Subclavian DVT

tridil2000, MSN, RN · Apr 5, 2005

Has anyone cared for a patient with this?
My pt had no activity restrictions......I was worried about a PE. What are some key things to assess with this patient? What can I do to help prevent a PE?
Thanks in advance.

i had a pt once with a jugular thrombosis. we started him on heparin in the er and he was going to the or the next day.

Speculating · Apr 5, 2005

i had a pt once with a jugular thrombosis. we started him on heparin in the er and he was going to the or the next day.

Wow a subclavian DVT I think that spook me too flashyrn2be I wouldn't want them on the floor I'd feel more comfortable having them in the ick-u. The jugular however sounds bad but remember it's got the whole body to go through to get back to the heart and lungs by then it's dissipated enough to not be of concern.

tridil2000, MSN, RN · Apr 5, 2005

The jugular however sounds bad but remember it's got the whole body to go through to get back to the heart and lungs by then it's dissipated enough to not be of concern.

~~

huh?

can you explain that journey to me?

UM Review RN, ASN, RN · Apr 5, 2005

it's got the whole body to go through to get back to the heart and lungs by then it's dissipated enough to not be of concern.

I would still be concerned about that little side trip through the brain....

Did they give the patient any clotbusters? Heparin, anything??

Speculating · Apr 5, 2005

The jugular however sounds bad but remember it's got the whole body to go through to get back to the heart and lungs by then it's dissipated enough to not be of concern.

~~

huh?

can you explain that journey to me?

Thanks Tridil you caught me thinking it gets me trouble everytime.

I think you almost have to consider going in after that one. The Lovenox and clot busters might even scare me to bust it loose. Keep us up I'm very intrested in how this one ends up.

zacarias, ASN, RN · Apr 5, 2005

Wow a subclavian DVT I think that spook me too flashyrn2be I wouldn't want them on the floor I'd feel more comfortable having them in the ick-u. The jugular however sounds bad but remember it's got the whole body to go through to get back to the heart and lungs by then it's dissipated enough to not be of concern.

I vaguely remember having a pt with a subclavian DVT (not his primary dx) in nursing school. They can be on the floor if they're stable. While a embolism will get to the lungs faster from a subclavian origin, a deep leg vein embolus can get there pretty quick too.

Speculating · Apr 5, 2005

I vaguely remember having a pt with a subclavian DVT (not his primary dx) in nursing school. They can be on the floor if they're stable. While a embolism will get to the lungs faster from a subclavian origin, a deep leg vein embolus can get there pretty quick too.

Your right to assume that and I would agree with you if the DVT were anywhere other than jugular. Trouble is only takes a heart beat to be unstable.

flashyrn2be · Apr 6, 2005

Pt was on a heparin drip. Scheduled for a thoracentisis (?spelling) the following day. Lungs sounded clear but diminished at bases. However, Pt at one time, during a 12 hour shift, coughed up a considerable amount of sputum - thick, chunky, green/yellow.

I looked up info on the net and found that approx. 26% of pts with subclavian DVT's end up with PE.

Thanks for your responses. Just trying to educate myself.

tridil2000, MSN, RN · Apr 6, 2005

Pt was on a heparin drip. Scheduled for a thoracentisis (?spelling) the following day. Lungs sounded clear but diminished at bases. However, Pt at one time, during a 12 hour shift, coughed up a considerable amount of sputum - thick, chunky, green/yellow.
I looked up info on the net and found that approx. 26% of pts with subclavian DVT's end up with PE.
Thanks for your responses. Just trying to educate myself.

if the pt'd dvt made its way to the lungs....the pt would c/o sob, cp and have an increase in resp rate. you would notify your primary rn right away and your instructor. they may even develop a pinky/frothy type sputem.

with the sputem you described, and the fact that he was going to have a thoracentisis the next day, it sounds as if he has other issues as well. you could have sent that sputem for a c&s if one wasn't sent already.

you would want to check on his last ptt. as a nurse you would check that the ptt is therapuetic on a heparin gtt. were you able to help with the thoracentisis? he may have had to get a greenfield filter placed to prevent future clots from getting up to the scv next time! this little umbrella filter sits in the inferior vena cava traping clots!

many people with dvts can go home on oral thrombolytics now. the body usually breaks them down in time. however, you never want to be the one whose dvt starts to go on a 1 way trip!

good luck in your future clinicals!

Speculating · Apr 6, 2005

Pt was on a heparin drip. Scheduled for a thoracentisis (?spelling) the following day. Lungs sounded clear but diminished at bases. However, Pt at one time, during a 12 hour shift, coughed up a considerable amount of sputum - thick, chunky, green/yellow.
I looked up info on the net and found that approx. 26% of pts with subclavian DVT's end up with PE.
Thanks for your responses. Just trying to educate myself.

You sound a little apprehensive don't your doing a good job of educating yourself. Your picking good stuff you made us all think, and I applaude you for hitting the internet up.

UM Review RN, ASN, RN · Apr 6, 2005

if the pt'd dvt made its way to the lungs....the pt would c/o sob, cp and have an increase in resp rate. you would notify your primary rn right away and your instructor. they may even develop a pinky/frothy type sputem.

Or not.

No, I'm not trying to confuse you, but a large portion of the patients I've cared for with PEs generally have vague c/o like SOB or diminished lung fields, and no c/o pain, no sputum production.

We really depend on D-dimers and CT angios to help dx PEs.