44 year-old woman with DVT dies of PE--- ???

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I took care of a patient over the weekend for 1 12-hour shift. I saw her the next morning on my rounds and she was perfectly fine. 1 hour later she was dead. Massive PE, the docs think as her admitting Dx: DVT. She was admitted 2 days prior. MY QUESTION: She asked me about TED hose application. I told her that this was a good question for the doctor because I didn't know if TED hose were contraindicated if someone already HAS a DVT. I know they are good for PREVENTION. I did ask a doc (after she passed away) what he thought. He said that he didn't think it was a good idea to constrict, possibly, blood flow if someone already HAS a DVT. I heard the family complaining, "WHY DIDN'T SHE HAVE ON TED HOSE!?" It's just haunting me a bit, you know? Wondered if any other nurses have ever encountered this dilemma. Thanks in advance. Personally, I'm upset that the doctor told her/wrote an order that she could increase ambulation only 1 day after she was admitted, INR not therapeutic yet, but on a hefty dose of Lovenox. Sighhhhhh... :( :confused:

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Specializes in Cardiac Telemetry, ED.

TEDs are not contraindicated in people with DVT. SCDs are.

You know, sometimes stuff just happens. PEs are known for being sudden and lethal. Those that survive them are fortunate, as the odds are against it.

I know you're worried that the PE broke off from the original DVT, but the fact is, if she had a DVT, she was, for whatever reason, in a hypercoagulable state, and the PE could easily have been a completely separate thrombus from her DVT. She may have even been working on it prior to admission. Don't beat yourself up.

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Specializes in ICU/Critical Care.

Yeah, unfortunately things like that happen. I've had a 30yo woman die after having an emergency c-section because she coded while in labor but she didn't die until a month and half later but she was trached, vented and unresponsive.

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i had a pe after a hysterectomy, being a nurse you know what can happen and it can really scare you

if patient has a dvt you know that this [sudden death] is a possibility and not something that you can do much about

i have always seen ted hose ordered but early ambulation has not been with my experience

i can see the families frustration but sometimes the worse things can happen God bless them

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Specializes in Trauma ICU, MICU/SICU.
I took care of a patient over the weekend for 1 12-hour shift. I saw her the next morning on my rounds and she was perfectly fine. 1 hour later she was dead. Massive PE, the docs think as her admitting Dx: DVT. She was admitted 2 days prior. MY QUESTION: She asked me about TED hose application. I told her that this was a good question for the doctor because I didn't know if TED hose were contraindicated if someone already HAS a DVT. I know they are good for PREVENTION. I did ask a doc (after she passed away) what he thought. He said that he didn't think it was a good idea to constrict, possibly, blood flow if someone already HAS a DVT. I heard the family complaining, "WHY DIDN'T SHE HAVE ON TED HOSE!?" It's just haunting me a bit, you know? Wondered if any other nurses have ever encountered this dilemma. Thanks in advance. Personally, I'm upset that the doctor told her/wrote an order that she could increase ambulation only 1 day after she was admitted, INR not therapeutic yet, but on a hefty dose of Lovenox. Sighhhhhh... :( :confused:

I believe the TED's were contraindicated, just like compression pumps are in a DVT. You didn't mention a heparin gtt. Why wasn't she on one? I've never heard of Lovenox to treat an acute PE.

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Specializes in being a Credible Source.
I took care of a patient over the weekend for 1 12-hour shift. I saw her the next morning on my rounds and she was perfectly fine. 1 hour later she was dead. Massive PE, the docs think as her admitting Dx: DVT. She was admitted 2 days prior. MY QUESTION: She asked me about TED hose application. I told her that this was a good question for the doctor because I didn't know if TED hose were contraindicated if someone already HAS a DVT. I know they are good for PREVENTION. I did ask a doc (after she passed away) what he thought. He said that he didn't think it was a good idea to constrict, possibly, blood flow if someone already HAS a DVT. I heard the family complaining, "WHY DIDN'T SHE HAVE ON TED HOSE!?" It's just haunting me a bit, you know? Wondered if any other nurses have ever encountered this dilemma. Thanks in advance. Personally, I'm upset that the doctor told her/wrote an order that she could increase ambulation only 1 day after she was admitted, INR not therapeutic yet, but on a hefty dose of Lovenox. Sighhhhhh... :( :confused:

I just wanted to try to help ease your burden a bit.

According to UpToDate, "A number of small randomized studies have shown that early ambulation with or without the use of leg compression does not increase the incidence of silent, recurrent, or fatal pulmonary emboli and, in one study, resulted in a significantly faster rate of resolution of pain and swelling when compared to bed rest alone" (followed by a list of studies from which they derive their comments).

It sounds like this poor lady's time was up. :cry:

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Specializes in being a Credible Source.
I've never heard of Lovenox to treat an acute PE.

It's the standard of care in these parts. Lovenox q12 while getting the warfarin started. Maintain Lovenox for at least 48 hours with therapeutic INR and overlap with warfarin.

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Specializes in ICU.
It's the standard of care in these parts. Lovenox q12 while getting the warfarin started. Maintain Lovenox for at least 48 hours with therapeutic INR and overlap with warfarin.

Really? Instead of a heparin gtt?

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Try this link for information re. guidelines for treating the pt. w/ dvt. I hope the OP finds peace. This is very sad to see a young person's life lost like this. It is esp. hard if you are about the pt's age or she is your mom's/dad's age. It stirs up a lot of really sad feelings. It was probably not entirely preventable. It is quite possible she had a coag disorder. Over the many years I have done this, I have had several young patients die and it has affected me to the core. It has made me listen a little closer, both to the pts. and the little voice inside. Life is very fragile, but wonderful in many ways too. Read the guidelines. It may help you understand the orders a little better.

http://www.ngc.gov/summary/summary.aspx?doc_id=5893&nbr=003879&string=deep+AND+vein+AND+thrombosis#s23

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Specializes in Med/Surg, Home Health.

hmm, we use heparin gtt always for DVT.

Hon, it wasnt your fault, dont beat yourself up over it.

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Specializes in Neuro ICU and Med Surg.
I believe the TED's were contraindicated, just like compression pumps are in a DVT. You didn't mention a heparin gtt. Why wasn't she on one? I've never heard of Lovenox to treat an acute PE.

The admitting diagnosis was DVT. Yes you can use teds and not SCD's. I would have thought that a heparin drip would be ordered for a acute DVT as well.

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Wow... I really appreciate EVERYONE'S response. :) Thank you SO much for your words and the information. :)

By the way... this lady was almost 300lbs and previously on birth control pills. She'd had an appendectomy recently. There were many risk factors associated with what happened to her... I was just concerned about the TED hose question that she asked me about the day before she passed. I intend to ask a critical care doctor about it, as well.

We DO sometimes have people on a heparin gtt for DVTs, and PE's as well. This lady was not KNOWN to have a PE until she coded. She was ADMITTED with the Dx: DVT in her leg. So... there ya go. Sighhhhhh... Just the whole thing... it's going to be on my mind for quite some time.

Her bubbly personality, smile and warmth of character touched me. When I gave report on her the first day that I had her, I started out my report, "Now, this doll baby in room ----..." She was just a sweetheart. :( !!!!

In my years of nursing (13), I have never had a patient CODE!!! :( Then to have them code and DIE! :( Seems, I was fortunate enough in my years of nursing to be able to move them off the floor either before they coded or got too bad off...

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