Hemostasis, Sponges, Drains Flashcards
Mechanical hemostasis is achieved by occluding severed vessels until platelet formation occurs. During the surgical procedure, the surgeon may use various mechanical methods to achieve hemostasis:
Give examples:
- manual pressure using various types of sponges
- using hemostatic clamps;
- suturing;
- and using staples,
- clips,
- ligatures,
- and/or pledgets
ligature
commonly known as a tie, is a strand of material that is tied around a blood vessel to occlude the lumen and prevent bleeding
Define pledget
a non-absorbable suture support that is used when there is possibility of sutures tearing through tissue.
Bone Wax
composed of a mixture of beeswax, isopropyl palmitate, and a softening agent. Provides a mechanical tamponade effect to stop oozing from cut bone surfaces. Bone wax is used in some orthopedic and neurosurgical procedures and on the sternum during heart procedures.
Chemical Method of Hemostasis- Chemical methods involves the use of:
- Pharmacological methods (medications, for example Epinephrine, Vitamin K, Protamine, Desmopressin, Lysine Analogues (aminocaproic acid; tranexamic acid)
- Topical hemostatic products for example active agents (thrombins), passive agents (collagen-based gelatins, spheres, flowable agents, and sealants.
Thermal Method of Hemostasis
Thermal/Energy based methods of hemostasis can include high-frequency electric current provided from an electrosurgical unit to coagulate bleeding points; bipolar vessel sealing devices; laser energy sources; ultrasonic energy; and radio frequency energy generated by Argon gas
Mechanical Method of Hemostasis
Involves applying physical pressure on the wound to stop the blood flow. Mechanical methods can include direct pressure using fabric pads/gauze sponges/sponges sutures, staples, or ligating clips.
Thermal Method of Hemostatis
- Laser - An intense and concentrated beam of light that coagulates and cuts at the same time while minimizing tissue destruction.
- Argon Beam - A device that uses ionized gas and electrical current to coagulate vessels.
- Electrosurgery - The electrosurgical unit (ESU) is used to apply electrical current through the patient’s tissue to cut and/or coagulate the tissue.
Chemical Methods of Hemostatis - Chemical methods to achieve hemostasis during surgical procedures includes pharmacological agents and topical hemostatic agents.
Give Examples:
- Microfibrillar Collagen
- Oxidized Cellulose
- Collagen Sponge
- Gelatin Sponge
- Fibrin Sealant
- Phenol Solution
- Thrombin
- Styptics
Types of Surgical Sponges
- Laparotomy Sponges
- Tonsil Sponges
- Neuro-patties or Cottonoids
- Dissector Sponges
- Radiopaque 4X4 Sponge
Counting Sponges
- Counts are performed before, during and after surgical procedures.
- Sponges are to be separated as they are counted
- Two people, one of whom is the RN circulator, should count the sponges simultaneously and audibly as each sponge is separated.
Participation in Sponge Counts
- All perioperative personnel involved in a surgical case are responsible for the accuracy of the sponge count.
- Each has a duty to remain aware of the location of the sponges on the sterile field and in the wound.
- Two people, one of whom is the registered nurse circulator, must perform the sponge count.
- The scrub person should maintain awareness of the location of all soft goods (eg, radiopaque sponges, towels, textiles).
- The scrub person and the circulating nurse should count sponges simultaneously and audibly as each sponge is separated from others in the pack before the beginning of the operation, before any closure begins, and when skin closure is begun.
- All sponges must remain in the same OR room until the count is complete.
Types of Drains and Their Uses
The drainage of body fluids and purulent material can be achieved by either passive (gravity) or active means (suction).
They are also used to drain pus, purulent, or necrotic material from a wound.
The type, location, and patency of all drains should be covered in the hand over report to PACU or the nursing unit.
- Penrose – Abdominal Surgery, peritoneal cavity or skin wound
- Nasogastric - Decompression of the stomach (Levin tube). Indications for a Miller-Abbott is to treat obstructive lesions of the small intestine. Nasogastric suction (Salem sump tube).
- T-Tube - Inserted into the biliary tract to allow for drainage of bile. Generally left in place for 10 days or more in order to develop a tract through which bile can drain after the tube is removed.
- Suction Drains - Abdominal or breast surgery (Jackson-Pratt). Orthopedic surgery (Hemovac). Jackson-Pratt and Hemovac are two specific types of suction drains and both removed blood or other fluids that might build up at the surgical site.
- Chest Tubes – Thoracic surgery and cardiac surgery
