hematoma after CABG

[littleannabell]

I am a home health nurse and I have a patient who had CABG approx. 3 weeks ago. She has very large hematoma under scabbed incision at left groin site. The distal end of the scab has come off and is now bleeding a fair amt. of serosang. fluid. I do not have a lot of experience with this and was wondering if this drainage would be coming from the hematoma or the incision. Thanks for your help.

[luvRNs, BSN, MSN, RN]

As a former open heart nurse, sounds like the physician needs to be called. Two reasons to call; If the hematoma is actively draining then what is the patient's coagulation status? The second concern is that there may also be an underlying infection here.

[littleannabell]

Thank you so much. I will def. let surgeon know.

[netglow, ASN, RN]

Also wonder about what is on/in the vessel... could be big time clot that could break/fragment and/or gush.

[ProBeeRN, BSN, RN]

In my experience, open heart surgeons tend to be very particular. When in doubt, make the call and give your assessment findings.

[qt2168]

I am curious though. Is it the hematom that is oozing or just the incision?

[littleannabell]

qt2168, I can't tell because when I remove the dressing nothing is draining at that time. The incision is on top of the hematoma so it is hard to tell. the hematoma is 10cm wide x 7cm long, it is very large. the incision is only about 3cm wide by 4or 5cm long with brown scab.

[shiccy]

If it's not actively oozing then it's probably OK as long as it's kept covered and proper cleaning is done... Sometimes it can be the first indication of infection, though, so letting the docs know is def a good thing. Is the incision red/hot? I know it's probably ecchymotic, but if it is infected you can still tell sometimes.

Let us know what he says!

[Tait, MSN, RN]

When in doubt, page it out!

I would call.

Tait