DEFINITION:

DIC is not a disease but a sign of an underlying condition that may be triggered by sepsis,
trauma, cancer, shock, abruptio placentae, toxins, or allergic reactions. It is potentially life-
threatening.

RISK FACTORS:
▪ Sepsis
▪ Obstetric complications
▪ Acute haemolysis (e.g., transfusion reaction)
▪ Trauma
▪ Shock
▪ Cancer (especially prostate cancer and acute promyelocytic leukaemia)
▪ Allergic reactions

PATHOPHYSIOLOGY:
Altered Haemostatic Mechanism

Formation of tiny clots in the microcirculation

Consumption of platelets and clotting factors to form microthrombi

Coagulation failure

Paradoxical bleeding/Ischaemia

Organ Dysfunction

DEATH
CLINICAL MANIFESTATIONS:

DIAGNOSTIC TESTS:
Blood Tests: Low platelet and fibrinogen levels; prolonged PT, PTT, and thrombin time; and
elevated fibrin degradation products (D-dimers).

MEDICAL MANAGEMENT:
❖ Treat The Underlying Cause of the DIC.
❖ Correct The Secondary Effects of Tissue Ischemia by Improving Oxygenation,
Replacing Fluids, Correcting Electrolyte Imbalances, And Administering Vasopressor
Medications.
❖ Cryoprecipitate is given to replace fibrinogen and factors V and VII.
❖ Fresh frozen plasma is administered to replace other coagulation factors.
❖ A controversial method to interrupt the thrombosis process is the use of heparin infusion.

NURSING MANAGEMENT:
Assessment:
❖ Nurses need to be aware of patients who are at risk for DIC.
❖ Sepsis and acute promyelocytic leukaemia are the most common causes of DIC.
 ❖ Patients need to be assessed thoroughly and frequently for signs and symptoms of
thrombi and bleeding and monitored for any progression of these signs.

Goals:
I. Maintenance Of Hemodynamic Status
II. Maintenance Of Intact Skin and Oral Mucosa
III. Maintenance Of Fluid Balance
IV. Maintenance Of Tissue Perfusion
V. Enhanced Coping
VI. Absence Of Complications

Diagnosis:
• Risk for deficient fluid volume related to bleeding
1. Avoid procedures/activities that can increase intracranial pressure (e.g., coughing,
straining to have a bowel movement).
2. Monitor vital signs closely, including neurologic checks:
▪ Monitor hemodynamic
▪ Monitor abdominal girth
▪ Monitor urine output
3. Avoid medications that interfere with platelet function if possible (eg, ASA,
NSAIDs, beta-lactam antibiotics).
4. Avoid rectal probes, rectal medications.
5. Avoid IM injections.
6. Monitor amount of external bleeding carefully
7. Use low pressure with any suctioning needed.
8. Administer oral hygiene carefully.
9. Avoid dislodging any clots, including those around IV sites and injection sites.

• Risk for impaired skin integrity related to ischemia or bleeding

a. Assess skin, with particular attention to bony prominences, skin folds.
b. Reposition carefully; use pressure-reducing mattress.
c. Perform careful skin care every 2 hr, emphasizing dependent areas, all bony
prominences, perineum.
d. Use lamb’s wool between digits, around ears, as needed.
e. Use prolonged pressure after injection or procedure when such measures must be
performed (at least 5 min)
f. Administer oral hygiene carefully.

• Potential for excess fluid volume related to excessive blood/ factor component
replacement
a. Auscultate breath sounds every 2–4 hr.
 b. Monitor extent of oedema
c. Monitor volume of IVs, blood products; decrease volume of IV medications if
possible.
d. Administer diuretics as prescribed.

• Ineffective tissue perfusion related to microthrombi

1. Assess neurologic, pulmonary, integumentary systems.
2. Monitor response to heparin therapy.
3. Assess extent of bleeding.
4. Monitor fibrinogen levels.
• Anxiety and fear of the unknown and possible death
1. Identify previous coping mechanisms, if possible: Encourage patient to use them as
appropriate.
2. Explain all procedures and rationale for these in terms patient and family can
understand.
3. Assist family in supporting patient.

COMPLICATIONS:
• Renal failure
• Gangrene
• Pulmonary embolism or haemorrhage
• Altered level of consciousness
• Acute respiratory distress syndrome
• Stroke