1. Hemostasis

2. Defined Stopping or arresting the loss of blood or hemorrhage

3. Coagulation Vessel or tissue injury results in: Process of coagulation or clot formation to achieve natural hemostasis in the body Body does this to prevent fluid loss which can cause hypovolemic shock untreated

4. Injury Intended or Not 1.Smooth muscle contracts and causes vasoconstriction 2.Clotting process begins Some clotting factors ready Some clotting factors come from damaged tissue Some clotting factors come from platelets

5. Clotting process Platelets rush to site and release chemical thromboplastin Prothrombin comes from the liver and is floating in the bloodstream prothrombin becomes > thrombin Fibrinogen is floating in the bloodstream and is activated by thrombin and creates > fibrin Fibrin is like a log with glue on it (whatever touches it sticks to it, (RBC, WBC, Plts,) = CLOT Ca++ (calcium) acts as a co-factor in the clotting process

6. Clotting Process Platelets>thromboplastin>prothrombin> thrombin>fibrinogen>fibrin

7. Dealing with Clotting Process Two options: Prevent bleeding by enhancing clotting process by other means –Hemostatics Accelerate or enhance clotting process Three types: mechanical, thermal, chemical or pharmacological –Systemic coagulants Calcium salts, vitamin K, platelets or plasma administration Prevent clotting altogether to prevent thrombus formation during some surgeries –Anti-coagulants (Heparin (IV or parenteral) –Will have to be reversed after procedure completed (protamine sulfate, vitamin K or calcium)

8. Types of Hemostasis Mechanical Thermal Pharmacological or Chemical

9. Mechanical Clamp Clips Ligature (ties or suture) Sponges Pledgets Bone wax Suction Drains Pressure device (tourniquet)

10. Thermal Electrocautery Laser Harmonic scapel Cryotherapy

11. Chemical or Pharmacological Gelatin (Gelfoam) Collagen (Avitene) Oxidized cellulose (surgicel) Silver nitrate Epinephrine (vasoconstrictor) –Typically an additive to local anesthetics Thrombin

12. Blood loss Monitored to determine transfusion needs EBL = estimated blood loss STSR and circulator’s responsibility to monitor at all times Determine how much irrigant you have used and subtract that amount from the amount of bloody fluid in the suction container to determine actual blood loss This information is reported to anesthesia who will consult surgeon to determine blood replacement therapy

13. Transfusions Autologous –self donated previously prior to surgery Homologous –donated from another

14. Blood types and groups Blood types: A B O AB Based on presence of A or B antigen on surface of RBC Rheses factor (RH factor): Rh postive Rh negative Based on presence of Rh antigen on surface of RBC –Have + –Don’t have - Antigens are proteins that set up antibody reaction Antibodies are proteins that respond to specific antigens

15. AB+O-O+ B-B+ A A A A- B and Rh antibodies A A A B B B A+ B antibodiesA and Rh antibodies B B B Rh A antibodies Rh antibodies AB- AB NO antibodies AB Rh AB Rh A, B, Rh antibodies A, B antibodies Rh

16. Blood Replacement Verification must be performed by two RNs or an RN and a physician Facility policies do not allow for non-RN or non-physicians to check or verify blood in Western North Carolina hospitals