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Blood loss during surgery - how is it measured or controlled?

Josephine

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Certain procedures, specifically bilateral hip or knee replacement, can be said by surgeons to be ill-advised due to the risk of excessive blood loss.

So how do they assess this during an operation?
weighing swabs
measuring the fluid in suction jars
make a visual assessment of blood on the drapes​

Weighing swabs:
Swabs come in a variety of sizes and usually in packs of 5. Very large swabs (or packs as we know them!) come in singles.
Each bundle of swabs or single pack has a known dry weight
During the surgery, the swabs are collected in a receptacle by the staff assisting the surgical team, generally known as a floor nurse or runner
S/he will collect them in fives and place them on the scale. The total weight is then assessed less the dry weight and the remaining number written on a chart.
Swabs are then retained in fives or singles in some way for the swab count

swab counting.JPG


SpongeCounterBags.jpg


Suction jars

These have graduations in the bottle so staff can easily check and record blood loss
When/if it is full, the container will be changed for an empty one

The anaesthetist is experienced in eye-balling the surgical drapes at the end of the surgery and making an assessment of the blood loss there.

suction unit a.JPG
 
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Josephine

Josephine

NURSE DIRECTOR
Nurse Director
Joined
Jun 8, 2007
Messages
84,925
Age
78
Location
The North
Gender
Female
Country
United Kingdom United Kingdom
Controlling blood loss during surgery

There are ways of controlling blood loss which are part and parcel of any surgeon's technique (see illustrations below)
diathermy - using an electrical current to seal a cut blood vessel
ligation - tying a ligature or thread around the cut vessel
transfixion sutures - if the ligation won't stay put, a suture with a needle is used to go through the adjacent muscle
hot packs which will cause blood to coagulate or clot​

Diathermy
This the use of specially directed electrical current which effectively 'fries' the tip of the cut vessel so it no longer bleeds. There are two types
Monopolar - use of one electrode
Bipolar - use of two electrodes​

They are described here
diathermy.jpg


Monopolar is used for general surgery
Bipolar more often used in delicate areas such as the face, eyes and also for infants.

Ligation
The end of the bleeding vessel is picked up by an artery forceps like this

artery forcep.JPG


It can then be used as a conduit for diathermy or a suture material is passed around the vessel where it is held in the forceps and tied.

Transfixion sutures
in situations where the vessel is large or buried in fibrous tissue making the previous methods unsuitable, a suture might be used instead

transfixion suture.jpg


Hot packs
If the blood loss is what is called "general ooze" rather than a specific blood vessel, it can often be brought under control by the use of large gauze packs dunked in hot water.
 

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