POST OPERATIVE POST OPERATIVE HEMORRHAGE HEMORRHAGE

HEMORRHAGEHEMORRHAGE

→ → is an uncommon yet serious complication is an uncommon yet serious complication of surgery that can result in hypovolemic of surgery that can result in hypovolemic shock and death.shock and death.

→ → it can present insidiously or emergently at it can present insidiously or emergently at any time in the immediate post operative any time in the immediate post operative period or up to several days after surgery.period or up to several days after surgery.

→ → is an excessive internal or external blood is an excessive internal or external blood loss.loss.

Post Operative hemorrhagePost Operative hemorrhage

It may occur from:It may occur from:

Dislodged clot in the wound.Dislodged clot in the wound. Slipped stitch or sutureSlipped stitch or suture Insecured ligation of blood vesselInsecured ligation of blood vessel Certain medicationsCertain medications

Clinical signs:Clinical signs:

Overt bleedingOvert bleeding ↑ ↑ painpain ↑ ↑ Abdominal girthAbdominal girth Swelling and bruising around Swelling and bruising around

incision.incision.

Classifications of Classifications of HemorrhageHemorrhage

ClassificationsClassificationsI. Time FrameI. Time Frame ∆ ∆ Primary- Hemorrhage occur at the time of Primary- Hemorrhage occur at the time of

surgerysurgery ∆ ∆Intermediary- Hemorrhage occur during the Intermediary- Hemorrhage occur during the

first few hours after surgery when the rise of first few hours after surgery when the rise of blood pressure to its normal level dislodged blood pressure to its normal level dislodged insecure clots from untied blood vessels.insecure clots from untied blood vessels.

∆ ∆Secondary- Hemorrhage may occur Secondary- Hemorrhage may occur sometime after surgery if a suture slips sometime after surgery if a suture slips because of blood vessel was not securely tied because of blood vessel was not securely tied or was eroded by a drainage tube.or was eroded by a drainage tube.

Types of hemorrhageTypes of hemorrhage

Internal Internal hemorrhagehemorrhage

External External hemorrhagehemorrhage

II. Type of blood vessel:II. Type of blood vessel:

Capillary- hemorrhage is Capillary- hemorrhage is characterized by slow general ooze.characterized by slow general ooze.

Venous- darkly colored, blood Venous- darkly colored, blood bubbles out quickly.bubbles out quickly.

Arterioles- blood is bright red and Arterioles- blood is bright red and appears in spurts with each appears in spurts with each heartbeat.heartbeat.

III. VisibilityIII. Visibility

Evident- Hemorrhage is on the Evident- Hemorrhage is on the surface and can be seen.surface and can be seen.

Concealed- Hemorrhage is a body Concealed- Hemorrhage is a body cavity and cannot be seen.cavity and cannot be seen.

The Patient presents The Patient presents with:with:

hypotensionhypotension Rapid, thread pulseRapid, thread pulse DisorientationDisorientation RestlessnessRestlessness Oliguria,Oliguria, Paled, cool skinPaled, cool skin

HYPOVOLEMIC SHOCKHYPOVOLEMIC SHOCK Most common seen in post operative Most common seen in post operative

patients, which occurs from a ↓ blood patients, which occurs from a ↓ blood volume.volume.

Early phase of shock manifestation:Early phase of shock manifestation: Ω Feeling or apprehensionΩ Feeling or apprehension Ω ↓ Cardiac output and vascular Ω ↓ Cardiac output and vascular

resistanceresistance Ω DyspneaΩ Dyspnea Ω ColdΩ Cold Ω TinnitusΩ Tinnitus

NURSING NURSING MANAGEMENT:MANAGEMENT:

Transfusing blood or blood Transfusing blood or blood products and determining the products and determining the cause of hemorrhage are the cause of hemorrhage are the initial therapeutic measures.initial therapeutic measures.

NURSING ALERT!NURSING ALERT!

The infusion rate is determined by The infusion rate is determined by the severity of blood loss and the the severity of blood loss and the clinical evidence of hypovolemia.clinical evidence of hypovolemia.

If massive blood replacement is If massive blood replacement is necessary, the bloof must be necessary, the bloof must be warmed in a commercial blood warmed in a commercial blood warmer.warmer.

NURSING NURSING MANAGEMENTMANAGEMENT

The surgical site and incision should The surgical site and incision should always be inspected after bleeding.always be inspected after bleeding.

The patient is placed in shock The patient is placed in shock positionposition

If hemorrhage is suspected but If hemorrhage is suspected but cannot be visualized the patient may cannot be visualized the patient may be taken back to the Operating be taken back to the Operating Room after emergency exploration Room after emergency exploration of the surgical site.of the surgical site.