Hemostasis

By Nikolaj Nerup, MD, PhD

 

 

Surgical bleeding may be divided anatomically into the following types;

 

                                                                 

 

 

 

 

Arterial bleeding                          

 

 

Venous bleeding

 

Capillary bleeding

 

Bleeding during surgery should be avoided during dissection, since bleeding may impair postoperative recovery and outcome, reduce visibility during the procedure, and provide a medium for bacterial infections. In addition, excessive bleeding and prolonged surgery has a tendency to deteriorate the patient’s endogenous coagulative system. In some situations, the coagulation is suppressed from an existing disease (liver disease, hemophilia, bone marrow involvement, malnutrition, etc.) or from anticoagulant therapy. This should be taken to notice before the procedure by interruption of drugs (if possible), treatment with additional medications or blood products (platelets / plasma), and (if available) controlled for by coagulation test like tromboelastography (TEG®), ROTEM® or Multiplate®.  To avoid bleeding of vessels during dissection, vessels should be divided over hemostats and ligatures or using electrocautery coagulation. If a bleeding should occur, keep calm and start by manual compression using a fingertip or gauze, until definitive repair. Use a systematic and judiciously approach. Blood will seek gravitational and often the position of the bleeding source is misinterpreted to be deeper than it actually is. Start therefore to seek out the source of bleeding in height when the blood thereby not run down over the area you are working in.   Several techniques to avoid and arrest bleeding can be used which will be reviewed in the following videos:  

 

 

 

                                                                 

 

 

 

 

 

 

 

Red, pulsating, high pressure, fast                     Dark red, continuous, low pressure,                   Continuous slow seepage 

                                                                                non pulsative - oozing                                          from a raw surface  

 

©2019 by Tobias Todsen, MD, PhD