Surgical Hemostasis

Question 1

primary hemostasis

Answer 1

platelets adhere to injury site and aggregate to form plug

Question 2

secondary hemostasis

Answer 2

clotting cascade; formation of insoluble fibrin strands and coagulation

Question 3

what are the 4 methods of hemostatic aids

Answer 3

1. blood flow reduction
2. topicals
3. ligation
4. energy devices

Question 4

blood flow occlusion

Answer 4

pressure: allows time for platelet plug to form

occlusion/distant flow reduction (ex. tourniquet)

Question 5

topical hemostatic agents

Answer 5

gelatin sponge
oxidized regenerated cellulose
active hemostatic agents (thrombin, fibrin)

Question 6

gelatin sponge

Answer 6

mechanical hemostatic agent; provides a matrix for blood clot formation

used in confined spaces
NOT used on visceral parenchyma surface

Question 7

oxidized regenerated cellulose

Answer 7

adherent, cloth like material that provides a matrix for clot formation

used best on liver/spleen surfaces

Question 8

methods of ligation

Answer 8

sutures
hemostatic clips

Question 9

suture ligation

Answer 9

using square knots to ligate vessels

suture should be:
- monofilament
- non-absorbable

large vessels/peduncles should be ligated with double ligation and strangle knots to increase friction

Question 10

hemostatic clips

Answer 10

used for deep vessels where it is difficult to suture

Question 11

electrocautery vs electrosurgery

Answer 11

cautery: uses direct heat applied to tissues

surgery: high frequency alternating current passes through tissue to cut, coagulate, desiccate, etc

controlled heat production

can be monopolar or bipolar

Question 12

monopolar ES

Answer 12

handheld pencil that sends energy through the body to a grounding pad underneath the patient

most common but less safe - can have grounding pad injury

Question 13

cutting vs coagulation mode of electrosurgery

Answer 13

cutting: continuous low voltage; cuts without hemostasis

coagulation: intermittent high voltage; cuts with hemostasis

Question 14

bipolar ES

Answer 14

two tipped pen that grasps the tissue to be ligated

tissue damage is limited to what is in between the tips

Question 15

vessel sealing devices

Answer 15

method of sealing large vessels (5-7 mm)

Question 16

harmonic scalpel

Answer 16

used for sealing small vessels (<5 mm)

Question 17

what causes hemostatic failure

Answer 17

suture/clip fails
insufficient attention to small/medium vessels
inappropriate method of hemostasis
iatrogenic injury
primary or secondary hemostatic disorder
failed to ID ongoing bleeding

Question 18

how to ID hemostatic failure

Answer 18

• blood pooling or clotting
• visual inspection of pedicles
• blot surgical site and look for bleeders
• remove pooled blood and clots with suction and inspect
• tachycardia despite adequate pain control
• excessive burning
• blood accumulation in abdomen/chest

Question 19

what does the method of hemostatic failure control depend on

Answer 19

patient stability
evidence of persistent blood loss

can either do conservation (ice and pressure) or exploratory surgery