Embolism Nursing Management

EMBOLISM

Embolus is a fragment of thrombus or a thrombus/that has broken away from the point of formation.

Embolism: occurs when an embolus moving through a blood vessel arrives at a narrowing of the vessel and thus occludes it.

Types of embolism

Air embolism: A bubble of air in the bloodstream caused during tubing changes due to negative intrathoracic air sucked in during inspiration will administering intravenous infusion.

Fat embolism: Multiple droplets of fat in the bloodstream occurs usually after severe multiple injuries, particularly, in the tong bones.

Arterial embolism: Arterial emboli arise from thrombi that develop in the chambers of the heart as a result of atrial fibrillation, myocardial infarction, infective endocarditis, or congestive cardiac failure.

Cerebral embolism: The embolus usually lodges in the middle cerebral artery or its branches, where it disrupts the cerebral circulation.

Pulmonary embolism: Where the clot is carried to the heart it is forced by the blood into the pulmonary, where it plugs the main artery or one of its branches.

Obstruction of one or more pulmonary arteries by a thrombus.

Clinical Manifestations

Dyspnoea, sudden substernal pain, rapid and weak pulse, shock, syncope and sudden death.

Diagnosis

1. Arterial blood gas systemic arterial hypoxemia is found. Radioisotope lung scans.

2. Pulmonary angiogram.

3. ECG-shows right heart strain.

4. Chest X-ray - shows patches of pneumonia enlargement of central pulmonary arteries.

Medical Management

1. Thrombolytic therapy (Urokinase, streptokinase) dissolves the thrombi in the deep veins and pulmonary circulation. After thrombolytic infusion, the patient is placed on anticoagulants e.g. Heparin.

2. Oxygen therapy corrects hypoxia, relieves pulmonary vascular vasoconstriction and reduce pulmonary hypertension

3. Elastic stockings: compresses the superficial veins and increases the velocity of deep venous blood by redirecting the blood through the deep veins.

4. Leg elevation: increases venous flow.

Surgical Management

If patient has persistent hypotension, shock and respiratory distress, elevated pulmonary artery pressure and large obstructions embolectomy is induced, This requires thoracotomy with cardiopulmonary bypass technique.

Total ligation or use of Teflon clips: applied to the vena cava - divide the caval lumen into small channels without occluding caval blood flow.

Insertion of a prosthetic umbrella device filter blood through IVC and prevents recurrent pulmonary embolism. [Through a cervical incision in the int. jugular vein. The device is adv. Through SVC and right atrium into IVC.

Transvenous catheter embolectomy [vacuum cupped catheter introduced transvenously into the affected pulmonary artery. Suction is applied to the end of the embolus and the emboli is aspirated into the cup. Entire catheter is withdrawn through the right side of the hearts and out the femoral venotomy. An inferior caval filter is inserted to protect against recurrence.