I am a new nurse working in a SICU and am trying to find some information on a patient situation, but am not finding anything on the internet! It is bugging me and just want thoughts from some of you guys.
Post-op liver transplant, intubated, propofol/fentanyl and IVF at 125/hr.
2 JP's on right side of abdomen draining serosanguinous immediate post-op; emptied about 200cc for first 5 hours.
BP stable; NSR. H&H 10.8 and 32. Stable patient.
About 5 hours in, urine output dropped to about 20 for two consecutive hours.
Paged resident; went to empty JPs and noticed that the gown and chux were completed saturated (pt was turned an hour before, so this was all within an hour); emptied the JP and immediately refilled with blood; emptied for a total of 740cc within 10 minutes.
Gave 500cc NS bolus for low urine output.
SBP was 120s (norm) and HR was 80s (also what it had been running). Again, stable.
Sent all the labs; H&H was still 10.5/32 based on ABG but the VBG (source was from JP drainage) H&H was 3.2 and can't remember- but it was low.
What I don't understand:
Docs said it was bleeding ascites? I have never heard of this and can not find anything on the internet about this, except that bloody ascites fluid = not good; yet they aren't too concerned.
Also- where did this blood come from since the pt came back from surgery with the JPs draining normal amounts of serosang drainage and then 5 hours later a random 700cc dark bloody drainage.
Why didn't this affect BP, HR and H&H?
I am wondering if it had to do with positional change from the turn? But, I am pretty sure the pt was turned on that side before, but i am not 100% sure now.
What am I missing?