Total knee and drain question......

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    Hi everyone,
    I work on a med/surg floor where we frequently have total hips and total knees. The other night, I had a patient that had a right total knee done. He came back to the floor sometime around noon.....he had a constavac drain....the drain pulled 650cc of blood that was then re-infused on the pm shift. Well..I come along to do the night shift...assess the patient....notice that there really wasn't a whole lot of additional drainage in the container..but didn't think much of it...because...sometimes our knees just don't drain that much. Anyways....the doc came in in the am to change the initial dressing and pull the drain. When he pulled the drain..a lot of drainage came out. He made the comment up at the desk that the drain probably clotted off..which happens. Anyways...we then procede to put the drain, tubing, etc. in the bio bag and notice that the clamp is clamped on the tubing!!!! The doc was called about it later in the day...and threw a fit. Now...I know for an absolute fact that I did not clamp the drain...our assumption is that is was done on the pm shift after the autologous blood was re-infused. The doc came in this am..and was still throwing a fit. He goes "I want to know who clamped that drain" I piped up and said...I didn't clamp him but I had the patient during the night and never noticed that the clamp was clamped. He was actually really nice and said "it's not your fault"...but I guess I still feel really, really bad. Chances are..by the time I would have noticed the clamp...it would have been clotted off anyways. But man..I feel bad! The patient now has a hot swollen knee...probably full of blood. The doc said "I told the patient too" he has a right to know that somebody screwed up". Now the patient probably thinks that I did it...which I know that I didn't. But anyways....to my actual question..geesh. Will this blood just re-absorb or whatever...or is he going to have problems...? I feel really bad that it happened..I just want everything to turn out alright. A new employee (and her preceptor) had the patient....I suppose the new employee didn't know any better but...geesh...it's leaving me feeling aweful...any advice?
    Sincerely,
    IloveSnoopy
  2. 6 Comments so far...

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    Wow. It's been 3 years since I've touched a constavac.

    That's the cannister shaped one with the red button/lever-right?And even then only one of our 30 or so docs used it. Most never had sufficient drainage so they thought a plain hemovac was better.

    Don't you clamp the incoming tube while you're filling the blood bag? Then unclamp it? And seems like we also turned the pump off and let it go to gravity........ohhhh wracking my brain here. I think you are right that the previous nurse probably clamped it while the bag filled. You were absolutely correct to tell the doctor. I'm sorry I can't suggest any more. Keep us osted OK?

    I think the blood will resorb.....eventually. I expect the doc will hold off on ambulation/cpm for perhaps a day? And he will ice it for sure.
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    had a tkr pt who developed foot drop post op not noted untill 2 days post however pt c/o numbness imm. post op thought to be from epidural incident reportable nursing held responsible i feel assessments didn't pick it up because epidural was thought to be the cause
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    We have one ortho that uses the autotransfuser. We all like them,because usually they tend to not need transfusions later. My guess is someone clamped it when they changed out the blood container and forgot to unclamp when they had the new one in place. Which could be easy to do if you are, like most ortho floors, way to busy. I always watch the new container for a few minutes after i have attached it to make sure the blood in the tubing is either flowing, or moving toward the chamber, and usually wait until it has passed the clamp. It should be reabsorbed however, the patient may have some decreased ROM for a while until the swelling and blood has been reabsorbed. It may slow their recovery but it shouldnt keep them from fully recovering.
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    Quote from roselcasey
    had a tkr pt who developed foot drop post op not noted untill 2 days post however pt c/o numbness imm. post op thought to be from epidural incident reportable nursing held responsible i feel assessments didn't pick it up because epidural was thought to be the cause
    Rosel did the surgeon not pick up on it? What about anesthesia, did they not see it? How often were nv checks done post op? Who first reported it? How about PT did they not worry about the patient's gait? Even ttwb it should have been obvious.
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    The blood should just reabsorb..It should not really cause any problems after the first few days...Chances are, if he pulled the drain the next morning anyway, it would have swollen anyway..
    I worked ortho for about 4 1/2 years...some docs used constavacs (I did not feel that those patients recieved any less transfusions), some used hemovacs, and some used no drains at all..many of the hips and knees were swollen anyway..many used transfusions anyway...
    However, you should not have to clamp the tubing from the leg to the canister when you are filtering the blood for reinfusion..just clamp the tubing to the bag once the blood is in the bag...but, I have even had nurses cut the wrong tubing once the transfusion was complete..

    Hope things work out for you...

    Remember, the only perfect person was hung on the cross many years ago..you are going to make mistakes in your life...just learn from them..


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