Saddle Pulmonary Embolism

[Sunshine716]

Hey nurse friends,

I have a question. How do you usually see Saddle PE's managed? I know it varies depending on a ton of factors unique to the patient, but how common is an embolectomy, etc? Is that done by an interventional radiologist? Heparin gtt vs LMWH (Lovenox)?

The patient is hemodynamically stable and there is only a small elevation in pulmonary pressure. Their EF is 65%. They had a large bowel resection less than a month ago so they are not a candidate for thrombolytics.

Do these usually dissolve eventually with anticoagulants over time? I guess I'm just wondering what are higher level care options/interventions should the patient become unstable? Or is the best time to perform an embolectomy when the patient is stable or is it such high risk that it's only done when the patient's condition begins to deteriorate?

Thanks for your help!

[Atl-Murse]

I dont know that is appropriate question for an RN. IR MD maybe

[Sunshine716]

Yes, to clarify, I wasn't asking for medical advice, but nursing experiences possibly in larger hospitals with more capabilities. The doctors (in this small hospital) have a wait and see mentality, but I just wanted to hear from those that have possibly had experiences with other interventions for a saddle PE such as embolectomy and how common it is? I know care can vary greatly from hospital to hospital depending on the kind of resources and expertise available.

[Rose_Queen, BSN, MSN, RN]

In critical patients, I have been involved in ECMO placement and for some, even cracking the chest, putting the patient on bypass, and removing the clot surgically. In those cases, the amount of clot is shocking, and most times we wonder how the patient even made it to the OR.