Hemostasis, Wound Healing, & Wound Closure, Ch 11, ST for the ST

Approximated

Returned to proximity; brought together by sides or edges.

Tonsil Sponges

Round sponges.

Components of Electrosurgery

Active electrode or Bovie Pencil, electrosurgical or generator unit (ESU),& inactive or dispersive electrode also called the grounding pad.

Intentional Wounds

Include chemical wounds, occlusion banding, and surgical site incision or excision.

If the procedure involves blood exposed to gastric enteric contents or amniotic fluid, can it be salvaged?

No.

Tensile Strength

Amount of pull or tension that a suture strand will withstand before breaking; expressed in pounds.

Acquired Bleeding Disorders

Bleeding disorder caused by an outside source.

What bleeding disorders are most commonly seen in the OR?

Acquired Bleeding Disorders

Laceration

Cut or tear

Types of Chemical Hemostasis

Absorbable gelatin (Gelfoam), Absorbable collagen (Avitene), Microfibrillar collagen, Oxidized cellulose (Nu-Knit, Surgi-Cel), Silver Nitrate, Epinephrine, & Thrombin.

How many days does it take for wound contraction (the result of the work of the dermal and subcutaneous myofibroblasts) to take place?

21 days.

How long is the traumatic surgical wound left open after debridement?

4 to 6 days.

Fistula

A fistula is an abnormal tract between two epithelium-lined surfaces that is open at both ends.

Dead Space

A space that remains in the tissues as a result of failure of proper closure of a surgical wound.

What are the 4 main blood types?

A, B, O, & AB.

Tissue Reaction

Abnormal response of tissue to foreign substances such as suture material.

Raytec

Also called 4 X 4s (the size of the sponge)

Incidental Wounds

Also known as iatrogenic wounds, are wounds that can happen as a result of therapy or treatment.

Kitners & Peanuts

Also referred to as dissecting sponges. Consists of small pieces of tightly rolled gauze.

Laparotomy Sponges

Also referred to as lap sponges or tape sponges due to the radiopaque strand or tape that hangs from the sponge.

Adhesion

An adhesion is an abnormal attachment of two surfaces or structures that are normally separate.

Hemostat

An instrument for preventing the flow of blood from an open blood vessel by compression of the vessel; available with either straight or curved jaws.

Wounds

Any tissue that has been damaged by surgical or traumatic means.

When are ligating clips (clips) often used?

Are often used in place of suture ligatures when many small vessels need to be ligated in a short period of time.

Chronic Wounds

Are those that persist for an extended period of time.

Argon Plasma Coagulation

Argon plasma coagulation involves the use of argon gas in combination with monopolar electrical energy in the form of a noncontact.

Unintentional Wounds

Include traumatic injuries, closed wounds, and open wounds. Classified in several different ways, according to severity.

When can blood not be used in an autotransfusion machine?

Blood exposed to collagen hemostatic agents and certain antibiotics cannot be used with these devices, as blood may coagulate the system.

In addition to suctioned blood, what other method can be used to obtain blood for an autotransfusion?

Blood may be drained from bloody sponges into a basin of saline, and then aspirated into the autotransfusion machine.

How may blood products be obtained?

Blood products may be homologous (donated by another person), autologous (donated previously by the patient and stored, or obtained through autotransfusion.)

Contusion

Bruise

Which surgeries will often call for blood replacement due to the high volume of blood loss?

Cardiovascular & Prostate surgery.

What are clips made of?

Clips are made of a nonreactive metal, such as titanium or stainless steel, or plastic material and come in various sizes as well as absorbable or permanent varieties.

Hemophilia

Clotting deficiency

Ultrasonic (Harmonic) Scalpel

Consists of a single-use titanium blade attached to a handpiece and a portable generator.

Contaminated Wound

Contamination occurs when a dirty object damages the integrity of the skin. A contaminated wound can become infected within a short period of time. Debridement of infected and/or necrosed tissue may be necessary, followed by thorough irrigation of the wound to further clean and wash out the contaminants, a procedure commonly referred to as an irrigation and debridement (I &D).

Examples of Clean (Class I).

Coronary artery bypass graft, total hip, breast biopsy, craniotomy.

Gangrene

Decay or death of an organ or tissue caused by a lack of blood supply. It is a complication resulting from infectious or inflammatory processes. Gangrene may be caused by a variety of chronic diseases and post-traumatic, post-surgical, and spontaneous causes.

Ischemia

Decreased supply of oxygenated blood to a body part.

When does dehiscence frequently occur?

Dehiscence frequently occurs between the fifth and tenth postoperative day.

Where is dehiscence most often seen?

Dehiscence is most often seen in debilitated patients with friable tissue.

Why do patients have to stop taking aspirin 1 week prior to surgery?

Due to its anticoagulant properties. (It's a blood thinner)

Who is the estimated blood loss reported to?

EBL is reported to and monitored by the anesthesia care provider, who will make the determination in consultation with the surgeon if blood replacement is necessary.

Friable

Easily torn or crumbled.

Types of Thermal Hemostasis

Electrosurgery, Lasers, Argon Plasma Coagulation, & Ultrasonic (Harmonic Scalpel).

EBL

Estimated Blood Loss

Three Types of Wound Healing

First intention (primary union), second intention (granulation), & third intention (delayed primary closure).

Autologous

From oneself.

Homologous

From the same species.

Rh (Rhesus Factor)

Genetically determined blood group antigen that is present on the surface of erythrocytes of some individuals; if the antigen is present the individual is Rh+ (positive) & if absent Rh- (negative).

Second Intention

Healing that occurs when a wound fails to heal by primary union, or the wound is left open and allowed to heal from the inside to the outside by filling with granulation tissue.

Third Intention

Healing that occurs when two granulated surfaces are approximated; also referred to as delayed primary closure.

Thermal

Heat or cold (can be chemical)

What happens if blood given to an Rh- negative individual is Rh+?

Hemolysis occurs, leading to anemia.

What is the most common bleeding disorder?

Hemophilia

Types of Mechanical Hemostasis

Hemostatic Instruments, Ligatures, Clips, Sponges, Pledgets, Bone Wax, & Pressure Devices.

What is most commonly used to compress blood vessels?

Hemostats

Transfusion Reaction

If mismatched blood is transfused, a transfusion reaction occurs and may range from mild reaction to anaphylactic shock.

Type AB Blood

Individuals produce neither antibody, and therefore type AB individuals may receive any type and are called universal recipients.

Type O Blood

Individuals with type O blood naturally produce both A & B agglutinins, making the O a universal donor.

Incision

Intentional cut through intact tissue for the purpose of exposing underlying structures.

Autotransfusion

Is the use of the patient's own blood, which has been processed for reinfusion.

How are vessels ligated?

Ligated using a ligature of the smallest diameter in order to reduce tissue reaction and are often placed at the base of a hemostat that has been used to clamp the end of a vessel.

What are ligatures made of?

Ligatures are made of either natural or synthetic material and are designed either to dissolve over a period of time or to remain in the body tissue permanently.

Hematoma

Localized swelling filled with blood resulting from a break in a blood vessel.

Bone Wax

Made of refined and sterilized beeswax. Used on cut edges of bone as a mechanical barrier to seal off oozing blood.

Electrosurgery

Most commonly used thermal hemostatic device.

Type B Blood

Naturally produces anti-A agglutinins.

Type A Blood

Naturally produces anti-B agglutinins.

Can blood be used for autotransfusion if the patient has a known local or systemic infection?

No.

When does an inflammatory reaction occur?

Occurs when injured tissues release histamine from the damaged cells. The histamine causes the small blood vessels in the area to dilate, increasing the blood flow to the area, resulting in heat, redness, & swelling.

Tourniquets

Often used on extremities to keep the operative site free of blood. Bleeding must be controlled prior to removal of the tourniquet, however, because the use of a tourniquet alone does not achieve hemostasis.

Classic Signs of Inflammation

Pain, heat, redness, swelling, & loss of function.

Dehiscence

Partial or total separation of a layer or layers of tissue after closure.

Puncture

Penetration

What happens after the vasoconstriction of the vessel?

Platelets begin to adhere to the sides of the injured vessel walls, clumping together to form a plug at the end of the injured vessel.

Examples of Chronic Wounds

Pressure sores or decubitus ulcer. A chronic wound may also be due to infection.

Coagulation

Process the body uses to achieve hemostasis

Evisceration

Protrusion of the viscera through the edges of a totally separated wound. Evisceration is an emergency situation that requires immediate surgical intervention to replace the viscera and close the wound.

Ligatures/Ties

Referred to as stick ties when a needle is attached; strands of suture material used to tie off blood vessels.

Traumatic Injury

Refers to physical injuries of sudden onset and severity that require immediate medical attention. Traumatic injuries are the result of a variety of blunt, penetrating, and burn injuries.

Debridement

Removal of devitalized tissue and contaminants.

Abrasion

Scrape

Granulation

Second intention wound healing in which the wound is left open to heal and the space is filled in from the bottom upward with granulation tissue.

Patties (cottonoids)

Smaller compressed radiopaque sponges used for neurological procedures.

What are sponges used for?

Sponges are used to apply pressure on bleeding areas or vessels and to absorb excess blood or body fluids.

Hemostasis

Stopping the loss of blood (hemorrhage)

Inflammation

The body's protective response to injury or tissue destruction.

Hemolysis

The destruction of erythrocytes.

Excision

The removal of tissue-such as a splenectomy (removal of the spleen) or hemicolectomy (removal of a portion of the colon).

Delayed Full-Thickness Injury

The full extent of damage caused by industrial accidents including crash injuries and deep injection of substances into the tissues may not be apparent for several days after the initial injury.

Simple Wound

The integrity of the skin is compromised. There is no loss or destruction of tissue and there is no foreign body in the wound.

Open Wound

The integrity of the skin is damaged.

Laser

The laser provides an intense and concentrated beam of light that is able to cut and coagulate tissue at the same time with very little surrounding tissue destruction.

Chemical Wounds

The most uncommon form of intentional wounds where a chemical is placed to the skin or other tissue surface in an effort to denude and/or coagulate the area.

Immunosuppressed Patients

The patient's immune system may be deficient due to congenital or acquired conditions. (Cancer patients for example).

Closed Wound

The skin remains intact, but underlying tissues suffer damage.

Proliferation Phase (Phase 2 of first intention healing)

This stage begins on approximately the third postoperative day and continues for up to 20 days.

Maturation Phase (Phase 3 of first intention healing)

This stage begins on the fourteenth postoperative day and lasts until the wound is completely healed (up to 12 months).

Lag Phase or Inflammatory Response Phase (Phase 1 of first intention healing)

This stage begins within minutes of injury and lasts approximately 3 to 5 days.

Clean Wound

Wound edges can be approximated and secured. A clean wound is expected to heal by first intention.

Complicated Wound

Tissue is lost or destroyed, or a foreign body remains in the wound.

Who can perform the identification prior to the administration of blood from the blood bank?

Two individuals should perform the identification. Individuals who can perform the identification include the registered nurse, surgeon, and anesthesia care provider.

First Intention

Type of healing that occurs with primary union that is typical of an incision opened under ideal conditions; healing occurs from side to side, dead space has been eliminated, & the wound edges are accurately approximated.

Clean (Class 1)

Uninfected, uninflamed operative wound in which the respiratory, alimentary, genital, or uninfected urinary tracts are not entered.

Pledgets

When bleeding occurs through needle holes in vessel anastomosis, small squares of Teflon called pledgets are used as buttresses over the suture line.