colon resection clinical pathway

[unsaint77]

I was reviewing a clinical pathway for colon resection and came up with two questions;

Q1) It says, as a pre-op, type and cross if hgb is less than 10 (for a male). colon resection is a major op, isn't it? i would think type and cross for possible blood transfusion is a good idea no matter what. Do you think it sounds right?

Q2) It says TEDs stocking pre-op. Is it necessary to put on antiembolism stocking BEFORE the op?

Thank you

[Rose_Queen, BSN, MSN, RN]

I was reviewing a clinical pathway for colon resection and came up with two questions;

Q1) It says, as a pre-op, type and cross if hgb is less than 10 (for a male). colon resection is a major op, isn't it? i would think type and cross for possible blood transfusion is a good idea no matter what. Do you think it sounds right?

Actually, in my 5 years working general surgery, I've only had to give blood for a colon resection a handful of times, and most of those were for GI bleeds that the endoscopy docs couldn't get under control. Most of the others were very critical patients who had a lot more than just an elective, scheduled, routine colon resection. Also, our anesthesiologists and surgeons won't transfuse until hgb is less than 8 and often, if there aren't other issues will wait until it's less than 7. In my experience, blood loss (except in trauma/GI bleed/critical patient) is usually 100-250cc. If the surgeon uses good technique, there shouldn't (generally speaking) be excessive blood loss. It's also possible to do a stat type and cross in the OR and have blood available within 30 minutes. In an extreme emergency, it's also possible (though not best practice and reserved for oh crap we're gonna lose the patient moments) to give O- uncross-matched blood. Blood transfusion, even if done properly, is not risk-free. Most physicians use it as a necessary evil, not a routine occurrence.

Q2) It says TEDs stocking pre-op. Is it necessary to put on antiembolism stocking BEFORE the op?

Thank you

The more prevention, the better! Anesthesia drugs can cause some pretty intense vasodilation. At that point, the patient is already lying flat with no active motion to promote blood return to the heart, leading to more venous pooling and potential for DVTs. My OR also uses SCDs (sequential stocking devices) that ideally should be in place and turned on prior to any anesthesia drugs being given. Granted, we reserve TEDs with SCDs for certain types of surgery/patient risks and usually only use SCDs by themselves, but I'm sure your facility can provide evidence to back up their clinical plan.

[unsaint77]

Thank you so much poetnyouknowit .