Disseminated Intravascular Coagulation Algorithm

Please review definition and pathophysiology when using the algorithm

Assess for the presence of risk factors, both major and minor or contributing:
Septicemia
Severe trauma
solid tumors and hematologic malignancies
Obstetric emergency
large aortic aneurysms or giant hemangiomas
Severe toxic or immunologic reactions (eg, transfusion reactions) or severe inflammation (eg, acute pancreatitis).
Source: http://emedicine.medscape.com/article/199627-overview#ClinicalCauses

YES NO
Are Risk
Factors
Present?
Initiate client education for Health Seeking
Behaviors:
 Teach risk factors to help client identify
rationale for early medical evaluation of
Monitor for presence of signs/ symptoms: health problems to prevent the
Life-threatening hemorrhage complication of DIC
Diffuse thrombosis o Promote safety in young adult
Occult bleeding client at greatest risk for trauma
Hemodynamic instability secondary to increased risk taking
Change in mentation behavior
NO
S/s of ARDS o Encourage pregnant women to
Oliguria seek prenatal care.
Petechiae & purpura o Follow ACS recommendations to
prevent cancer
 Teach s/s to report.

Are positive
findings present? Initiate the plan of care for a Risk for Ineffective
Therapeutic Regimen management:
 Explain course and progression of disease to client and
family.
 Discuss that DIC can be acute or chronic. And is
Potentially
frequently experienced by clients with sepsis, obstetric
unstable? Stable? emergencies and malignanc y.
 Acute DIC is a medical emergency that requires critical
care intervention while chronic DIC can be managed as
an outpatient.
Follow collaborative plan of care PC:
 DIC is diagnosed by evaluating the DIC score of a
Hemorrhagic shock
coagulopathy panel that includes platelets, fibrinogen,
FDP, PT/PTT, CBC, Fibrinogen
See plan of care for acute arterial thrombosis,
 Acute DIC is managed through treatment of the
critical limb ischemia, acute renal failure,
underlying cause and supportive care, anticoagulants,
cardiac tamponade, intracranial hemorrhage
antithrombotics, activated protein C (APC), and
antifibrinolytics while chronic DIC is managed with
antiplatelets.
 Teach client complications of disorder

Susan McCabe revised 10/1/08

 Collaborative Problem
OUTCOMES/BENCHMARKS:
A & O X 3, RR 12-20, eupneic, pulse oximetry > 90-95%, lungs clear
HR: 60-100 no dysrhythmia, chest pain fee, 100 <SBP < 140, no s/s of frank or occult bleeding,
platelets > 100, PT/PTT WNL, urine output > 30 ml/hr

Potential Complication: Hemorrhagic shock/MODS secondary to DIC

ASSESS s/s of DIC: Monitor for presence of the disorder

Life-threatening hemorrhage
Diffuse thrombosis/gangrenous digits Initiate ACLS monitoring; monitor for tachypnea,
Occult bleeding hypotension, and tachycardia
Hemodynamic instability Monitor Pulse oximetry to identify desaturation, & if present
evaluate ABGs for acidosis
Change in mentation
Initiate cardiac monitoring to identify compensatory
S/s of ARDS tachycardia and dysrhythmia
Oliguria Initiate neurochecks to indentify ICH
Petechiae & purpura Mon results of coagulopathy study: Platelets < 50-100,
increased FDP, prolonged PT/PTT and decreased
Assess for high risk populations fibrinogen
Septicemia Monitor CBC for decreased Hg & HCT
Severe trauma Monitor LFTs for hepatic dysfunction
solid tumors and hematologic malignancies Monitor results of chest x-ray and echocardiography to
Obstetric emergency evaluate for ARDS, cardiac tamponade, hemothorax
large aortic aneurysms or giant Monitor CT head for hemorrhagic stroke
hemangiomas Monitor BMP for elevations in serum creatinine and
Severe toxic or immunologic reactions (eg, calculate GFR
transfusion reactions) or severe Monitor urine output >30 ml/hr
inflammation (eg, acute pancreatitis). Monitor ultrasound in obstetric client

Potential Complication: Hemorrhagic shock/MODS secondary to DIC

DO CALL
Initiate actions to promote hemostasis and prevent
thrombosis Evaluate for the presence of refractory hypoxemia,
Initiate oxygen therapy and titrate to maintain pulse oliguria, hepatic failure, worsening chest pain, neuro
oximetry >90-95% deficits, hemorrhage, hemodynamic instability and
Prepare to intubate of client develops impaired signs of MODS
consciousness and hypoxemia Initiate ACLS protocol and shock management, call the
Establish IV access & initiate fluid resuscitation ready response team and MD
Administer anticoagulation therapy according to hospital
protocol in cases with obvious thromboembolic
disease or where fibrin deposition predominates
Administer Antithrombin III IV as ordered
Administer antifibrinolytics such as amicar if ordered
Administer IV fluids and vasoactive agents as prescribed
according to results of hemodynamic monitoring
Administer PRBS & blood products as ordered & monitor
for reaction
Apply sequential TEDS as ordered
Treat the underlying cause
Antibiotics for sepsis and Drotrecogin alfa-activated
(Xigris) in severe sepsis, surgical intervention for trauma,
etcHematology consult
Performs nursing actions to minimize complications
of an exacerbation of the disorder
Initiate bleeding precautions
Implement ventilator bundle if intubated
Complications of immobility

Susan McCabe revised 10/1/08

DIC score:
Source: http://emedicine.medscape.com/article/779097-diagnosis

Does the patient have an underlying disorder (eg, sepsis, trauma, obstetric emergency)
Risk assessment
compatible with DIC?

Platelet count
Laboratory coagulation D-dimer and FDPs
tests Fibrinogen
PT and aPTT

Platelet count: >100 = 0 points, <100 = 1 point, <50 = 2 points

Elevated fibrin marker: No elevation = 0 points, moderate increase = 2 points, strong
Scoring increase = 3 points
Prolonged PT: <3 sec = 0 points, >3 <6 = 1 point, >6 = 2 points
Fibrinogen level: >1 g/L = 0 points, <1 = 1 point

Greater than or equal to 5 = compatible with overt DIC, repeat scoring daily
Calculate score
Less than 5 suggestive of non-overt DIC

Susan McCabe revised 10/1/08