Disseminated Intravascular

Coagulation
(DIC)
Priority Concepts
• Perfusion
• Clotting
• Infection
Disseminated Intravascular
Coagulation (DIC)-Description
• Serious bleeding & thrombotic
disorder
• Abnormal initiated and
accelerated clotting
• Decrease in clotting factors,
PLT’s = uncontrollable
hemorrhage
▫ PROFUSE BLEEDING
from PLT depletion &
clotting factors
Diseases/Risk Factors
• Acute • Malignancies
• SHOCK ▫ Leukemia
▫ Hemorrhage ▫ Metastatic solid tumors
▫ Cardiogenic • Tissue damage
▫ Anaphylactic ▫ Major burns and trauma
▫ Septic ‘SEPSIS” ▫ Heatstroke
• Hemolytic processes ▫ Severe head injury
▫ Mismatch blood ▫ Transplant rejections
▫ Acute hemolysis ▫ Post op damage
• OB condition ▫ Pulmonary emboli
▫ Abruptio placenta ▫ Snakebite
▫ Septic abortion ▫ Acute anoxia
▫ HELLP syndrome
Pathophysiology
• Abnormal response of the normal clotting cascade
stimulated by a disease process or disorder
• Tissue factor is released at the site of tissue injury
• Abundant intravascular thrombin produced
• Fibrinogen conversion to fibrin breaking down
newly formed clots=creating fibrin-split =inhibit
normal blood clotting
• Blood loses ability to form a stable clot at injury sites
leading to hemorrhage
• Depression of clotting inhibitory mechanisms
▫ Anti-thrombin III, and protein C
Clinical Manifestations
• Bleeding in a person with no
• Respiratory
previous history or obvious
cause ▫ Tachypnea, dyspnea,
▫ Petechiae, oozing blood, pulmonary embolus, ARDs
tachypnea, hemoptysis, • Cardiac
tachycardia, hypotension, ▫ Ekg changes
bloody stools, hematuria,
dizziness, headache, LOC
changes, bone and joint pain
• Thrombotic
▫ Fibrin or platelet deposit in
microvasculature
▫ Integument manifestations
 Cyanosis, ischemic tissue
necrosis, hemorrhagic
necrosis
Diagnostic Studies
• D-dimer: Elevated
• Screening Tests
▫ PT: prolonged
▫ PTT: Prolonged
▫ aPTT: Prolonged
▫ Thrombin time: Prolonged
▫ Fibrinogen: Reduced
▫ PLT’s: Reduced
• Others: Table 30-20
Interprofessional Care
• Dx quickly
• Stablize client: O2, volume replacement
• Treat underlying causative disease or problem
• CONTROL ongoing thrombosis and bleeding
• If due to malignancy: Chemotherapy
• Bleeding: Blood products while treating primary
disorder
▫ PLT’s, cryoprecipate, FFP: life-threatening
Interprofessional Care
• Findings of thrombosis
▫ Anticoagulation: Heparin or Enoxaparin (LMWH)
• Heparin: Treat DIC ONLY when the benefits
(reduce clotting) outweighs the risk (further
bleeding)
• Antithrombin III: fulminant DIC; increases risk
of bleeding
• Chronic DIC: does not respond to PO
anticoagulants, but can be controlled with long-
time heparin use
Nursing Interventions
• Early detection of bleeding & clotting: hidden
and overt
• Assess for signs of external & internal bleeding
• Protect from additional sources of bleeding
• Administer blood products as indicted
• Provide safety during administration of blood
products
• Minimize tissue damage
• Administer medications safely
Critical Rescue
• Thus the best management of sepsis and DIC is
prevention. Identify patients at greatest risk for
sepsis and DIC.
• Practice strict adherence to aseptic technique
during invasive procedures and during contact
with nonintact skin and mucous membranes.
• Teach patients and families the early
manifestations of INFECTION and when to seek
assistance.
Resources
• Chapter 22:407-407
• Lewis