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Flashcards in Hemostasis Deck (57)
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1

What is hemostasis?

spontaneous physiological defense mechanism to stop hemorrhage

2

What does hemostasis depend on?

vascular, extravascular and intravascular factors

3

What is the end product of hemostasis?

an effective thrombus

4

What is surgical hemostasis used for?

used to augment, faility or bypass physiological clotting

5

What is the goal of surgical hemostasis?

to reduce blood loss and resultant complications

6

What are 4 issues with surgical bleeding?

1. obscures surgical field, reducing accuracy and efficiency
2. blood on field, gloves, drapes, instruments is ideal medium for bacterial growth
3. extravated blood has negative effects on body
4. severe or prolonged hemorrhage may result in shock, hypoxemia, death

7

What are the problems caused by extravasated blood in the body?

1. irritates tissues
2. prevents coaptation of wound edges
3. delays healing
4. encourages infection
5. promotes intraabdominal adhesions

8

What is primary hemorrhage?

occurs immediately after disruption of blood vessels
occurs during surgical dissection

9

How do you minimize primary hemorrhage?

know anatomy--ligate vessels
traverse one tissue plane at a time
apply tension in tissue handling?

10

What is delayed hemorrhage?

(intermediate) within 24 hours of injury
(secondary) >24 hours of injury

11

What is delayed hemorrhage often caused by?

often caused by ineffective treatment of primary hemorrhage
1. slipped ligatures
2. necrosis of ligated or cauterised vessels

12

What is the use of hemostatic forceps?

can be used to clamp vessels that will not be repaired. crushing the vessel stops hemorrhage and damages vessel wall, activating clotting.
only for small vessels

13

What hemostatic forcep is used for a wound?

1. smallest forceps capable of achieving hemostasis
2. curved hemostats improve visibility

14

How do you apply hemostatic forceps to stop bleeding?

1. grip in dominant hand with wide based tripod grip
2. small superficial bleeders point the tip towards the vessels
3. for deep bleeders, large vessels or pedicles apply hemostasis with convex surface facing end of vessel

15

How do you apply hemostatic forceps to stop bleeding?

1. grip in dominant hand with wide based tripod grip
2. small superficial bleeders point the tip towards the vessels
3. for deep bleeders, large vessels or pedicles apply hemostasis with convex surface facing end of vessel
4. for large vessels use jaw rather than tip
5. for large pedicles clamped with a carmalt or similar to minimize slippage

16

What are the most secure methods for hemostasis?

vascular clips and ligatures

17

What is an advantage of vascular clips and ligatures?

they are less likely to slip than a clot is to be dislodged

18

What is a disadvantage of vascular clips and ligatures?

foreign material is left in the wound

19

How do you apply vascular clips?

1. dissect vessel free from the surrounding tissue
2. diameter of vessel between 1/3-2/3 the length of the clip
3. apply several mm from cut end of vessel
4. clip artery and vein separately

20

What are the advantages of vascular clips?

1. can be placed more rapidly than ligatures
2. good for poorly accessible locations

21

What is a disadvantage of vascular clips?

more likely to be dislodged during surgical manipulation

22

What is the most commonly used method of hemostasis?

ligatures

23

What are the advantages of ligatures?

1. more secure than hemostatic clips
2. better suited for occlusion of multiple vessels and vascular pedicles
3. for large vessels the increased security outweighs the application time

24

What is a disadvantage of ligature?

take longer to apply

25

What is a disadvantage of ligature?

take longer to apply

26

What is the advantage of a square knot (ligature)

least likely to loosen (unless half hitch)

27

What is the advantage of surgeon knot?

used for large pedicles if cannot adequately tighten a square knot (apply square knot over top)

28

What material should not be used with a surgeon's knot?

chromic gut because friction causes fraying at the knot

29

What are two ways you can tie ligatures?

hand or instrument ties

30

What is recommended for large vessels with regards to applying ligatures?

use double ligatures