Subclavian DVT

Speculating · Apr 7, 2005

not a nurse yet but a little confused here. Wouldn't the blood trace through jugular (internal or external) vein straight to subclavian to brachiocephalic vein straight into the sup. vena cava to right atrium of the heart?

You have 1700 posts and your not a nurse yet. Looks like you need to be studying - Internal --->Right Atruim.

geekgolightly, BSN, RN · Apr 7, 2005

not a nurse yet but a little confused here. Wouldn't the blood trace through jugular (internal or external) vein straight to subclavian to brachiocephalic vein straight into the sup. vena cava to right atrium of the heart?

pretty much. good call. i was wondering when someone was going to catch that the jugular does not feed the entire body before going back to the heart.

this is why pulling an IJ is so dangerous. occlusive dressing = literal lifesaver

tridil2000, MSN, RN · Apr 7, 2005

good call. i was wondering when someone was going to catch that the jugular does not feed the entire body before going back to the heart.

this is why pulling an IJ is so dangerous. occlusive dressing = literal lifesaver

:redlight: although a bit sarcastic, i asked for an explanation of THAT so called jouney uppost. :smackingf

tridil2000, MSN, RN · Apr 7, 2005

No, what I will do is give them a GI cocktail if there's good HX then they go home if they better with OTC pepcid.

every cc: indigestion that i have dealt with in 18 years gets an ecg.

tridilbsncen

tridil2000, MSN, RN · Apr 7, 2005

Wait a minute you don't know what a GI cocktail because your a floor nurse trying to puff your chest and talk ER to me. That's why your rambling it's okay ;-) :balloons:

this cat fight is quite funny considering 1 of you thought the jugular vein flows *to* the brain and the other thought it empties *into the entire body*... :lol2:

ps, speculating, if you're going to start a cat fight, at least spell correctly! doh!! :doh:

UM Review RN, ASN, RN · Apr 7, 2005

this cat fight is quite funny considering 1 of you thought the jugular vein flows *to* the brain and the other thought it empties *into the entire body*...

Glad you're enjoying it, Tridil~

Once again, I will defend my position. As a Tele nurse, my work consists largely of dealing with the effects of clots.

We get DVTs (clot is in a limb, presenting a risk to the patient), we get MIs (clot has actually caused a blockage and necrosis of heart tissue), we get A-fib (clot can originate from upper part of chamber and cause problems, which is why A-fibbers are on Coumadin), and we get strokes (clot has travelled to brain and caused a blockage).

That being said, here's a little education about stroke:

From Stroke and Cerebral Ischemia, John R. Hesselink, MD, FACR

http://fmri.ucsd.edu/NeuroWeb/Text/br-710.htm

The source of the embolus is usually either the heart (patients with atrial fibrillation or previous myocardial infarction) or ulcerated plaques at the carotid bifurcation in the neck.

From The American Stroke Association website (which has an excellent video training on the NIHSS for free for professionals, by the way):

Cerebral embolism refers generally to a blood clot that forms at another location in the circulatory system, usually the heart and large arteries of the upper chest and neck. A portion of the blood clot breaks loose, enters the bloodstream and travels through the brain's blood vessels until it reaches vessels too small to let it pass. A second important cause of embolism is an irregular heartbeat, known as atrial fibrillation. It creates conditions where clots can form in the heart, dislodge and travel to the brain.

So as you can see, an embolus can actually cause problems to different parts of the body. A subclavian embolus would certainly be close enough to the heart to cause an MI, PE, or CVA.

Of the three, I would seriously rather have the PE or the MI than the stroke, which is why I mentioned further along the circuit--the brain.

OK. Are we having fun yet?

UM Review RN, ASN, RN · Apr 7, 2005

every cc: indigestion that i have dealt with in 18 years gets an ecg.

PS

An ECG doesn't necessarily determine the presence of an MI. So you might want a set of cardiac enzymes with that ECG. Just a thought. :)

tridil2000, MSN, RN · Apr 7, 2005

Glad you're enjoying it, Tridil~
Once again, I will defend my position. As a Tele nurse, my work consists largely of dealing with the effects of clots.
We get DVTs (clot is in a limb, presenting a risk to the patient), we get MIs (clot has actually caused a blockage and necrosis of heart tissue), we get A-fib (clot can originate from upper part of chamber and cause problems, which is why A-fibbers are on Coumadin), and we get strokes (clot has travelled to brain and caused a blockage).
That being said, here's a little education about stroke:
From Stroke and Cerebral Ischemia, John R. Hesselink, MD, FACR
http://fmri.ucsd.edu/NeuroWeb/Text/br-710.htm
The source of the embolus is usually either the heart (patients with atrial fibrillation or previous myocardial infarction) or ulcerated plaques at the carotid bifurcation in the neck.
From The American Stroke Association website (which has an excellent video training on the NIHSS for free for professionals, by the way):
Cerebral embolism refers generally to a blood clot that forms at another location in the circulatory system, usually the heart and large arteries of the upper chest and neck. A portion of the blood clot breaks loose, enters the bloodstream and travels through the brain's blood vessels until it reaches vessels too small to let it pass. A second important cause of embolism is an irregular heartbeat, known as atrial fibrillation. It creates conditions where clots can form in the heart, dislodge and travel to the brain.
So as you can see, an embolus can actually cause problems to different parts of the body. A subclavian embolus would certainly be close enough to the heart to cause an MI, PE, or CVA.
Of the three, I would seriously rather have the PE or the MI than the stroke, which is why I mentioned further along the circuit--the brain.
OK. Are we having fun yet?

first off, i adore your name angie. that is so creative! secondly, i am not going to argue with you, i have tremmendous respect for tele nurses. i did step down for 2 years before becoming the manager of the unit. however, you need to understand some more anatomy to clearly understand thrombosis.

there is the arterial bed and then there is the venous bed. a venous clot can form in any vein really. dvts are the most common. they travel up the ivc, to the scv and then into the ra. from there, they get pumped into the rv, out the pa and into the branches of the lungs. that's where the problem occurs. this clot gets stuck there, creating a dead space where no gas exchange can occur. the size of the clot, and exactly how much of the bed is occluded, will have a direct realtionship to the severity. there is no way these clots can somehow make their way through this 'bed' and through capillaries and into the pv BACK to the la. so clots that originate out of the lv do not come from the venous side.

on the other hand, a pt can develop a clot (thrombosis) in the la or the lv, the arterial side, from a rhythm like a fib, or even svt! even a bad mitral valve can cause an arterial clot to form. these clots are usually smaller, but if they find their way out of the lv, into the aorta up into the carotid atreries, into the small arterioles of the brain, they can be devstating, causing a cva. if they are significant enough and they find their way down the dec. aorta, they can cause a mesenteric artery occllusion (causing a bowel infarct), or a renal artey occlusion. they also can head down the femoral artery and block off circulation to the leg. these pt lose their pulses below that site. that's why pedal pulses are so important to check, even on tele!

all this said, the mi could be included in the arterial group if in fact a clot formed on the left side of the heart and was thrown out into a coronary artery. perhaps the smallest of clots get caught up in an area of the coronary that has arteriolosclerosis and some significant narrowing already. but most clots that cause mis are usually the result of poor blood flow in the coronary itself, bc of existing arteriosclerosis, and the blood moves slower through this narrowing, and over time 'gets sticky' and stagnant which ends up building up so much, a clot forms right there.

so depending on where the clot forms, and the anatomy it travels through, tells you where the potential problem will be. a clot that forms in the venous bed, after getting through the right side of the heart can not get through the lungs and therefor not be the cause of an arterial embolism etc. so when the pt had a jugular thrombosis, it could move down into the sup vena cava, into the ra and into the rv and then into the lungs. it's done there. trips over. no whole body, no trip through the brain (that's where it came from...oddly enough!)

oh and if someone does come to the er with upper gi complaints we do an ecg to cover ourselves all the time. we don't always do enzymes, bc then they have to be admitted for 24 hours to complete the series. we'd have twice as many tele pts for you in that case! and lord knows, we give you enough already!

regards,

tridil

UM Review RN, ASN, RN · Apr 7, 2005

they travel up the ivc, to the scv and then into the ra.

Aahhhh! This is where I've been mistaken.

I had it backwards. Somehow I thought that the clot-forming part of the atria was on the right side. :smackingf

Musta been absent that day.

So if I have it right now, in A-fib, clots form in the LEFT atrial appendage, causing aterial emboli that can travel to the brain. I get it now.

Thanks for the correction, tri.

tridil2000, MSN, RN · Apr 7, 2005

So if I have it right now, in A-fib, clots form in the LEFT atrial appendage, causing aterial emboli that can travel to the brain. I get it now.

Thanks for the correction, tri.

~~

really, any part of the left side could be responsible. the mitral valve, if not closing or opening properly can be a source, and even the aortic valve as well. the aortic valve tends to get calcium build up on it as people age, coupled with stagnant blood around it from an incompetent valve, an emboli can form there quite easily. these get thrown out the aorta and can really go anywhere. the tiniest of clots can be huge problems in a cerebral artery/arteriole.

there's always more to learn!:)

now, if i could get someone to share an xray web site that shows chf and pneumonias on xray, i'd be set! i am looking at going to np school and never get a chance to read xrays and would love to learn and see more!

anyone?

UM Review RN, ASN, RN · Apr 7, 2005

now, if i could get someone to share an xray web site that shows chf and pneumonias on xray, i'd be set! i am looking at going to np school and never get a chance to read xrays and would love to learn and see more!

Sure. How about this one? Scroll down and click on the pic to make it larger.

http://pleiad.umdnj.edu/radweb2003/html/rpa/case7/case7.htm#

geekgolightly, BSN, RN · Apr 7, 2005

PFO's and vegetative growth are culprits often too. workup for ischemic at our hospital always includes a TEE