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Post-operative bleeding |
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1. Support the patient. If hypotensive and tachycardic, establish iv access and replace lost blood volume 2. Diagnose cause, nature and site of blood loss 3. Control the bleeding point
Post-operative bleeding is described as immediate, reactionary and secondary.
Immediate: When true haemostasis has not been achieved at end of surgical procedure.
Reactionary: Within 48 hours of surgery and caused by a rise in BP opening up divided blood vessels, which were not bleeding at completion of surgery.
Secondary: Occurs around 7 days following surgery. Usually due to the blood clot being destroyed by infection or causing ulceration to local vessels.
Bleeding usually comes from one of three sources: 1. Gingival capillaries 2. Vessels in the bone of the socket 3. A large vessel under a flap or in bone such as the inferior alveolar artery
Management: Reassure patient and take a good history (including medical and drug history). Wear gloves and an apron. In good light and using suction clean the area and try to identify the source of the bleeding. Squeeze the edges of the socket together—this will stop gingival bleeding. LA and suturing will achieve haemostasis in this case. If bleeding continues it is from vessels in bone, which need some form of pack.
Technique: Give LA if needed. It may be necessary to undo sutures and evacuate the clot to identify the bleeding point. Place a tight suture around it and repeat until bleeding is reduced. Close wound and ask patient to bite down on a gauze for at least 15 minutes. Bleeding from the socket requires a pack, such as ’Surgicel’ resorbable haemostatic gauze (oxidized cellulose) +/- agents such as adrenalin or epsilon aminocaproic acid soaked in mesh.
If all fails, admit to hospital and treat with a pressure pack, analgesia and a sedative anti-emetic. Haematological investigations on such patients would be wise. |
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Principles of management of post-operative bleeding |