The Perioperative Patient for Registered Nurses

Causes of Surgical Bleeding

Almost any patient’s incision can cause excess bleeding. Besides the fluid volume and physiologic effects of blood loss, bleeding can also create challenges for the surgical team when visualizing a wound. The term hemostasis can be defined as the halt of blood flow or hemorrhage through the formation of a clot.

Bleeding during a surgical procedure tends to occur in two formats: pulsating bleeding from an artery or oozing from a vein. If hemostasis is not achieved, a hematoma can form. This is a collection of blood outside of the vessel. Sometimes hematomas will reabsorb, but other times they must be surgically evacuated.

(Cromb, 2019; Phillips & Hornacky, 2020)

Estimating Blood Loss Intraoperatively

There are different methods for estimating blood loss — subjective and objective. The perioperative nurse assists the anesthesia provider and the surgeon to estimate blood loss. The scrub and circulating nurses must keep track of irrigation fluid used throughout a case to subtract from fluids in the suction canisters and when considering the saturation of sponges.

Subjective

Objective

  • Visual estimation – based on the saturation of the sponges

 
  • Weight using scales
    • Not too costly or advanced
    • Does not provide an absolute answer as you cannot confirm if the blood has mixed with other fluids (irrigation, other body fluids)
    • When combined with visual estimation (ie. Considering the colour of the fluid on the sponge) may have a more accurate idea
    • Need to know the dry weight of sponges before they are saturated (can be estimated by weighing a dry pack of sponges)

  • Analysis of patient blood (ie. Hemoglobin)
    • More expensive method of monitoring
    • More time consuming
    • Not always practical

(Kollberg et al., 2019)