A nurse is caring for a client who had a percutaneous insertion of an inferior vena cava filter and was on heparin therapy before surgery. The nurse would inspect the surgical site most closely for signs of:
A. Thrombosis and infection
B. Bleeding and infection
C. Bleeding and wound dehiscence.
D. Wound dehiscence and evisceration.
Correct Answer: B. Bleeding and infection
After inferior vena cava insertion, the nurse inspects the surgical site for bleeding and signs and symptoms of infection. Otherwise, care is the same as for any post-op client. During the vascular access for IVC filter insertion, bleeding and thrombosis are the most common complications. Other complications that can occur during this time include filter tilt (angulation of more than 15 degrees along the longitudinal axis of IVC), filter migration (change in position of the filter by more than 2 cm) or operator error (filter placement in the inaccurate location or incorrect orientation); these can result in a difficult to retrieve as well as an ineffective IVC filter.
Option A: IVC thrombosis can occur, resulting in pain and edema of bilateral lower extremities; this can also result in an increased risk of a pulmonary embolism due to the thrombus extending above the filter and embolizing to the lungs.
Option C: There is a possibility of inferior vena cava penetration by the IVC filter. Hooks were added to the filters to decrease the incidence of filter migration, but this has shown to increase inferior vena cava perforation rates significantly.
Option D: The longer the time that the filter remains in place, the greater the rate of complications during retrieval. Some of the most commonly noted complications during filter retrieval include fracture and IVC injury (e.g., dissection). Thus removal of IVC filter as soon as it is no longer needed is highly recommended.
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