Tender loving care of patient with DVT after IVF (in vitro fertilization)

P. Revathy1,*, K. Brindha2

1Emergency Ward Incharge, KauveryHeartcity, Trichy, India

2Emergency Ward Staff Nurse, KauveryHeartcity, Trichy, India

*Correspondence: Tel: +91 8508698000; Email: nursing.heartcity@kauveryhospital.com

Abstract

A 30-year-old woman who received IVF treatment in an outpatient setting arrived at our cardiac department with leg pain for 7 days. Based on the rapid evaluation, the patient was diagnosed with deep vein thrombosis. Prompt treatment saved the patient’s life.

Abbreviations:

in vitro

fertilization (IVF), last menstrual period (LMP), expected date of delivery (EDD)

Definition

IVF is a complex series of procedures used to promote fertility and conceive a child. During IVF, mature eggs are collected from the ovaries, and fertilized with sperm in the laboratory. The fertilized egg (embryo) or eggs (embryos) are then transferred to the uterus. One complete IVF cycle lasts about three weeks. Sometimes these steps slip into different parts and the process can take longer.

IVF is the most effective form of reproductive technology. It may use eggs, sperm or embryos from a known or anonymous donor. In some cases, someone, a surrogate mother, may have an embryo implanted in her uterus and proceed to pregnancy.

In vitro fertilization is a treatment for infertility. IVF may include fertility drugs to increase eggs, or intrauterine insemination, a procedure in which sperm is placed directly into the uterus near ovulation.  In vitro fertilization is offered as a primary infertility treatment for women over 40 years of age. IVF can also be done if people have a certain medical condition.

The common problems are,

  1. Fallopian tube damage or blockage
  2. Ovulation disorder
  3. Endometriosis
  4. Uterine fibroids
  5. Prior tubal sterilization or removal.
  6.  Impaired sperm production or function
  7. Unexplained infertility
  8. Genetic disorder
  9. Fertility preservation due to cancer or other health conditions.

DVT

Deep vein thrombosis occurs when a blood clot forms in one or more of the body’s deep veins, usually in the legs, Deep vein thrombosis can cause leg pain or swelling.

Risk factors of DVT

  1. Age
  2. Lack of movement
  3. Injury or surgery
  4. Pregnancy
  5. Birth control pills
  6. Being overweight or obese

Case Presentation

A 30-year-old euglycemic, normotensive female patient came with the complaints of left leg pain for 7 days, with reduced physical activity. She got initial treatment at Emergency Department and was shifted to ward for further management.

On examination, she was conscious and oriented.

Temperature -98.6, Heart Rate -86 b/m, Blood Pressure -110\70 mm/hg, Respiratory Rate-20b\m

Her marriage was first degree consanguinity, in the year 2015.  She had undergone IVF treatment and was resting at her home for 50 days. Her LMP was 28.1.2023 and EDD was expected on 4.11. 2023. There is no previous surgical history.

Her investigation finding were,

  1. ECG: Ischemic changes
  2. ECHO: mild LV dysfunction
  3. VENOUS DOPPER: ACUTE DEEP VEIN THROMBOSIS involving common saphenous vein, external iliac vein, common femoral vein and superficial femoral vein.

Scan Report

Venous Doppler Report

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Immediate Care

  1. The patient was stabilized initially at the casualty.
  2. T. Ecosprin 75 mg, T. Dexona 0.5 mg, Inj. Clexane 60 mg were given as ordered by the consultant.
  3. A general assessment was made from head to toe.
  4. We assessed vital functions and the pain score was 6/10.
  5. The patient’s condition was explained to the patient’s attenders and consent was obtained for further treatment.
  6. IV fluids started immediately.
  7. The patient took her medication, which her obstetrician had prescribed (Cap. Sustain 200 mg, Tab. Folvite 5 mg, Tab. Iron XT, Syp. Sucrafil 15 ml).

Nursing Interventions

The most important nursing actions carried out by the nurses were as follows:

1. Provide comfort

  1. Elevation of the affected limb; both the limbs were elevated.
  2. Graduated compression stockings were applied.
  3. Active and passive movements were recommended to eliminate and to reduce discomfort.

2. Compression therapy

Compression stockings were applied. Stockings are made in stages that reduce the caliber of the superficial veins of the leg and increase the flow in the deep veins. External compression devices and wraps are short stretch elastic wraps applied from toes to knees with 50% spiral overlap. Intermittent pneumatic compression devices increase blood velocity more than stockings.

3. Position and exercise

Active exercises were done by the patient to improve circulation. Active & passive leg exercises should be performed to increase venous flow, in case if the patient is bedridden, the legs and lower legs should be periodically raised above the level of the heart.

Nursing care provided:

  1. Patient was shifted to ward for further close monitoring.
  2. Vital signs were constantly monitored and intake and output are maintained
  3. Basic blood investigations were done. Investigations included CBC, ESR, sodium, potassium, RFT and blood group and typing.
  4. Nurses followed AIDET techniques (knowledge, introduction, duration, explanation and thanks) of communication with patients and participants to gain their trust and improve the statistical level.
  5. Both limbs were elevated.
  6. Stockings were applied and advised to follow the same after her discharge.
  7. We advised her to take a normal diet
  8. Apart from all this care, patient was emotionally very much disturbed and was scared. We nurses talked to her and supporedt her psychologically throughout her hospital stay. Patient was much overwhelmed.
  9. Patient got discharged on 7.3.2023 with good hemodynamically status.
  10. The advised discharged medications are
    1. Inj. Clexane 60 mg 1-0-1(9AM/9PM)
    2. Tab.Ecosprin 75 mg 0-1-0(After Food)
    3. Cap.Susten 200mg 1-0-1(Vaginal)
    4. Tab.Shelcal  0-1-0
    5. Tab.Folvite 5mg 1-0-0
    6. Tab. Dexona 0.5 mg 0-0-1
    7. Tab.Iron XT 1-0-0
    8. Syp.Sucrafil 15 ML 1- 1-1
  11. We scheduled her review after 2 weeks from the discharge date and she was advised to follow all the instructions at her home as well.

Outcome

The patient returned home happy. The family appreciated we saving the mother and baby who would be  treasured  for many years . The joy seen on their face still stands before our eyes.

Discussion

The patient received the most appropriate treatment at the right time with symptoms of symptomatic bilateral leg pain

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Ms. P. Revathy

Emergency Ward Incharge

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