Dvt resulting in amputation

[shan03]

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?

[shan03]

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!

[Esme12, ASN, BSN, RN]

come back here we will discuss it here...and we are now curious!

[osi2011]

I agree, very interesting case! I also learned something new here, difference between arterial and venous thrombosis, and if I really thought about it I would have realized that: no pulse=blockage of arterial flow not: "red hot calf" and DVT...well I have to go back and study that part of fundamentals in depth a little more...lol...but I still can't help but feel that it could have been prevented...the reason why is that if a proper HTT assessment was being done on the patient by each nurse, one could have noted that there was no pedal pulse and alert the charge nurse or physician for further investigation. Please correct me if I am wrong, but I was taught (just only been in nursing school for almost 4 weeks yay!!) that each morning or whenever you come on shift, you complete a HTT assessment on your patients that have been assigned to you, even if you seen them yesterday and it was reported to you today that the patient is stable, you should still conduct a HTT assessment, it does not have to be in complete detail but the fundamental basics to ensure that the patient is indeed stable, and note if there is anything that needs to be documented and reported to....but I guess it all depends on the facility and what the clinical instructors want...

[Esme12, ASN, BSN, RN]

You do a head to toe assessment at LEAST once on EVERY patient in acute care. More frequently of it is ordered or the patient is critical.

Of course an arterial thrombus is different from the venous thrombus...one is in the artery one is in the vein. ONe is more acute and emergent right up front. Think of an arterial occlusion to the LE as a heart attack of the leg.

[psu_213, BSN, RN]

At my previous job, I worked on a PCU, where we did a head to toe assessment on each patient each 8 hours. One supervisor there commented (I forget the context now) that PCU nurses struggled when "pulled" to medsurg since nurses did just a focused assessment, rather than a head to toe on admitted patients on their units because of the larger patient loads.