Have you ever heard of Disseminated Intravascular Coagulation (DIC)? If not, don’t worry—you’re certainly not alone. DIC is a complex medical condition, and it can be challenging to understand how this disorder works and the potential impacts it can have on people.
In this blog post, we will explore what DIC is precise, its associated symptoms, and how to manage its symptoms better if you or somebody close to you has been diagnosed with DIC. We want every one with this condition to have access to knowledge that could help make their lives more manageable in these challenging times.
Table of Contents
Definition OF (DIC) Nursing
DIC is a medical condition in which the blood starts to clot excessively and abnormally throughout the body. This causes an increase in blood clotting factors, leading to blocked blood vessels that reduce the amount of oxygen and nutrients delivered throughout the body. When this condition progresses, it can cause widespread organ damage.
DIC progresses through two stages: overactive clotting followed by bleeding.
In stage one, excessive clotting is caused by an accumulation of different blood clotting factors, leading to blockages in the tiny blood vessels. This can lead to decreased oxygen and nutrients throughout the body, resulting in organ damage.
In stage two, these clots can break up and cause excessive bleeding that cannot be easily stopped. As DIC progresses, the bleeding can become more severe and cause further organ damage.
Symptoms OF DIC
The symptoms of DIC can vary greatly depending on which stage the patient is in: overactive clotting or excessive bleeding. Some of the most common symptoms include:
• Nausea and vomiting
• Pain or tenderness in the chest, abdomen, or arms
• Pale skin
• Easy bruising
• Shortness of breath
• Decreased urination
• Swelling in the extremities
The underlying cause of DIC can vary greatly, but an infection or injury usually triggers it. Examples of conditions that could lead to the development of DIC include:
• Blood cancer
• Bone marrow disorders
• Autoimmune disorders
• Severe trauma or burns
• Some major surgeries
• Pregnancy complications
• Snake and spider bites
It is also possible for DIC to develop spontaneously (without a known cause).
How do you ASSESS the DIC patient?
1-Skin assessment: Perform an extensive skin assessment to identify petechiae, bruises, swelling, and tenderness. Don’t forget to examine the oral mucosa for discoloration or any other signs of abnormal bleeding.
2-Top to Toe: Conduct a thorough head-to-toe review to detect any symptoms associated with DIC.
3-GU: Inspect the urinary system for traces of blood in the urine. If the patient is a menstruating woman, inquire about her last menstrual period and any irregularities such as heavier than usual flow, abnormal consistency of discharge or presence of clots.
3-GU: In the gastrointestinal (GI) system, look for signs of blood in the stool and perform an occult stool test to detect any invisible traces of blood.
4-Cardiac Assess the patient’s cardiac system for chest pain and use an electrocardiogram (ECG) to detect changes in heartbeat rhythm which could be caused by clotting.
5-Neuro: Check for neurological symptoms such as one-sided deficits, facial droop, double or blurry vision, headaches, slurred speech, and decreased LOC, which could indicate an ischemic or hemorrhagic stroke due to the advanced stages of DIC.
6- Respiratory-Observe the patient’s respiratory system for evidence of shortness of breath, labored breathing, and decreased oxygen saturation levels, as these may point to a pulmonary embolism.
7-Vascular: Examine the limbs for signs of blood clotting, such as coolness, loss of sensation, and discoloration, which may all lead to permanent damage, dysfunction, or even complete limb loss if not treated promptly.
Additionally, ask the patient if they’ve had any recent falls or traumas and focus on assessing the affected area for signs of bruising, bleeding, and pain.
Managing DIC at Home
It is essential to understand that managing the symptoms of DIC is not easy and should be done under medical supervision. Some tips for better managing DIC at home include:
• Eating a balanced diet rich in vitamins and minerals
• Keeping an eye out for any signs of excessive bleeding
• Avoiding any activities that could lead to injury or further clotting
• Taking medications as prescribed by your doctor
• Keeping a regular check-up schedule with your doctor
• Staying hydrated and getting enough rest.
People diagnosed with DIC can also benefit from support services such as counseling or support groups. These services can provide an outlet for those struggling with the condition and help them learn how to manage their symptoms better.
What TESTS will be ordered?
Lab tests for DIC screening and testing can include:
1-Platelets – decreased
2-Fibrinogen – decreased
3-D-dimer – increased
4-PT/INR – prolonged
5-Activated Partial Thromboplastin Time (APTT) – prolonged
6– Thrombin time (TT) – Prolonged
7– FDPs, fibrin degradation products – increased
8– ESR, erythrocyte sedimentation rate – increased
9-Blood cultures – to determine the presence of an infection that could be causing DIC
10 – A complete blood count (CBC) – to look at the levels of red and white blood cells and platelets.
How is DIC diagnosed?
DIC diagnoses are based on medical history, physical exams, and tests. The underlying cause must be identified, as DIC does not occur alone.
Medical History & Physical Exam
To diagnose DIC, your doctor will ask about any medical conditions or recent events that could be causing it or are risk factors. During the physical exam, your doctor will look for symptoms of blood clots, bleeding, or a condition that could be causing DIC or its complications.
If DIC is suspected, your doctor may order several blood tests. The results can be used in a scoring system to determine if you have DIC. Sometimes, additional tests may be required, and your condition may be monitored over time.
Tests for Other Medical Conditions
To confirm the cause, your doctor may suggest further tests or procedures. These could include
- ADAMTS13 testing to check blood levels of a protein that can be low in thrombotic thrombocytopenic purpura, or
- A liver biopsy to test for cirrhosis or chronic liver disease with similar symptoms.
How is Disseminated Intravascular Coagulation Treated?
The best way to treat disseminated intravascular coagulation (DIC) depends on its severity level and the root cause. DIC treatment’s primary objectives are to manage bleeding and clotting issues and address the underlying cause.
Chronic Disseminated Intravascular Coagulation
Treatment will depend on the severity of the symptoms and involve controlling clotting and bleeding and treating the underlying cause. Blood thinners (anticoagulants) can be given as pills, injections, or IVs to reduce clotting.
Acute Disseminated Intravascular Coagulation
Procedures and therapies
Other treatments may include:
- Clotting factor replacement therapy
- Plasma transfusion
- Platelet transfusion
- oxygen therapy. (Oxygen is given through nasal prongs, a mask, or a breathing tube.)
Without treatment, DIC can lead to severe complications such as
- ARDS (acute respiratory distress syndrome)
- Gastrointestinal bleeding
- Heart attack
- Stroke, or venous thromboembolism.
Therefore it is essential to treat the condition to avoid these potentially life-threatening outcomes.
DIC Nursing Interventions
Nurses play an essential role in managing DIC. Their interventions include:
1-Assess and monitor respiratory status; take note of the rate, rhythm, and presence of cyanosis; listen to the lungs for any areas where the air is not moving.
In acute and chronic DIC, blood clots can form or travel to the lungs, resulting in embolism, evidenced by shortness of breath, cyanosis, and chest pain.
2-Evaluate and monitor cardiac health; obtain an ECG if indicated.
Tachycardia, changes in blood pressure, and reduced capillary refill are signs of deteriorating cardiovascular function.
3-Assess changes in the level of consciousness.
Early signs of hypoxia include confusion and irritability; also, watch for any indications of stroke since blood clots may travel to the brain.
4–Administer oxygen as needed; check Arterial Blood Gas (ABG) and oxygen saturation levels.
For optimal tissue perfusion, oxygen saturation must remain 90% or higher.
5-Provide wound care and pressure for external bleeding due to procedures such as venipuncture and IV access.
Apply extra pressure to help to clot, above and beyond what is expected.
6-Observe the amount and color of urine; decreased perfusion to the kidneys can cause hematuria and decreased urination (output below 30 mL/hr).
7-Monitor for blood in stool; administer stool softeners to avoid straining during bowel movements.
Dark blood in the stool may indicate a gastrointestinal bleed, while bright red blood could be from bleeding hemorrhoids or anal fissures.
8-Observe for hemoptysis or blood in suctioning; this is a standard marker of DIC.
When suctioning secretions, note any blood present in the emesis.
9-Monitor diagnostic tests (labs):
- Platelet count- decreased
- PT / PTT- increased
- D-dimer level- markedly increased
Changes in these labs can help determine if treatment is effective.
10-Implement bleeding precautions; no razors, soft toothbrush, limit needle sticks as much as possible, limit BP readings.
11-Minimize bleeding risks from friction, injury or pressure; look out for petechiae and purpura, which can indicate DIC.
12-Administer medications and blood products as necessary; heparin may be given when clotting is more of a problem; excessive blood loss may require transfusion; antibiotics are often given to treat infection or sepsis.
These interventions can help restore balance and reduce the risk of further complications.
How do You Educate the Patient/Family?
It is essential to educate the patient and family on DIC, the treatment plan, and lifestyle changes that may be needed.
- Explain DIC’s diagnosis, symptoms, and potential complications; provide information about possible treatments and therapies.
- Talk about any lifestyle modifications that may need to be made, such as avoiding certain activities that can lead to further injury or bleeding.
- Encourage the patient to adhere to their medical plan and take medications as prescribed.
- Discuss nutrition and diet, including foods that may help reduce inflammation and clotting problems.
- Provide information on self-care practices such as exercising regularly, avoiding smoking and alcohol, and reducing stress.
- For long-term anticoagulant medication (heparin) use, provide instructions for self-injections and regular monitoring of blood tests.
- Patients prescribed long-term heparin medication need to learn about correct administration, routine lab tests, and lifestyle modifications, such as avoiding activities that could cause physical harm (e.g., contact sports).
Mrs. Marie Brown has been a registered nurse for over 25 years. She began her nursing career at a Level I Trauma Center in downtown Chicago, Illinois. There she worked in the Emergency Department and on the Surgical Intensive Care Unit. After several years, she moved to the Midwest and continued her nursing career in a critical care setting. For the last 10 years of her nursing career, Mrs. Brown worked as a flight nurse with an air ambulance service. During this time, she cared for patients throughout the United States.