Nursing management of multiple diagnoses and thrombectomy procedure

Revathy1, Vijayalakshmi2, Ranjitha3

1,2Emergency ward In charge, Kauvery Heart city, Trichy, Tamil Nadu

3Emergency Ward Senior Staff, Kauvery Heart city, Trichy, Tamil Nadu

Introduction

A Thrombectomy is an invasive, image guided procedure to remove a blood clot (thrombus) from a blood vessel using catheters and devices like stent -retrievers or aspiration. It is commonly used to treat Acute ischemic stroke caused by large artery blockage, but can also be used for deep vein thrombosis, pulmonary embolism and even acute myocardial infarction. By using catheter-based devices like stent retrievers or aspiration catheters, Thrombectomy provides an effective way to prevent serious potentially life-or limb threatening complications by quickly clearing the blockage.

Background

A 68-Year- old, with a history of diabetes and hypertension, had a domestic fall and sustained injury to right hip f. He was initially evaluated at a local hospital

While receiving in Emergency department, he was conscious and dyspneic. He was on inotropes, Inj. Dobutamine and O2 support.

CT abdomen was done, which showed comminuted fracture of right iliac bone with multiple fracture fragments with pubic diastasis and adjacent hematoma, prostatomegaly, multiple simple cysts in both kidneys and right lobe of liver.

CT chest showed bilateral minimal pleural effusion with atelectatic changes.

Orthopedic opinion obtained in view of right iliac comminuted fracture and pubic diastasis. Immediate Care.

His CT pulmonary Angiogram showed massive pulmonary embolism and shifted here for mechanical thrombectomy procedure.

On receiving to Emergency Thrombectomy. Vital signs assessed and BP (100/60 mmHg) on Inotrope support. HR-118 bpm. He was explained the high risk High risk consent was obtained. Patient shifted to Cath lab. Patient underwent pharmacomechanical thrombectomy + IVC filter placement on 09/09/2025with successful results.

There was no procedural and post procedural complication. He was transfused with 2 units of PRBC. Cardiologist opinion was obtained. His general condition gradually improved, and he was tapered off from inotropes and O2 support. He was observed and had no bleeding manifestations. He was discharged in a stable state and advised to continue his care

Nursing Management

  • To ensure that the patient received in emergency to safe timely and provide effective care nurses.
  • Monitor vital signs.
  • Nurses used AIDET technique (Acknowledge, Introduce, Duration Explanation\Thank you) while communicating with patients and attenders to gain their confidence and improve the satisfaction level.
  • Patient shifting to Cath lab with inotropic support, O2 10 liter.
  • Ortho opinion was done, advice by pelvic binder applying.
  • Then patient shifting to further management to specialty.
  • He was treated with antibiotics, anticoagulants and other support. Orthopedic review was obtained.
  • Right lilac communicated fracture pubic diastasis / vertebral compression fracture and pelvic binder immobilization for 6 weeks was advised.
  • Urologist opinion was sought for scrotal swelling and scrotal support applied.
  • He improved symptomatically hence patient was discharged.

Discharge Advice

  • Strict bed rest/waterbed
  • Bupregesic applied.
  • Chest physiotherapy

References

  • Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al; American Heart Association Stroke Council. 2018 Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.
  • Bottinor W, Polkampally P, Jovin I. Adverse reactions to iodinated contrast media. Int J Angiol. 2013
  • Brinjikji W, Demchuk AM, Murad MH, Rabinstein AA, McDonald RJ, McDonald JS, et al. Neurons over nephrons: systematic review and meta-analysis of contrast-induced nephropathy in patients with acute stroke.
  • Dencker D, Pedersen F, Engstrøm T, Køber L, Højberg S, Nielsen MB, et al. Major femoral vascular access complications after coronary diagnostic and interventional procedures: a Danish register study.

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