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:

A lot of people have a genetic predisposition to blood clots, DVT and PE. I am convinced that the majority of people in this age group that die suddenly like this from blood clots have the predisposition. Also, other members of the family may need to be warned that they could also have the trait and tested.

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A few days ago I cared for a guy who had hx of DVT and was in hospital for a gastro bug. Anyway, he asked for TEDs telling me his hx, I asked the nurse educator on the ward and she said that TEDs should be used for people with hx of DVT if they're immobile. The pt actually said he wore TEDs at night when he was at home. The doctors then Rx the TEDs for his inpatient stay.

I haven't been a nurse for too long and I work on an ENT ward so a lot of the other RNs didn't really know either.

Sorry to hear about that lady, though.

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Specializes in being a Credible Source.
Really? Instead of a heparin gtt?
Yep. Heparin drips are really uncommon in our hospital.

According to UpToDate, studies find compared to a heparin drip, SC Lovenox "results in lower mortality, fewer recurrent thrombotic events, and less major bleeding" which statement is followed by 12 studies which back up the statement.

They summarize data from the studies including:

In 18 trials (8054 patients), SC LMWH decreased mortality (odds ratio 0.76, 95% CI 0.62-0.92).

In 22 trials (8867 patients), SC LMWH decreased recurrent thrombosis (odds ratio 0.68, 95% CI 0.55-0.84).

In 12 trials, thrombus size reduction was more common with LMWH (odds ratio 0.69, 95% CI 0.59-0.81).

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Specializes in Cardiac Telemetry, ED.

We use LMWH to bridge to Coumadin as well.

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Specializes in Cardiac/Tele/CVICU.

I've cared for two DVT pts as a student nurse... neither wore TEDS as it was contraindicated for them. Both were on heparin drips. At our hospitals here, everyone wears TEDS, no matter what they're in for, unless it's contraindicated.

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I have to agree with everyone, not your fault! I work homecare, by the way, people are sent home nowadays on lovenox until coumadin is therapeutic, both people with DVT and with PE. While I was at the hospital, it seemed to depend on the doctor. Some ordered weight based hep gtt, some lovenox BID. :)

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Again... ;)... I'm REALLY appreciating reading everyone's input here. Thanks to ALL of you!! :)

Sincerely,

Marie :)

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i wonder if the womans weight was part of the reason for no order for ted hose...

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Is weight a contraindication for TED hose?

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hmm, we use heparin gtt always for DVT.

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

In the last couple of years we have hardly ever used heparin drips anymore. Always lovenox until coumadin is therapeutic.

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Specializes in LTC, Hospice, Case Management.

I had DVT at 30 years old (smoker and BC pills). As soon as DVT confirmed per ultrasound, I was sent for VQ scan to see if I also had PE, even tho no symptoms... and I did have one. Dr. ordered TEDS that same day and at that time I was on Heparin, although I think most of our Dr's in this area are now using Lovenox.

And as someone else said, I did later find out I have a family disposition for blood clots (we got tested when 3 other family members had DVT's within a 5 year span).

Lucky for me, my outcome was much better than the OP's patient, I played around for nearly 3 days insisting that I just pulled a muscle in my leg and couldn't possibly be a clot!

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Specializes in med/surg/tele/neuro/rehab/corrections.

What does a DVT feel like? Just wondering.

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