Everything RTs need to know about DIC

Tuesday is the day I'm setting aside to review things we learned in respiratory school but could stand a little review. Also, we will look into expanding our medical knowledge above and beyond what we are expected to know.

I will call these RT Wisdoms, and you can link to these posts at your convenience by clicking on the link RT Wisdoms near the top of this blog.

Today we will discuss DIC.

I worked a bunch of years in the hospital before I had a clue what DIC was. Of course I remember having patients in the critical care, most of them on ventilators, who seemed to be seeping fluid out their pores. But, considering it wasn't respiratory, I didn't think anything of it.

Then one day I remember one of our senior RTs told me in report she told the nurses to keep a particular close watch on this trauma patient because he was at high risk for DIC and ARDS, and I had no clue how she knew this. I knew what ARDS was, but how do you know someone is going to go into ARDS? And, what the heck is DIC?

I decided long ago I needed to educate myself, and make myself a more rounded RT. Which is nice, because instead of going into a room and having no clue what was going on with the patient other than his respiratory status, I was more focused on the Big Picture. And, as we learn in RT school, every organ can effect breathing.

So, that in mind, what do we RTs need to know about DIC.

First of all, DIC is an acronym for Disseminated Intravascular Coagulation and is always a secondary disease, or a consequence of other diseases.

This is a disease process when the proteins in the bloodstream that normally cause clotting in an injured area overreact, and form tiny clots all over the body, and then, clotting factors now exhausted, this causes the patient to bleed abnormally.

When you do an ABG, for example, you might hold the site for the recommended five minutes and the patient still has not stopped bleeding. Usually, when this happens, the RN will have to wrap gause around the puncture site and bind tape around the patients arm to act like a turniquate. I've seen this done on many occasions.

Technically speaking, on these patients, a doctor will want to limit the number of blood draws (ABGs included), because of the complication of bleeding. Another thing for us RTs to remember is to be very careful when suctioning. Ideally (and I think this should be standard procedure anyway), the catheter should not be advanced all the way to the corina so as not to puncture it and cause it to bleed.

In severe cases, the patient will seep ooze right out of the pores on his skin. This can be quite disgusting. But I've seen it quite a few times.

DIC can also cause sudden bruising, clotting, and, as I described, bleeding from multiply parts of the body, and can lead to severe bleeding, stroke, and lack of blood flow to arms, legs and organs.

How do you know what patients are at high risk for this disease process? Take note of the following:

1. Infection in blood (Sepsis, and I covered this in a previous post.)


2. Severe tissue injury, as in burns, trauma (particularly trauma to the head and brain)


3. Recent surgery or anesthesia


4. Reaction to transfusions


5. Labor and delivery problems


6. Liver disease

Trauma patients not only are at risk for getting DIC, but also Sepsis. And sepsis in itself is primary cause of DIC in the hospital setting. And, DIC may lead to acute renal failure and, ultimately, to miltiple organ failure -- including the lungs.

This is why it's also a good idea to do a thorough review of the chart, particularly lab results. The following are some lab results that might show DIC:

1. PTT: According to Medline Plus this is a test to determine how long it takes for the blood to clot. If a patient is on a blood thinner like coumadin the PTT may be therapeutically high. A high PTT is anything greater than 33, and >60 is considered critical, and may be indicative of DIC.


2. PT: Same as PTT, except for the the high value is >12.7 and >40 is critical


3. D-Dimer: >500 may be indicative of acute bleed, but can also indicative of PE and DVT.


4. Platelets: <80,000>


5. INR: >1.2 is considered high, but >6 is critical. This is indicative of DIC or acute bleed.

Now, keep in mind these critical values will vary from hospital to hospital, but at least this gives you an idea of what critical is, and what the labs of a patient in DIC might look like.

Also, you should know that there is a lot more involved in the DIC process than what I describe here, but this is pretty much all that an RT really needs to know about DIC. Now you can put this wisdom to good use and impress someone the next time you find one of these patients.

That concludes today's class.