Principles of Hemostasis (8)

Question 1

How should you stop low-pressure hemorrhage from small vessels in surgery?

Answer 1

applying pressure to the bleeding points with gauze sponges

once clots form, sponge should be gently removed

Question 2

Which instrument can be used to control bleeding from small vessels?

Answer 2

small hemostatic forceps (mosquito)

Question 3

How should you ligate larger vessels, particularly arteries?

Answer 3

double ligatures - transfixation (to prevent ligature from slipping off the vessel end)

Question 4

Using the [smallest/largest] suture possible for vessel ligation improves knot security

Answer 4

smallest

Question 5

Explain the location of the circumferential ligature to the transfixation ligature and why it is so

Answer 5

circumferential: closer to the heart - more likely to slip!

transfixation: less likely to slip, more secure

Question 6

Ligature types?

Answer 6

transfixation

Question 7

What is the difference between a transfixion on a vessel versus an ovarian pedicle?

Answer 7

arteries: SQUARE throw

pedicle: surgeon’s throw because under tension

Question 8

T/F: A surgeon’s throw can be used situationally on arteries

Answer 8

FALSE

Question 9

What is bone wax, and when do you use it?

Answer 9

plug in bone, create pressure, bleeding stops

pressed into bleeding channels of bone to control hemorrhage through a tapenade effect

Question 10

When are gelatin-based hemostatic products not appropriate to use?

Answer 10

in closure of skin incisions, as they may interfere with healing

Question 11

What is gel foam?

Answer 11

provides a physical matrix that initiates clotting through contact activation

Question 12

What is a punch biopsy?

Answer 12

hemostatic foam
6 mm minimum

Question 13

What is this?

Answer 13

punch biopsy

Question 14

What is surgicel?

Answer 14

absorbable cellulose sponge that is more like a 4x4 gauze in appearance

Question 15

What are the pros and cons of surgicel?

Answer 15

• substrate for clot formation
• can be cut to the desired size and placed on an area of hemorrhage

not activated by tissue fluids other than blood

Question 16

What is the difference between electrocautery and electrosurgery?

Answer 16

electrocautery: coagulates small vessels or cuts tissue by using heat generated by direct electric current into a metal wire or probe — electric current does not enter the body

electrosurgery: refers to generating heat inside the tissue using an alternating electric current that passes through the tissue creating a circuit

Question 17

T/F: Electrosurgery has current pass through the patient’s body

Answer 17

TRUE

Question 18

Electrocautery or electrosurgery?

Answer 18

electrosurgery

Question 19

Electrocautery or electrosurgery?

Answer 19

electrocautery

Question 20

When is electrosurgery used?

Answer 20

for hemostasis for vessels less than 1.5 to 2 mm in diameter

Question 21

Which waveforms are on the cut and coagulation settings regarding electrosurgery?

Answer 21

cut: constant waveform

coagulation: intermittent waveform (can cut on this setting depending on tissue type)

Question 22

Electrocautery or electrosurgery?

Answer 22

electrosurgery

Question 23

What is monopolar electrosurgery?

Answer 23

involves the flow of current from an active electrode (handpick) through the patient to a groundplate
- most common electrosurgery technique

Question 24

How can monopolar electrosurgery be harmful?

Answer 24

if an adequate low-impedance ground pad is not present, the circuit will inadvertently use alternate paths to ground, and as a result will burn the patient

Question 25

How do you reduce risks of burn with monopolar electrosurgery?

Answer 25

use a large pad placed in good contact on a well-vascularized area of tissue that is close to the operative site

Question 26

How do you prevent burns with monopolar electrosurgery?

Answer 26

Question 27

What are the conditions for using monopolar electrosurgery?

Answer 27

- field must be relatively dry, and the electrode kept clean and free of debris - **direct** contact of the electrode with the tissue produces lower heat sufficient to coagulate

Question 28

What is indirect contact with monopolar electrosurgery?

Answer 28

involves touching the electrode to an instrument, allowing more precise application of energy and effective coagulation

Question 29

How do bipolar electrosurgery work?

Answer 29

uses a forceps-like hand piece current passes from one tip of the forceps to the opposite tip through the tissue being held between the tips

Question 30

What does bipolar electrosurgery not require? When is it used?

Answer 30

ground plate or pad used when precise coagulation is necessary and to prevent damage to adjacent structures

Question 31

What is radiosurgery?

Answer 31

Question 32

How does CO2 laser work?

Answer 32

tissue vaporization occurs as this light energy is absorbed by water into soft tissues

Question 33

T/F: With CO2 laser, little heat is dissipated to the surrounding tissues

Answer 33

TRUE - has less bleeding, less pain, less tissue swelling, decreased risk of infection

Question 34

What is vessel sealing? When is it used?

Answer 34

hemostasis in laparoscopic and thoracoscopic, open abdominal procedures Uses pressure and pulsed low-voltage energy to fuse collagen and elastin of the vessel wall and achieve homeostasis