Coagulation/hemostatic Agents

Question 1

What is the goal of hemostasis management?

Answer 1

Decrease and control healing 
Minimize need for blood replacement 
Optimize view of the surgical field 
Avoid damage to major organs 
Shorten the length of surgery and length of stay 
Decrease risk of infection
Decrease health care costs

Question 2

What happens during coagulation cascade?

Answer 2

Damaged blood vessel wall
Formation of platelet plug - activated by collagen
In place of damaged vessel creates clot
(Fibrin threads)

Question 3

What triggers the intrinsic pathway?

Answer 3

Triggered by events that occur within a blood vessel

- damage to vessels endothelium

Question 4

What triggers extrinsic pathway?

Answer 4

Triggered when injury to a vessel occurs

- vessel cut during surgery

Question 5

What is principle enzyme of hemostasis?

Answer 5

Thrombin

Question 6

What does thrombin covert?

Answer 6

Coverts fibrinogen to fibrin and activated clotting factors

Question 7

What is thrombin?

Answer 7

Begins as prothrombin and is glycoprotein present is plasma

Conversion of thrombin from prothrombin is catalyzed by factor Xa

Activates platelets, regulates endothelial cells and directs actions of other cells

Question 8

Damange to blood vessel during surgical setting?

Answer 8

Collagen exposed to circulating platelets

Platelets binds directly to collagen and creates “platelet plug”
- strengthened by von willebrand factor that helps form additional links betweel platelets and collagen

• temporary measure that occurs while clotting casacde is triggered for plug to come clot

Question 9

Arterial bleeding looks like?

Answer 9

Pulsating bleeding

Question 10

Venous bleed looks like?

Answer 10

Oozes

Question 11

Reasons for bleeding in surgery?

Answer 11

Meds 
Coagulopathies
Surgical incisons
Unseen sources
Exposed bone 
Medical conditions

Question 12

Complications of bleeding during surgery?

Answer 12

Surgery view obstructed
- can lead to longer OR times

Blood replacement may be required and may cause additional risks for pt

Cause risk of hypothermia and there can be potential for coagulopathies

Question 13

What donblood transfusions increase risk of?

Answer 13

Organ failure 
Systemic inflammatory response syndrome 
Transfusion related acute lung injury 
Increased risk of infection
Increased mortality

Question 14

Hemodilation and acidosis?

Answer 14

When patient recieves large amounts of babked blood, acidosis occurs due to lactate production in tissues + IV admin of chlorides

Question 15

What is lactic acid?

Answer 15

Produced in muscle cells and RBCs

Forms when body breaks down carbohydrates to use energy when O2 levels are low

Question 16

What is thrombocytopenia?

Answer 16

Deficient # of circulating platelets

Can develop during surgery due to massive blood loss
Or
Can develop after heparin admin

Question 17

Hypovolemic shock?

Answer 17

Result of volume depletion from hemorrhage and can reduce cardiac output and affect other physiological functions including pulmonary gas exchange

Question 18

Wats of estimating blood loss?

Answer 18

Inspecting drapes, suction canisters and sponges

Weighing sponges

Monitoing labs

Question 19

How can nurse assist with estimating blood loss?

Answer 19

Placing used sponges in a location easily visualized

Weighing sponges

Communicating irrigation solutions usef
(Subtracted from suction canisters)

Question 20

3 ways of achieving surgical hemostasis?

Answer 20

Mechnical methods
Thermal-based 
Chemical agents 
- pharmacological
- topical hemostatic agents

Question 21

Examples of mechanical methods?

Answer 21

Direct pressure - sponges
Sutures/staples/clips
- pressure/ligation
Dressings after surgery complete

Question 22

Examples of thermal based methods?

Answer 22

Monopolar/bipolar ESD
Lasers 
Ultrasonic devices 
Vessel sealing 
Argon

Question 23

Chemical agents: pharmaceutical?

Answer 23

Epinephrine
Vitamin K
Protamine
Vasopressors

Question 24

What are ligating clips?

Answer 24

Metal clips that sre absorbable

v shaped staple like that are placed around the lumen of a vessel or structure to close it

May be part of count

Question 25

What is epinephrine?

Answer 25

Hormone that causes vasoconstriction 

- topical or injected

Question 26

What does Vitamin K do?

Answer 26

Can be given pre op to reverse the effects of warfarin

Question 27

Why does Protamine do?

Answer 27

Reverses heparin anticoagulation

Question 28

What do vasopressors do?

Answer 28

Stimulate release of von willebrand factor from endothelial cells
- increases plasma levels and enhance primary hemostasis
Ex: desmopressin for patients who have hemophilia A

Question 29

What are topical hemostatic products and surgical sealants?

Answer 29

Can be applied to a bleeding area as an adjunt therapy

May require physician order

May not be indicated for intravascular use

Come from synthetic, human, plant and animal sources

Question 30

4 categories of topical hemostatic products?

Answer 30

Mechanical
Actives
Flowables
Fibrin Sealants + surgical sealants

Question 31

Mechanical hemostatic products?

Answer 31

Collagen, cellulose, gelatin, polysaccharides

Act passively
- dont interupt clotting cascade

Do not contain thrombin

Require presence of blood to activate platelets and promote platelet formation

Question 32

Active topical hemostatic agents?

Answer 32

Biologically participate in coagulation cascade
- stimulate fibrinogen at bleeding site to form fibrin clot

Includes thrombin

• should never be injected intravascularly
• relies on presence of fibrinogen

Does not need to be removed from site before wound is closed

Question 33

Flowable hemostatic agents?

Answer 33

Combine mechanical and active agent into a single product

Contains thrombin without fibrinogen

Block flow of blood and actively convert fibrinogen into fibrin
- requires direct contact with pt blood as fibrinogen source

Question 34

Fibrin sealants hemostatic agents?

Answer 34

Consists of concentrated fibrinogen and thrombin
- when mixedwkrh blood creats fibrin clot

Form a barrier imoervious to most liquids

Thin liquid, can be aerosol spray

Often used with flowable agent

Question 35

3 types of fibrin sealants?

Answer 35

Fibrin sealants
Polyethylene glycol (PEG) polymers
Albumin with glutaraldehyde

Question 36

Surgical tissue sealants?

Answer 36

Adhesives

• cyanoacrylates
• synthetic skin sealants
• tissue sealants
• glutaraldehydes
• PEG polymers
• all glue tissue together

Question 37

Nurses responsibility when topical hemostatic products snd tissue sealants are ordered?

Answer 37

Assess allergies
Cultural considerations 
Product approval statements 
- may be specific pt populations 
Requirements for transport, storage, handling, and disposal 
Preparation
Time limit in sterile field