Hemostasis, Sponges, Drains

Question 1

Mechanical hemostasis is achieved via occluding severed vessels until platelet formation occurs. List the methods used (6):

Answer 1

Pressure (hand, digit, sponge)

Hemostats (clamps)

Ligating clips (Hemoclips, Weck clips) (Small, staple-like devices)

Ligature (tie)

Pledget (non-absorbable suture used when possibility of sutures tearing through tissue; most commonly used in vascular closure, septal repair, myocardial, heart valve suturing, hepatic repair)

Bone wax (ortho/neuro cases; should be used sparingly/contraindicated when rapid bone regen is desired- acts as physical barrier that prevents bone union)

Question 2

Thermal method of hemostasis includes application of extreme cold/heat. List devices available (5):

Answer 2

Argon Beam Coagulator (ABC)

ESU (Monopolar most often used for coagulation [hemostasis]

Cryosurgery

Hypothermia

Laser (cut/coag same time)

Question 3

Pharmacological agents to achieve hemostasis during surgical procedures (5):

Answer 3

Epinephrine

Vitamin K

Protamine

Desmopressin

Lysine analogues (aminocaproic/tranexamic acid [TXA])

Question 4

Chemical methods to achieve hemostasis (7):

Answer 4

Microfibrillar Collagen (Avitene)

Oxidized Cellulose (Surgicel, NuKnit; should never be used with thrombin b/c it interferes with its action)

Collagen Sponge (Collastat, Superstat, Helistat; contraindicated in presence of infection or in areas where blood/fluids have pooled)

Gelatin Sponge (Gelfoam; used with thrombin, saline or dry)

Fibrin Sealants (Tisseal, Crosseal, FloSeal)

Thrombin

Styptics (epinephrine, tannic acid, silver nitrate; produces vasoconstriction effect)

Question 5

Types of surgical sponges (5):

Answer 5

Laparotomy sponges

Tonsil sponges

Neuro-patties (cottonoids; used on delicate structures such as nerves, brain tissue, spinal cord)

Dissector sponges (cherries, peanuts, kittnoid)

Radiopaque 4x4 (Raytec)

Question 6

Types of drains (5):

Answer 6

Penrose drains (abdominal surgery- peritoneal cavity or skin wound)

Nasogastric tube

T-tubes: used to drain the common bile duct via the abdominal wall. Inserted into the biliary tract to allow for drainage of bile.

Suction drains (Jackson-Pratt; to drain accumulated blood and fluid from operative site_

• Abdominal or breast surgery (Jackson-Pratt)
• Orthopedic surgery (Hemovac)

Chest tubes (Thoracic/cardiac surgery)

Question 7

Basic types of dressings used (4)

Answer 7

Occlusive dressings

Gauze dressings

Hydrogel dressings

Pressure dressings

Question 8

Occlusive dressings

Answer 8

Used to prevent drying of the surgical wound and to increase proliferation of epithelial cells.

Pressure/dermal ulcers, donor sites, burns, abrasions

Impermeable materials made of polyurethane/fine mesh gauze impregnated with petroleum, xeroform, iodophor, abx ointment

Opsite, Tagaderm, vasoline gauze, Xeroform, Dermicel