Pelvic area blood pooling and increased hemorrhage risk

[lee.mckinley]

I'm trying to understand the reasons for increased hemorrhage risk after abdominal surgery. Specifically the statement "Blood pools in the pelvic area after abdominal surgery and increases the risk for hemorrhage".

1) I understand blood pooling in the areas where vessels are damaged, but not why it pools in an area other than the damage. While some veins that would return the blood to the heart have been damaged, there are others that can pick up the extra load.

2) Aside from the severed vessels is the increased risk related to pressure of pooling blood? or nearby location if there is a rupture?

Thank you,

Lee

[nurseprnRN, BSN, RN]

This doesn't make a lot of sense to me as given. Are they talking about decreased venous return from the pelvic basin that somehow increases venous pressures in the operative site, where the cut vessels might leak (assuming here that there wasn't adequate hemostasis intraoperatively)? Or are they talking about random blood sloshing around the operative site, some of which sits in the pelvic area? And even if so (most surgeons clean up or prevent such spillage a great deal better than that), so what?

Is the reference you're quoting addressing a particular surgery, or just any old abdominal surgery? Is there any more information, or references in the bib?

[Lev, MSN, RN, NP]

When I think of blood pooling in the pelvic area after surgery, I think of that as the hemorrage. I have a young patient (in her 30s) who had a hysterectomy once, who was severely anemic. She kept thinking she needed to have a BM. She mentioned this during shift change right after the lab called with the critical value. I think her hematocrit was 18 or 19 hemoglobin was 5. I told the night shift RN, I bet you all that blood is sitting in her abdomen. I said it in passing and then forgot about it. As I was transfusing, her HR shot up to the 170s. I called a rapid response (this was a non-tele floor) and she was sent to step-down. There they did a cat scan which basically showed a large hematoma plus other small pockets of blood spread throughout pelvis, but she was not actively bleeding. She was hemorrhaging in a way...internally. I don't understand that sentence. Is it from a test question or one of your powerpoints at school? I hope it's not from your text book, because it's confusing.

[lee.mckinley]

The question is about pt. safety (monitoring) after any abdominal surgery. I didn't quote it exactly because it is from copyrighted NCLEX preparation materials. Obviously anyone is at increased risk for hemorrhage after surgery, but I don't understand the part about blood pooling in the pelvic area because a pt. had surgery in that area. They are not clear what they mean by blood pooling. Anytime blood pools, wouldn't it also clot?

[nurseprnRN, BSN, RN]

Maybe. And don't forget that clots lyse. Lev has given you the classic example of blood pooling in the lower abdomen after surgery, so what about that didn't you understand?

It's the surgery that increases the risk for bleeding, not the blood pooling in the abdomen. That's what happens when the blood starts sloshing around in there.

Or am I still missing something in your question? Are they perhaps asking what you should be doing for a postop patient to evaluate for potential postop hemorrhage that you wouldn't see on dressings or tube drainage because it's confined inside the peritoneum (or retroperitoneum)?

[Esme12, ASN, BSN, RN]

The biggest issue of there is unresolved bleeding to even leaky vessels post op from trauma and manipulation there would have to be a HUGE blood loss before any symptoms were physically present.

[AJJKRN]

Because I started on a trauma/surgical floor this question makes me think about our "major bowel" surgeries. This makes me think about the surgical anastomoses leaking and one of the things that we would keep an eye on to get ahead of the game was the patients hourly urine output/VS for the first twelve hours after surgery and coming from PACU. So does your answer have to do with adequate urine output maybe? It's a big key indicator along with trending vital sign changes in shock.

[Lev, MSN, RN, NP]

Blood pooling just means that it is going where it shouldn't be i.e. it leaves the intravascular space (the veins, arteries, and capillaries) and isn't in circulation where it can be used by the body. It just sits there. Most of the time, it is reabsorbed slowly by the body.

[lee.mckinley]

Thank you all for your comments - I was concerned I had missed a concept or had something incorrect in my thinking. I think I just over-thought the statements. I did not have an abdominal surgical pt. during my clinicals and feared I was missing something.

[klone, MSN, RN]

I think another issue maybe they're trying to address is if the blood is "pooling in the abdomen/pelvis" then that means it's pooling INSIDE where it's not visible/obvious/apparent, so one might be less likely to identify the hemorrhage immediately, the way they would if it was pooling externally.

[Esme12, ASN, BSN, RN]

The blood will "pool" in the path of least resistance...the pelvic cavity...before there are physical symptoms of the patient a large accumulation can occur.

[lee.mckinley]

I like your critical thinking flow sheet for nursing students. I just completed nursing school, but I think I'm going to use that for a bit until I have a better knowledge base.