[nursebynite]

Does anyone know the reason why some ortho surgeons want their pt's hemovacs decompressed when the output reaches 500 cc, and others want them to stay compressed until hemovac is removed- just curious

[meownsmile]

Depending on what happened in surgery some patients have more drainage. It depends on how much disection the doc had to do, what their bleeding time prior to surgery was. If they were on asprin prior to surgery etc. Our docs usually use the 800ml mark. We call and have to have an order to remove compression from the HV. We usually will ice and elevate at that point also. We know the routine, but we have to call and report the drainage, we usually just tell the doc what we've done.

[P_RN]

800 cc is a lot!! Do you empty per shift or twice a shift or is that 800 cc each time? I'd think the doc would be looking for a bleeder with that much output.

One doc was skilled at near bloodless surgery, it was absolutely amazing to watch his patients do better than the standard.

And is this a true hemovac or one of the reinfusion thingies?

[meownsmile]

NO,, it is hemovac,, IF we encounter 800ml within a shift we will ice elevate and decompress the hemovac. We will empty intermittently within the shift and call it if it reaches the set amount. Some have more some much less. Never had to have anyone go back in for a bleed though. Usually if we have that much the doc is pretty much aware already that there was going to be a substantial amount of drainage. It also depends on if and how much irrigation he has used during surgery too, along with serrous fluids and blood, so to call it all blood isnt really true.
We use autotransfusers and have our protocol for those too.

[Marie_LPN]

For TJR e have some docs who fill the knee up with antibiotic saline while they're closing, so that creates a LOT of Hemovac drainage. If a tournequet wasn't used during the case d/t a history of DVT, that might make a difference as well.

[P_RN]

I don't think I have ever seen a total with that much of ANY kind of output. Maybe 80-100 but gosh 800?

No I take that back we had one man who was bleeding so bad it was running off the edge of the bed. The doc was trying to tell us we were just panicking over nothing. We finally convinced him to at least come see and guess what? Back to the OR.

Marie do your docs use the cell saver?

[Marie_LPN]

We use the CellSaver on our spine cases and AAAs. Typically bloodloss for our totals is around 300-400.

[P_RN]

Ya mean there's something else?
Been in ortho so long I actually "forgot" about other kinds of operations