Hemostasis and Drains

What is Surgical bleeding?

Bleeding which results from surgical manipulation of the tissues

What is Hemorrhage

Potentially life threatening Bleeding which can arise spontaneously or from surgical manipulations

Hemostasis

Measures/actions taken to prevent or control surgical bleeding

Arterial Bleeding

Bright red, pulsating spurts

venous bleeding

Dark red and continuous

Capillary bleeding

Continuous ooze

What is Electrosurgery

Application of high frequency electrical current that is generated by ESU

Electro scalpel (cutting)

Uses a continuous waveform to vaporize tissue

Electrocoagulation

Uses interrupted waveform creating heat for coagulation

Contact coagulation and fulguration(sparks)

Electrocautery

Delivers a high frequency electrical current to a specific area of tissue 

Generates heat and coagulates vessel 

What is a Ligasure and what is it used for

Bipolar vessel sealing device

Open and laparoscopic procedures-energy to tissue through a jaw piece 

When using gauze to clear blood from a surgical field in what manner should you do it?

Dab-not wiping 

What are the main causes of Surgical bleeding

Bleeding disorder

Thrombocytopenia

‘Thrombocytopathy

Poor surgical technique

What is a drain

A surgically implanted device that facilitates the evacuation of secretions fluids or air from tissues or body cavities

What is the function of a drain

To facilitate healing by reducing dead space or removing unwanted materials

What is dead space

Abnormal space between tissue layers where blood and serum may accumulate

What are techniques used to manage dead space

Suture obliteration

Compression bandage

Drainage 

Classification of Drains-Flow

Passive-flow by gravity

Active-flow by vacuum- continuous, intermittent

How many exit sites should a drain have

Single exit

Characteristics of a Flat Drain

Passive flow

Single exit site

Exta/intraluminal Flow

Remove in 2-5 days

Used to drain Sub Q spaces

Secure top and bottom 

NEVER fenestrate

-ex=penrose 

Characteristics of a Tubular Drain

Passive or active

Intra/extraluminal flow

Soft or rigid tube

± fenestrations

Use in deeper tissues or body cavities

what is an example of an Active drainage system

Jackson Pratt Closed suction drain

Principles of drain