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Download Antigens are proteins that set up antibody reaction - A
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Hemostasis Defined • Stopping or arresting the loss of blood or hemorrhage 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 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 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 Clotting Process • Platelets>thromboplastin>prothrombin> thrombin>fibrinogen>fibrin 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) Types of Hemostasis • Mechanical • Thermal • Pharmacological or Chemical Mechanical • • • • • • • • • Clamp Clips Ligature (ties or suture) Sponges Pledgets Bone wax Suction Drains Pressure device (tourniquet) Thermal • • • • Electrocautery Laser Harmonic scapel Cryotherapy Chemical or Pharmacological • • • • • Gelatin (Gelfoam) Collagen (Avitene) Oxidized cellulose (surgicel) Silver nitrate Epinephrine (vasoconstrictor) – Typically an additive to local anesthetics • Thrombin 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 Transfusions • Autologous – self donated previously prior to surgery • Homologous – donated from another 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 A AB and Rh antibodies B A+ B- B+ B antibodies A and Rh antibodies A antibodies Rh AB AB AB- B Rh antibodies AB+ AB AB A NO antibodies O- O+ A, B, Rh antibodies A, B antibodies 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
