Hemorrhage Nursing Interventions

Guidelines:

• Identification (insert story)
  • Little looks like a lot
  • Irrigation count
  • subtle/out of view
    • Laparoscopic
      • Always sweep on entry!
      • Visibility of instruments
        • Robots
• Antifibrinolytic
  • Transexamic acid TXA most common
  • Risk for hypercoagulopathy, evidence supports use
  • Reduces blood transfusion
    • Cellsaver
• Pressure,time, clamp, consider downstream
  • Kidneys

Considerations:

• Robot emergent undocking
  • gown for surgeons always
  • Sharps still attached
  • Beware bovie wires
• PACU ultrasound
• TXA timing
  • labs routine
• Know if heparin dosed pre-op
  • Protamine reversal (remind sugammadex reverse succs, 2 to remember
  • Vascular expect increased dosages
• B/P & where monitored (aline, pt positioning)
• Death triad, again

Nurse’s role:

• Identify
• Alarm
  • All should know facility policy
• Carts
• Products and where located
• Runner for blood
• I/o reporting
• Documentation
• Second scrub if avail

Pitfalls:

• Med errors
• Adverse event at field
  • Failure to identify
  • Secondary location
• DIC

Examples:

• Vascular has anastomosis fail (communication (quiet), support effort at field, anticipate needs)
• Red screen upon laparoscopic entry (anticipate x-lap, alarm, begin prep for open/counts if avail – emergent)

Linchpins (Key Points):

• Hemorrhage requires team effort to make physical effect at field, chemical assistance
  helps but not curative