Disseminated Intravascular

Coagulation (DIC)
Renee Smith DNP, EdD(C), ACNP
CDU Faculty
 DIC
 Also called consumption coagulopathy,
defibrination syndrome
 Occurs as complication of diseases &
conditions that accelerate clotting
 Accelerated clotting factors causes small
blood vessel occlusion, organ necrosis,
depletion of circulating clotting factors &
platelets & activation of the fibrinolytic
system
 DIC
 Activation of the fibrinolytic system, which
provokes severe hemorrhage
 Clotting in the microcirculation usually
affects the kidneys & extremities may
occur in brain, lungs & pituitary & adrenal
glands & GI mucosa
 Vit K deficiency, hepatic disease, &
anticoagulant therapy, may cause similar
hemorrhage
 DIC
 DIC is generally acute condition but may
chronic in cancer patients
 Prognosis depends on early detection &
treatment, severity of disease & treatment
of underlying condition or disease
 Causes
 Disorders that produce necrosis, e.g. burns,
trauma, brain tissue destruction, transplant
rejection, & hepatic necrosis
 Infection (most common e/t of DIC) including
gm neg or gm pos septicemia, viral, fungal, or
rickettsial infection, protozal infection
(falciparum malaria)
 Neoplastic disease, actue leukemia & mets CA
 Obstetric complications, abruptio placentae,
amniotic fluid embolism & retained dead fetus
 Assessment Findings
 Abnormal bleeding without accompanying history of
serious hemorrhagic disorder (petechiae, hematomas,
ecchymosis, cutaneous oozing
 Coma
 Dyspnea
 Nausea
 Oliguria
 Seizures
 Severe muscle, back & abdominal pain
 Shock
 Vomiting
 Diagnostics Test Results
 Blood tests show prolonged PT greater
than 15 secs
 Prolonged PTT greater than 60-80 secs
 Fibrinogen levels less than 150mg/dL
 Platelets less than 100,000/uL
 Fibrinogen degradation products often
greater than 100ug/ml
 Positive D dimer test specific for DIC
 Nursing Diagnoses
 Risk for fluid volume deficit
 Ineffective tissue perfusion: peripheral
 Fatigue
 Treatment
 Bedrest
 Transfusion therapy: fresh frozen plasma,
platelets, packed RBC’s
 Drug Therapy
 Anticoagulant: Heparin IV
 Interventions
 Don’t scrub bleeding areas- to prevent
clots from dislodging & causing fresh
bleeding, use pressure, cold compresses,
& topical hemostatic agents to control
bleeding
 Enforce complete bed rest during bleeding
episodes-if patient is agitated, pad the
side rails to protect him from injury
 Interventions
 Check all IV & venipuncture sites
frequently for bleeding , apply pressure to
injection sites for at least 10 mins, alert
other personnel to the patients tendancy
to hemorrhage-these measures prevent
hemorrhage
 Monitor I&O’s hourly, esp. when giving
blood products-to monitor the
effectiveness of volume replacement
 Interventions
 Watch for transfusion reactions & fluid
overload, weigh dressings & linen & record
drainage to measure the amount of blood
lost
 Weigh the patient daily, particularly in
renal involvement-to monitor for fluid
excess
 Interventions
 Watch for bleeding from the GI tract & GU
tract-to detect early signs of hemorrhage
 Measure the patients abdominal girth at
least every 4 hours & monitor closely for
signs of shock to detect intra abdominal
bleeding
 Monitor the results of serial blood studies
particularly Hct, Hgb, & coagulation
studies-to guide therapy
 Interventions
 Inform the family of the patients
appearance (IV lines, NG, bruises, dried
blood)
 Provide emotional support for the patient
& family (social worker, chaplain etc…)
 Providing support in a crisis situation
reduces the familys anxiety
 Teaching Topics
 Explaining the disorder & treatment
options to the patient & family
 Bleeding prevention