[kprnc58]

Hi to all nurses.
I'm an "old R.N." working in a small hospital in mn. We do alot of joint replacements. Would love to hear from nurses about their experiences with blood loss in totals, and at what hgb's your dr's order transfusions. We also use suretrans system for autotransfusion and often see fevers within 48hrs post op, anybody else see this?
kprnc58

[Grace Oz]

Welcome to allnurses!

[Nurse_Drumm]

Hi there!

I too work in a small facility and care for many ortho patients. I work on a med/surg floor that also specializes in ortho and oncology. We do many total joints, mainly knees and hips. I live in Vermont, so we also see a lot of fractures in the winter from skiing accidents. I've been a RN for 4 years now, and just love it!

As far as blood loss, yes, we do see it frequently, especially in the knees. Our facility also uses the suretrans system. But I've gotta say, our ortho docs don't seem to sweat the blood loss too much, and I've seen Hgb's as low as 8 and the docs don't order transfusions. We keep them well hydrated, and monitor the bleeding. Most of the time, it scares me a bit to have H+H's so low, but by god, those numbers start to rise after a few days all by themselves. I really think they push it too much on occasion, but... the numbers rise. Once in a blue moon, we have to transfuse, but I must admit, it's not very often with the orthos.

As far as the temps go? Absolutely count on it. I'm not sure I've EVER had a post-op ortho that DIDN'T get a temp at some point. From my experience, any time there is trauma to a bone, be it via fracture or operatively, there's going to be a temp. I've gone so far now as to warn my patients that they WILL at some point have a fever, but assure them that it's par for the course. You know what? Sometimes, I won't even medicate for the temp the first time I see they have one, but will wait 4 hours and recheck it then. If, after 4 hours the temp is still elevated, I'll medicate, but more often than not, the temp resolves itself pretty quickly. I don't know, call me crazy, but my methods seem to work.... LOL.

Hope this puts you a little more at ease..... Took me a long time to realize these things are pretty much "normal".

Ahhhhh.... gotta love nursing.

[P_RN]

Sorry to be late in welcoming the new ortho member. I've been in the hospital for the last 3 weeks. I'm retired now so my experience is a few years old. But when I started everybody got transfused at hgb of 10. That was in the old days before HIV, Hep, etc were so rampant. I've seen docs do virtually bloodless surgery on JW patients, I've seen docs with minimal blood loss transfuse, not transfuse, cell save, etc. It's up to the individual doc. Most would have autologous blood banked but not all.
I've found that most patients have an elevated temp after surgery. Good pulmonary toilet (cough and deep breathe to us older nurses) will help much more than trying to convince the doc to allow APAP. Up OOB the next am and ambulating helps a lot too. I have seen Hgb's of 4 (chronic/religious etc) and the patient does fine. I've seen a drop of 2 points (say from 12 to 10) and the patient flakes out......Over my 33 years I doubt there's much I haven't seen, but every day brought something new, so that's how it is.