Treatment for PE

[ilovematt48]

hello all! i have some questions about PE tx! I know that you would anticoagulate w/ Heparin. But my professor wants to know what type of aticoagulant/ or other intervention you'd do for a KNOWN PE that is present and not moving and a NOT KNOWN PE that is moving? I can't find anything about this in my med-surge book or notes!! Please give me so advice here!!!

Thanks! - Allison -

[UM Review RN, ASN, RN]

Heparin drip or Lovenox for the known, not moving PE.

If you have a PE that is moving, :eek:you'll know soon enough, because the patient will Code pretty suddenly.

[Daytonite, BSN, RN]

Well, if a PE is moving and you don't know it, why would anticoagulation be ordered in the first place? If it were, as a stab in the dark, it would have to be Heparin to prevent the clot from getting any bigger. There are only two major drugs used for anticoagulation: Heparin and Coumadin. Coumadin would be ordered if the patient were a known clot maker and at risk to form PEs. The only other thing I can think of would be one of the clot busters, such as TPA to break up the clot immediately. I've been out of active practice for a few years, but I've never heard of TPA being given for a PE.

[EricJRN, MSN, RN]

By known/not known, does she mean whether or not a PE has been confirmed by imaging studies (rather than just suspected)?

At one point or another, just about every thrombolytic agent (heparin, Coumadin, LMWH, tPA) has been studied in the management of PE. It makes for an interesting search.

What about interventions more specific to nursing? These patients will encounter dyspnea at some point, so you'll elevate the head of the bed, give oxygen per unit protocol, and call the physician, anticipating some new med orders (maybe anticoagulation, pain control) and lab orders (coag studies, D-dimer, CBC, maybe cardiac enzymes).

[wtbcrna, MSN, DNP, CRNA]

Here is nice simplified summary of PE treatment:

"The following treatments are the most frequently used for PEs.

Oxygen can be given in several ways. One is through tubing that is inserted at the tip of the nostrils, called a nasal cannula.

If you have severely low oxygen levels, you will be given a higher flow of oxygen through a mask.

You may be so sick that you require ventilator treatment. A large tube is placed into your trachea (windpipe) and connected to a ventilator (breathing machine), which assists or does the breathing for you. If a ventilator is required, you will usually be sedated so that you are not aware, which also helps to ease your breathing and make it effortless.

Blood-thinning medication is given through your IV, injected in the skin directly, and also taken by mouth.

Heparin is usually the first medication given. This is given in an IV and works to stop further clot formation from occurring. It is administered continuously through the IV.

Another medication is called enoxaparin (Lovenox), or a low molecular weight heparin. This medication is given subcutaneously, or just under the skin. It only has to be given every 12 hours, but it does require an injection each time. The current trend is to use low molecular weight heparin for the treatment of PE.

The oral blood-thinning medication called warfarin (Coumadin) is usually given shortly after the heparin or a low molecular weight heparin is started. The medications are continued until blood tests show that the warfarin is adequately thinning the blood. Once this is shown, then the heparin or enoxaparin is stopped, and the warfarin is continued as an outpatient.

Blood pressure elevators are IV medications given to critically ill people with low blood pressures. The most commonly used medication is dopamine (Intropin). It works to elevate the blood pressure into an acceptable range.

"Clot buster" medications (also called thrombolytics) are given to those who are critically ill. The purpose is to break up the clot that is blocking the blood vessel in the lung. These medications are used only in those with massive PE, blood pressure collapse, or severely low oxygen that does not respond to treatment. Examples of these medications are reteplase (Retavase), TPA, streptokinase, and urokinase. "

http://www.emedicinehealth.com/pulmonary_embolism/page5_em.htm

The only thing that I can think of about treating an unknown PE is that you would treat it symptomatically until the exact cause was known ie. O2, ventilatory support, pressors etc.

[yoginurse2b]

Also if you give anticoagulants, remember to check PTT for Heparin and PT/INR for Coumadin to make sure that they are within the therapeutic range.

[mcknis]

o2, TPA, coumadin/lovenox, etc