What is a supportive treatment for a client with disseminated intravascular coagulation?
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Disseminated intravascular coagulation, or DIC, is a complicated condition that can occur when someone has severe sepsis or septic shock. Both blood clotting and difficulty with clotting may occur, causing a vicious cycle. Small blood clots can develop throughout your bloodstream, especially in the microscopic blood vessels called capillaries, blocking the blood flow to many parts of your body, including your limbs and your organs. This blood flow brings oxygen and nutrients to the tissues. On the reverse side of the cycle, DIC can increase bleeding. The body uses up so many of the blood clotting proteins for the multiple blood clots in the blood vessels that there are not enough left to clot the blood elsewhere. Show
Several medical conditions can cause DIC, including sepsis. DIC affects about 35% of patients who have sepsis. Sometimes incorrectly called blood poisoning, sepsis is the body’s life-threatening response to infection. Sepsis and septic shock can result from an infection anywhere in the body, such as pneumonia, influenza, or urinary tract infections. Like strokes or heart attacks, sepsis is a medical emergency that requires rapid diagnosis and treatment. Worldwide, one-third of people who develop sepsis die. Many who do survive are left with life-changing effects, such as post-traumatic stress disorder (PTSD), chronic pain and fatigue, organ dysfunction (organs don’t work properly), and/or amputations. Symptoms of DIC
Treatment of DICWhen someone has DIC caused by sepsis, the primary task is to treat the sepsis and the infection that caused it. Treating the clots is also important. Heparin, an anticoagulant, often called a blood thinner, usually dissolves clots and prevents new ones. When someone receives heparin, their blood is tested regularly for its ability to clot – whether it is clotting too quickly or not quickly enough – so the heparin dose can be adjusted as needed. A transfusion of platelets may be necessary. Platelets are a component of your blood that helps form clots. Complications from DICIf clots prevent blood from reaching parts of the body, tissue damage occurs. For example, if clots prevent blood from circulating properly to the hands or feet, the tissue may start to turn splotchy, then bluish in color (cyanotic), and then black (gangrenous) if the skin dies. Once the tissue is at this stage, it must be removed. For some people, this may be a small patch of skin or a few fingers or toes. For others, it could mean the amputation of one or more limbs. If blood isn’t effectively reaching vital organs like your kidneys, liver, or lungs, they may have trouble functioning. For example, your kidneys may not be able to filter urine effectively. When this happens, you may need dialysis. If the kidneys regain function, you may no longer need dialysis. Or, if you are having difficulty breathing because of DIC, the doctors may choose to place you on a ventilator, a machine that pushes air into your lungs, effectively breathing for you. This is removed when you can breathe again on your own. Long-term outlookThe long-term outlook for people who have DIC depends on how much damage the clots may have caused to the body’s tissues. About half of those with DIC survive, but some may live with organ dysfunction or the results of amputations. If you suspect sepsis, call 9-1-1 or go to a hospital and tell your medical professional, “I AM CONCERNED ABOUT SEPSIS.”  Would you like to share your story about sepsis or read about others who have had sepsis? Please visit Faces of Sepsis, where you will find hundreds of stories from survivors and tributes to those who died from sepsis. Suggested Citation: Sepsis Alliance. Sepsis and Disseminated Intravascular Coagulation (DIC). 2022. https://www.sepsis.org/sepsisand/disseminated-int…-coagulation-dic/ Updated February 10, 2022. Disseminated intravascular coagulation (DIC) is defined by the International Society of Thrombosis and Haemostasis (ISTH) as an acquired syndrome characterized by the intravascular activation of coagulation without a specific localization and arising from different causes. It can originate from and cause damage to the microvasculature; if the damage is sufficiently severe, organ dysfunction can result. The activation of coagulation pathways results in extensive formation of intravascular fibrin, especially in small and midsize vessels. In addition to this fibrin formation, DIC is characterized by excessive thrombin generation with widespread microvascular thrombosis, which can lead to multiorgan ischemia and consumption of platelets and coagulation factors. Additionally, cross-talk via cytokines promotes activation of inflammatory and complement activation pathways. DIC is associated with numerous illnesses and conditions such as sepsis and trauma. Diagnosis of DIC involves a combination of laboratory tests and clinical evaluation. Laboratory findings suggestive of DIC include a low platelet count, elevated D-dimer concentration, decreased fibrinogen concentration, and prolongation of clotting times such as prothrombin time (PT). Indications for TestingLaboratory testing for DIC is appropriate in patients with bleeding or microthrombi in combination with an associated DIC risk factor, including sepsis, obstetric disease, malignancy, and liver disease. Criteria for DiagnosisOvert Disseminated Intravascular CoagulationThe ISTH has developed a scoring system to aid in the diagnosis of overt DIC using laboratory testing results. This scoring system is appropriate for patients with an underlying disorder known to be associated with DIC. A score of ≥5 is compatible with overt DIC. Repeat testing is important to monitor the dynamic progression of DIC. ISTH Overt DIC Scoring System
Nonovert Disseminated Intravascular CoagulationThere are also nonovert (chronic) forms of DIC that have more subtle coagulopathy. The nonovert DIC scoring system described below is appropriate for patients with an underlying disorder known to be associated with DIC; use repeat testing to determine a patient’s evolving score.
Laboratory TestingPlateletsLow platelet count is a key laboratory finding in DIC; however, it is not a specific feature of DIC and may be seen in other conditions. Moderate to low thrombocytopenia (platelet count of 50-100 k/µL) is observed in the majority of patients with DIC, although severe thrombocytopenia (platelet count of <50 k/µL) may also occur. In the early stages of DIC, or when there is significant acute phasing of platelets due to illness, the platelet count may be normal. D-DimerD-dimer is a product of the plasmin degradation of fibrin cross-linked by factor XIIIa (FXIIIa); D-dimer is only produced if thrombin, FXIIIa, and plasmin are active. D-dimer measurement is the best single laboratory test for DIC diagnosis but is not used in isolation. D-dimer concentrations are increased in patients with overt and nonovert (chronic) DIC; however, D-dimer elevation may also occur with trauma, venous thromboembolism, or other conditions. In these conditions, the elevations are usually milder than those seen in DIC. A normal D-dimer level has excellent negative predictive value and generally excludes a diagnosis of DIC. Repeated, sequential measurement of D-dimer concentrations, to capture evolving illness, may provide additional diagnostic information in patients when there is a high clinical suspicion for DIC but the initial D-dimer value is normal or not elevated to the DIC range. FibrinogenFibrinogen is an acute phase reactant and, despite its ongoing consumption, can remain at normal concentrations for a long time after DIC onset. Repeated, sequential measurement of fibrinogen concentrations may provide additional diagnostic information. Fibrinogen remains a component of the ISTH scoring system and can contribute to the overall clinicopathologic picture. Clotting TimesBecause of the consumption of coagulation factors, PT and activated partial thromboplastin time (aPTT) are prolonged in most cases of DIC , although normal or shortened PT and aPTT may also be observed in patients with DIC because of circulating activated clotting factors early in the course of DIC or in chronic DIC. The ISTH scoring system includes evaluation of PT prolongation. Clotting times may also be prolonged in the presence of anticoagulant drugs. Refer to Impacts of Common Anticoagulants on Coagulation Testing for possible interferences with coagulation assays based on the specific drug administered. Which treatment is most appropriate for patients with DIC?Treatment of underlying conditions is recommended in three types of DIC, with the exception of massive bleeding. Blood transfusions are recommended in patients with the bleeding and massive bleeding types of DIC. Meanwhile, treatment with heparin is recommended in those with the non-symptomatic type of DIC.
What is disseminated intravascular coagulation and how is it treated?Disseminated intravascular coagulation (DIC) is a rare but serious condition that causes abnormal blood clotting throughout the body's blood vessels. You may develop DIC if you have an infection or injury that affects the body's normal blood clotting process.
What does the nursing management of a patient with DIC include?The following are the common nursing care planning and goals for clients with DIC: maintenance of hemodynamic status, maintenance of intact skin and oral mucosa, maintenance of fluid balance, maintenance of tissue perfusion, prevention of complications.
What is the priority nursing action when caring for a client with disseminated intravascular coagulation?Definitive treatment of DIC focuses on addressing the underlying cause, when possible. Okay, let's look at the nursing care you'll provide for a client with DIC. Your priorities of care are to decrease bleeding, monitor for abnormal clotting, and address the underlying cause.
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