Hemostasis

1. Hemostasis

2. Defined • Stopping or arresting the loss of blood or hemorrhage

3. Coagulation • Vessel or tissue injury results in: • Process of coagulation or clot formation to achieve natural hemostasis in the body • Body does this to prevent fluid loss which can cause hypovolemic shock untreated

4. Injury Intended or Not • Smooth muscle contracts and causes vasoconstriction • Clotting process begins • Some clotting factors ready • Some clotting factors come from damaged tissue • Some clotting factors come from platelets

5. Clotting process • Platelets rush to site and release chemical thromboplastin • Prothrombin comes from the liver and is floating in the bloodstream prothrombin becomes > thrombin • Fibrinogen is floating in the bloodstream and is activated by thrombin and creates > fibrin • Fibrin is like a log with glue on it (whatever touches it sticks to it, (RBC, WBC, Plts,) = CLOT • Ca++ (calcium) acts as a co-factor in the clotting process

6. Clotting Process • Platelets>thromboplastin>prothrombin> thrombin>fibrinogen>fibrin

7. Dealing with Clotting Process • Two options: • Prevent bleeding by enhancing clotting process by other means • Hemostatics • Accelerate or enhance clotting process • Three types: mechanical, thermal, chemical or pharmacological • Systemic coagulants • Calcium salts, vitamin K, platelets or plasma administration • Prevent clotting altogether to prevent thrombus formation during some surgeries • Anti-coagulants (Heparin (IV or parenteral) • Will have to be reversed after procedure completed (protamine sulfate, vitamin K or calcium)

8. Types of Hemostasis • Mechanical • Thermal • Pharmacological or Chemical

9. Mechanical • Clamp • Clips • Ligature (ties or suture) • Sponges • Pledgets • Bone wax • Suction • Drains • Pressure device (tourniquet)

10. Thermal • Electrocautery • Laser • Harmonic scapel • Cryotherapy

11. Chemical or Pharmacological • Gelatin (Gelfoam) • Collagen (Avitene) • Oxidized cellulose (surgicel) • Silver nitrate • Epinephrine (vasoconstrictor) • Typically an additive to local anesthetics • Thrombin

12. Blood loss • Monitored to determine transfusion needs • EBL = estimated blood loss • STSR and circulator’s responsibility to monitor at all times • Determine how much irrigant you have used and subtract that amount from the amount of bloody fluid in the suction container to determine actual blood loss • This information is reported to anesthesia who will consult surgeon to determine blood replacement therapy

13. Transfusions • Autologous • self donated previously prior to surgery • Homologous • donated from another

14. Blood types: A B O AB Based on presence of A or B antigen on surface of RBC Rheses factor (RH factor): Rh postive Rh negative Based on presence of Rh antigen on surface of RBC Have + Don’t have - Blood types and groups Antigens are proteins that set up antibody reaction Antibodies are proteins that respond to specific antigens

15. A A B B Rh Rh A A A A B- B+ B B B A- A+ B Rh Rh B and Rh antibodies B antibodies A and Rh antibodies A antibodies Rh AB AB AB+ O- O+ Rh Rh Rh AB Rh AB AB- AB A, B, Rh antibodies Rh antibodies NO antibodies A, B antibodies

16. Blood Replacement • Verification must be performed by two RNs or an RN and a physician • Facility policies do not allow for non-RN or non-physicians to check or verify blood in Western North Carolina hospitals