Implementing Methods to Improve Perioperative Hemostasis in the Surgical and Trauma Settings

Abstract

Achieving perioperative hemostasis is vital to surgical success. Inadequate control of bleeding is associated with serious adverse outcomes, including extended duration of surgery, unanticipated blood transfusions, shock, infection, impaired wound healing, longer hospital stays, and mortality. Appropriate clinical management of bleeding in the surgical and trauma settings requires careful collaborative planning and coordination by the entire perioperative team. Perioperative nurses, because of their strategic role in patient care, must be familiar with risk factors for excessive bleeding and the fundamental roles of hemostatic agents, environmental temperature, and blood transfusion in controlling bleeding in the surgical patient. Knowledge of the characteristics, safety, efficacy, and costs of available topical hemostatic agents promotes their appropriate selection in the OR. By incorporating evidence-based approaches into practice, perioperative nurses can support effective intraoperative hemostasis, thereby improving patient outcomes.

Tranexamic acid toxicity in human periarticular tissues

“…One such area that has been targeted across the surgical specialties is intra- and postoperative blood loss. 1 Within orthopaedic surgery, this is particularly relevant in patients undergoing hip and knee arthroplasty, commonly performed procedures that are frequently associated with considerable blood loss. 2 Postoperative anaemia may predispose patients to an increased risk of cardiopulmonary events and adverse transfusion reactions, 3 while prolonged hospitalization associated with significant blood loss may result in an increased risk of hospital-acquired infections.…”

Hemostasis in Cardiac Surgery: How We Do it with Limited Resources

“…By converting fibrinogen to fibrin, active hemostats-namely the three topical thrombin products: bovine thrombin (Thrombin-JMI®), pooled human plasma thrombin (Evithrom®), and recombinant thrombin(Recothrom®)-facilitate clot formation at the bleeding site [55][56][57]. Active hemostatic agents are the most commonly used adjunctive hemostatic therapies in the surgical setting and conservative estimates show that more than one million patients are treated with topical thrombin administration annually in the United States [58].…”

Optimizing Hemostatic Practices: Matching the Appropriate Hemostat to the Clinical Situation

“…Common mechanical hemostatic agents include porcine gelatin products (eg, Gelfoam ® , Gelfoam Plus ® , Surgifoam ® ), cellulose products (eg, Surgicel ® , Surgicel Fibrillar™, Surgicel Nu‐Knit ® ), bovine collagen products (eg, Avitene™ sheets, Avitene Ultrafoam™ collagen sponges), and polysaccharide spheres (eg, Arísta ® , Hemostase MPH ® , Vitasure™) 13‐15 . Although useful in cases of minimal bleeding, mechanical hemostats are only appropriate for use in patients with an intact coagulation cascade because mechanical hemostats rely on fibrin production to achieve hemostasis 15,16 . Mechanical agents are easy to use because they are available in easy‐to‐open packages, require no special preparation or storage, and can be easily applied via direct pressure on the bleeding site 15 …”

“…By converting fibrinogen to fibrin, active hemostats—namely the three topical thrombin products: bovine thrombin (Thrombin‐JMI ® ), 21 pooled human plasma thrombin (Evithrom ® ), 22 and recombinant thrombin (Recothrom ® ) 23 —facilitate clot formation at the bleeding site 14‐16 . Active hemostatic agents are the most commonly used adjunct hemostatic therapies in the surgical setting, with conservative estimates indicating that more than one million patients are treated with topical thrombin application annually in the United States 24…”