, Telemetry, Transplant.
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.

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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

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