Methods of Hemostasis

The surgical team can stop bleeding and achieve hemostasis in three unique ways, click on the boxes to learn more:

Mechanical

1. Direct pressure such as holding a sponge or towel on a bleeding site 
2. Suture materials 
3. Ligating clips 

Thermal-Based Energy

1. Electrocautery 
2. Lasers 

Chemical

1. Medications

Let us look at each of these methods more closely.

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Methods of Hemostasis – Mechanical

Different mechanical tools can be used during surgery to provide temporary or permanent hemostasis.

(Phillips & Hornacky, 2020)

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📁 Documentation Highlight

Clips used for hemostasis must be meticulously documented in the patient record because it is vital to keep track of any implants being left in the patient. Why is this important? If the patient requires any diagnostic imaging in the future, including an MRI, the technicians need to be able to identify if there are metal implants and if they are MRI-compatible. Follow your institution’s charting policies as to what is required for documentation.

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Thermal-based Energy

Different thermal-based equipment can be used during surgery to provide hemostasis.

(Phillips & Hornacky, 2020)

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Chemical Methods

Chemical methods of hemostasis work to react with blood to form a clot. Many of these chemical materials will re-absorb over time as the body heals. They do not have to be removed. There is one exception. Hemostatic chemical materials cannot be packed into a closed space where they could swell and cause pressure on surrounding tissues such as the spinal canal, or in neurosurgery. In this instance, surgeons will still use a chemical agent but will carefully ensure it is removed before closing.

Click on the various chemical hemostatic agents below to learn more about them. There are many quick videos to provide you with a visual and overview of the agent from their supplier. It is vital that perioperative nurses are knowledgeable about and follow the manufacturer’s directions for hemostatic agents, sealants, and adhesives.

(ORNAC, 2021)

Absorbable Gelatin (Gelfoam) 

1. It can come in a powder or foam pad.  
2. It is an absorbable hemostatic agent.  
3. It can be cut without crumbling.
4. When placed on a bleeding capillary, it swells and forms a large clot. 
5. It may be soaked in a liquid such as saline, thrombin, or epinephrine, depending on the surgeon’s preference. 

Oxidized Cellulose (Surgicel)

1. It can be cut into strips and laid directly on a bleeding or oozing site.  
2.  When oxidized, cellulose forms a clot quickly as soon as it touches blood.
3. It is good to use in areas where it is difficult to control bleeding by other methods. 
4. It is not recommended for use on bone as it can inhibit bone regeneration unless it is removed before closing the wound. 

Oxytocin 

1.  Oxytocin may be directly injected into the uterine muscle to cause a contraction during c-section surgery.
2. It can be injected systemically to help with a hemorrhage from the uterus.  

Epinephrine 

1. Epinephrine is a vasoconstrictor.  
2. It can be used topically within an incision on gelfoam sponges. It is commonly used in ear and microsurgical procedures.
3. Epinephrine can be absorbed systematically and can cause cardiac stimulation. Care must be taken when using epinephrine. It is often diluted and only used in lesser amounts. 

Silver nitrate 

1. Silver nitrate comes in the form of applicator sticks. These are applied topically to cause vasoconstriction.  
2. It is commonly used in burns or on nasal and oral surgical sites. 
3. It can help seal areas that cannot be surgically closed and must be left to heal by secondary intention. 

Thrombin (Tisseel, Floseal)

1. This accelerates the coagulation of the blood and helps with capillary bleeding. It combines with fibrinogen to form a clot. 
2. Thrombin can come as a powder that is sprinkled on a wound.  
3. Hemostatic devices such as Tisseel and Floseal combine Thrombin with other active ingredients to achieve hemostasis.
4. This accelerates the coagulation of the blood and helps with capillary bleeding. It combines with fibrinogen to form a clot. 
5. Thrombin can come as a powder that is sprinkled on a wound.  
6. Hemostatic devices such as Tisseel and Floseal combine Thrombin with other active ingredients to achieve hemostasis.

Collagen (Surgiflo, Hemopatch) 

1. Collagen is an absorbable, topical hemostatic agent.  
2. It is applied dry. 
3. There is an adhesion of platelets when it meets a bleeding surface, and fibrin is deposited within the collagen. 
4. It must be applied with firm pressure against the bleeding surface.  

(Phillips & Hornacky, 2020)

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🧠 Graded Activity

In Blackboard complete the Graded Activity: Methods of Hemostasis.

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💬 Communication Highlight

While the surgical team works to obtain hemostasis and control bleeding, it is not always enough. The perioperative team must communicate and work together to recognize when there is substantial blood loss. The scrub nurse must keep track of the amount of irrigation fluid used during a procedure so that this can be considered when reviewing the amount of blood/fluid in the suction canisters and saturated sponges. The team estimates the total blood loss and through analysis of blood work, determines if a transfusion of blood product is required.

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Screening before surgery

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