“Consider your patient’s diagnosis. What kind of cancer do they have? And ask yourself, ‘Could this patient be in disseminated intravascular coagulation (DIC)? Is there something more that we should be doing or looking at?’” Leslie Smith, RN, APRN-CNS, DNP, BMTCN®, AOCNS®, oncology clinical specialist at the National Institutes of Health in Bethesda, MD, told Jaime Weimer, MSN, RN, AGCNS-BC, AOCNS®, oncology clinical specialist at ONS. Smith discussed the nursing considerations for the management of DIC. This episode is part of a series about oncologic emergencies; the others are linked in the episode notes. You can earn free NCPD contact hours after listening to this episode by completing the evaluation linked below.
Music Credit: “Fireflies and Stardust” by Kevin MacLeod
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Highlights From Today’s Episode
“If the D-dimer is high, that is indicative of a clotting issue occurring. So, the next step for the nurse would be to look for the lab or ask for an order—you can order a DIC panel in some institutions—but look at coagulation labs. And really care and support these patients. DIC is not a disease in itself; it is a symptom of a disease, it is a syndrome. And it’s indicative of another problem occurring.” Timestamp (TS) 07:09
“In the chronic form, patients who live in a chronic inflammatory state—maybe from arthritis or whatever the process is—their coagulopathy will not be as severe as an acute form. They may have an elevated prothrombin time (PT) or partial thromboplastin time (PTT). Their platelets may be a little bit low and their fibrinogen may be just a little bit low, but it’s not life-threatening. And in an acute stage of DIC, it is life-threatening.” TS 08:43
“If we are taking care of patients who have received CAR T cells, for example, nurses know to monitor for cytokine release syndrome, we’re watching for fever, we’re watching the C-reactive protein levels or the ferritin levels, and we’re treating appropriately via tocilizumabs . . . preventing DIC that way. Patients who are at risk for developing sepsis. . . . watching for signs of impeding infection . . . . Those types of things can prevent DIC from occurring.” TS 12:26
“I think it can be a little bit confusing for the nurse because they’re vague symptoms. So, if you have a patient that is maybe thrombocytopenic, you could attribute, ‘Well, they have all this petechiae from their thrombocytopenia.’ It’s difficult. That’s why you need to really draw a lab. . . . It is not just one lab or one sign or symptom that will diagnosis DIC. There’s no one thing that tells you that the patient has DIC. You need to look at all the lab work to make that determination.” TS 14:15
“Nurses are going to support the patient with transfusions. . . . And this will help in an attempt to normalize the lab or at least get the factors and the platelets back up. And then treating the disease. . . . And then in addition, if the patient is infected or septic, administering the antibiotics.” TS 16:26
“DIC is often thought—especially by patients or family—that once you start that chemotherapy or the antibiotics, that the DIC will go away. That is not true. It can take days to weeks for the DIC to resolve itself. It’s not something that is going to happen overnight. The patient will need to continue to be supported.” TS 18:13
“Consider what is the diagnosis of your patient. If they have cancer, what kind of cancer do they have? And ask the question to yourself, ‘Could this patient be in DIC? Is there something more that we should be doing or looking at?’” TS 19:22
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