MO787USE OF THE PREVENTIVE HAEMOSTASIS IN SURGICAL COMPLICATIONS OF VASCULAR ACCESS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Simone Corciulo ◽  
Bianca Covella ◽  
Luigi Rossi ◽  
Carlo Lomonte
Keyword(s):  
Blood Loss ◽  
Vascular Access ◽  
Injury Risk ◽  
Postoperative Bleeding ◽  
Systolic Pressure ◽  
Skin Incision ◽  
High Flow ◽  
Time Of Application ◽  
Life Threatening ◽  
Short And Long Term

Abstract Background and Aims Arteriovenous fistula (AVF) is currently the recommended vascular access type and its preservation is required to ensure a safe treatment for HD patients. Nevertheless, reinterventions are often needed to treat life threatening complications such as eschars, aneurysms, high flow.These surgical procedures are at high risk of bleeding, time-consuming and technically demanding. Here we describe our approach by using preventive hemostasis to treat different types of AVF complications, such as aneurysmectomy, high flow fistula correction, ulcerectomy. Method The technique consists of a few steps. First, regional anesthesia is performed by brachial plexus nerve block and intravenous antibiotic prophylactic therapy is administered. Then, an inflatable tourniquet is placed on the arm, proximally to the elbow joint, after wrapping the site with a soft gauze to prevent postoperative discomfort and bruising due to accidental pinch of the skin. The arm is then elevated to allow passive exsanguination and a 5” Esmarch bandage is applied from the hand to the tourniquet cuff. The methodical application of the Esmarch bandage requires an assistant to hold the arm properly in the upright position. Once the bandage is applied, the tourniquet is inflated to complete the exsanguination of the extremity. The inflation pressure has to be adapted to patient systolic pressure, generally a 'suitable' pressure for an upper limb tourniquet is 250-300 mmHg. Lastly, the Esmarch bandage is unwrapped and, after sterile surgical draping, it is possible to proceed to skin incision. Results From Jan 2019 to Dec 2020, we enrolled 9 patients with AVF complications treated with the preventive emostasis. The mean age of the patients was 62 years (range, 45-80 years). Table 1 shows types of AVFs and complications, performed revisions, outcomes, short and long term complications. The tourniquet average time of application was 29 + 7,7 min. Preventive hemostasis ensures absence of blood loss, even during high flow access revision. In one patient, a moderate subcutaneous hemorrhage occurred 8 hours after the end of the surgical procedure, requiring further revision. No vascular or soft tissue complications were reported except for temporary dysesthesias. Conclusion Our experience shows that preventive haemostasis offers several advantages for surgeons and patients, allowing a clear operative field and avoidance of application of clamps, prevents blood loss, and reduce the need for blood transfusion. Furthermore, reperfusion injury risk is minimized. The only complication occurred suggests the recommendation to suture skin incision after removing the tourniquet to reduce risk of postoperative bleeding. In conclusion, the technique is reliable and safely applicable to surgical treatment of vascular access complication.

Aprotinin in the management of life-threatening bleeding during extracorporeal life support

Perfusion ◽  
2000 ◽  
Vol 15 (3) ◽  
pp. 211-216 ◽  
Author(s):  
Abhik K Biswas ◽  
Leslie Lewis ◽  
John F Sommerauer
Keyword(s):  
Blood Loss ◽  
Blood Product ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Postoperative Bleeding ◽  
Case Series ◽  
Coagulation Cascade ◽  
Massive Blood Loss ◽  
Dosing Regimens ◽  
Life Threatening

Contact with the synthetic surfaces of an extracorporeal circuit induces alterations in vascular components, derangements of the coagulation cascade and a systemic inflammatory response. Aprotinin reduces intraoperative and postoperative bleeding in adults undergoing cardiopulmonary bypass; however, trials in children have not had similar favorable results. While there have been some anecdotal reports, there have been no prospective clinical trials exploring the utility of aprotinin in the prevention of or as a therapy for bleeding while on extracorporeal life support (ECLS). We present a case series on our experience utilizing aprotinin for the treatment of life-threatening bleeding during ECLS. The combination of a loading dose followed by a continuous infusion resulted in significant reduction in blood loss and blood product utilization. This suggests that aprotinin may have clinical efficacy in the management of massive blood loss while on ECLS; however, larger controlled trials will be essential to determine the efficacy and appropriate dosing regimens before widespread use in ECLS can be advocated.

The Role of Tranexamic Acid in Controlling Bloodloss During PCNL for Staghorn Calculi

2019 ◽  
Vol 69 (12) ◽  
pp. 3745-3748
Author(s):  
Raluca Costina Barbilian ◽  
Victor Cauni ◽  
Bogdan Mihai ◽  
Ioana Buraga ◽  
Mihai Dragutescu ◽  
...  
Keyword(s):  
Blood Loss ◽  
Tranexamic Acid ◽  
Percutaneous Nephrolithotomy ◽  
Kidney Stones ◽  
Postoperative Bleeding ◽  
Invasive Technique ◽  
Transfusion Rate ◽  
Staghorn Calculi ◽  
Type Of Surgery

The aim of this paper is to assess the efficiency and safety of the tranexamic acid in reducing blood loss and the need for transfusion in patients diagnosed with staghorn calculi treated by percutaneous nephrolithotomy. Percutaneous nephrolithotomy (PCNL) is a minimally invasive technique used for large kidney stones. Hemorrhagic complications and urinary sepsis are serious complications associated with this type of surgery. Tranexamic acid is an antifibrinolytic drug that has the property of reducing intra or postoperative bleeding. The experience with tranexamic acid in preventing blood loss during percutaneous nephrolithotomy for is limited. The use tranexamic acid in percutaneous nephrolithotomy for staghorn type stones is safe and is associated with reduced blood loss and a lower transfusion rate.

scholarly journals Assessment the role of tranexamic acid in prevention of postpartum hemorrhage

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Nevein Gerges Fahmy ◽  
Fahmy Saad Latif Eskandar ◽  
Walid Albasuony Mohammed Ahmed Khalil ◽  
Mohammed Ibrahim Ibrahim Sobhy ◽  
Amin Mohammed Al Ansary Amin
Keyword(s):  
Blood Loss ◽  
Cesarean Section ◽  
Tranexamic Acid ◽  
Postpartum Hemorrhage ◽  
Postoperative Bleeding ◽  
Control Group ◽  
Study Group ◽  
Mortality And Morbidity ◽  
Lower Segment Cesarean Section ◽  
Prophylactic Use

Abstract Background Postpartum hemorrhage (PPH) is one of the leading causes of maternal mortality and morbidity worldwide. It is believed that hemostatic imbalance secondary to release of tissue plasminogen activator (tPA) and subsequent hyperfibrinolysis plays a major role in PPH pathogenesis. Antifibrinolytic drugs such as tranexamic acid (TXA) are widely used in hemorrhagic conditions associated with hyperfibrinolysis. TXA reduced maternal death due to PPH and its use as a part of PPH treatment is recommended, and in recent years, a number of trials have investigated the efficacy of prophylactic use of TXA in reducing the incidence and the severity of PPH. The study is aiming to assess the efficacy of tranexamic acid in reducing blood loss throughout and after the lower segment cesarean section and reducing the risk of postpartum hemorrhage. Results The amount of blood loss was significantly lower in the study group than the control group (416.12±89.95 and 688.68±134.77 respectively). Also the 24-h postoperative hemoglobin was significantly higher in the study group (11.66±0.79 mg/dl) compared to the control group (10.53±1.07mg/dl), and the 24-h postoperative hematocrit value was significantly higher in the study group (34.99±2.40) compared to control (31.62±3.22). Conclusion Prophylactic administration of tranexamic acid reduces intraoperative and postoperative bleeding in cesarean section and the incidence of postpartum hemorrhage.

scholarly journals Liver Retraction Using n-Butyl-2-Cyanoacrylate (NBCA) Glue during Laparoscopic Splenectomy and Azygoportal Disconnection in Cirrhotic Patients

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Du Kong ◽  
Wei Wang ◽  
Gang Du ◽  
Binyao Shi ◽  
Zhengchen Jiang ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Portal Hypertension ◽  
Liver Function ◽  
Blood Loss ◽  
Laparoscopic Splenectomy ◽  
Postoperative Bleeding ◽  
Gastroesophageal Varices ◽  
Liver Retraction ◽  
Significant Difference ◽  
Cirrhotic Patients

Background. Although liver retraction using n-butyl-2-cyanoacrylate (NBCA) glue has been applied to laparoscopic upper abdominal surgery in noncirrhotic patients, there is still no consensus on its safety and feasibility for cirrhotic patients. In this study, we aimed to investigate the safety and effectiveness of liver retraction using NBCA glue during laparoscopic splenectomy and azygoportal disconnection (LSD) for gastroesophageal varices and hypersplenism secondary to liver cirrhosis and portal hypertension. Methods. Thirty-nine gastroesophageal varices and hypersplenism secondary to liver cirrhosis and portal hypertension patients were included in our study. We performed LSD in the presence of NBCA glue (n = 22, NBCA group) and absence of NBCA glue (n = 17, n-NBCA group), respectively. The operation time, blood loss, postoperative hospitalization, and liver function were compared between the two groups. Results. There was no mortality during the operation. One patient in non-NBCA group received open surgery due to parenchyma hemorrhage. Postoperative pleural effusion occurred in 2 cases of the NBCA group and 1 of the non-NBCA group. One showed left subphrenic abscess in the non-NBCA group. No postoperative bleeding occurred after 9-30 months of follow-up. The time of operation in NBCA group was significantly shorter than those in n-NBCA group (198.86±17.86 versus 217.81±20.25min, P<0.01). Blood loss in NBCA group was significantly lower than non-NBCA group (159.09±56.98 versus 212.50±88.51 ml, P<0.05). The levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were increased on day 1 after LSD and decreased to normal level on day 7 after LSD in both groups. There was no significant difference in postoperative hospitalization and liver function between the two groups. Conclusion. Liver retraction using NBCA glue during LSD for gastroesophageal varices and hypersplenism secondary to liver cirrhosis and portal hypertension is safe, effective, and feasible.

scholarly journals Comparison between scalpel incision and electrocautery incision in midline abdominal surgery: a comparative study

2021 ◽  
Vol 8 (5) ◽  
pp. 1507
Author(s):  
Amit Yadav ◽  
Lakshman Agarwal ◽  
Sumit A. Jain ◽  
Sanjay Kumawat ◽  
Sandeep Sharma
Keyword(s):  
Postoperative Pain ◽  
Blood Loss ◽  
Abdominal Surgery ◽  
Wound Infection ◽  
Skin Incision ◽  
P Value ◽  
Wound Area ◽  
Significant Difference ◽  
Group A ◽  
Group B

Background: Fear of poor wound healing have curtailed the use of diathermy for making skin incision. Scalpel produces little damage to surrounding tissue but causing more blood loss. Our aim of study was to compare electrocautery incision with scalpel incision in terms of incision time, blood loss, postoperative pain and wound infection.Methods: Total of 104 patients were included in the study undergoing midline abdominal surgery. Patients were randomized into electrocautery (group A) and scalpel (group B). The incision dimension, incision time and blood loss were noted intraoperatively. Postoperative pain was noted on postoperative day 2 using visual analog scale. Wound complications were recorded on every postoperative day till the patient was discharged.Results: 52 patients in each of the two groups were analyzed. There was significant difference found between group A and group B in terms of mean incision time per unit wound area, 8.16±1.59 s\cm2 and 11.02±1.72 s\cm2 respectively (p value=0.0001). The mean blood loss per unit wound area was found to be significantly lower in group A (0.31±0.04 ml\cm2) as compared to group B (1.21±0.21), p value=0.0001. There was no significant difference noted in terms of postoperative pain and wound infection between both groups.Conclusions: Electrocautery can be considered safe in making skin incision in midline laparotomy compared to scalpel incision with comparable postoperative pain and wound infection with less intraoperative blood loss and less time consuming.

scholarly journals The Pathophysiology and Management of Hemorrhagic Shock in the Polytrauma Patient

2021 ◽  
Vol 10 (20) ◽  
pp. 4793
Author(s):  
Alison Fecher ◽  
Anthony Stimpson ◽  
Lisa Ferrigno ◽  
Timothy H. Pohlman
Keyword(s):  
Blood Loss ◽  
Whole Blood ◽  
Damage Control ◽  
Clinical Information ◽  
Fresh Frozen Plasma ◽  
Practical Reasons ◽  
Freeze Dried ◽  
Life Threatening ◽  
Sudden Decrease ◽  
Polytrauma Patient

The recognition and management of life-threatening hemorrhage in the polytrauma patient poses several challenges to prehospital rescue personnel and hospital providers. First, identification of acute blood loss and the magnitude of lost volume after torso injury may not be readily apparent in the field. Because of the expression of highly effective physiological mechanisms that compensate for a sudden decrease in circulatory volume, a polytrauma patient with a significant blood loss may appear normal during examination by first responders. Consequently, for every polytrauma victim with a significant mechanism of injury we assume substantial blood loss has occurred and life-threatening hemorrhage is progressing until we can prove the contrary. Second, a decision to begin damage control resuscitation (DCR), a costly, highly complex, and potentially dangerous intervention must often be reached with little time and without sufficient clinical information about the intended recipient. Whether to begin DCR in the prehospital phase remains controversial. Furthermore, DCR executed imperfectly has the potential to worsen serious derangements including acidosis, coagulopathy, and profound homeostatic imbalances that DCR is designed to correct. Additionally, transfusion of large amounts of homologous blood during DCR potentially disrupts immune and inflammatory systems, which may induce severe systemic autoinflammatory disease in the aftermath of DCR. Third, controversy remains over the composition of components that are transfused during DCR. For practical reasons, unmatched liquid plasma or freeze-dried plasma is transfused now more commonly than ABO-matched fresh frozen plasma. Low-titer type O whole blood may prove safer than red cell components, although maintaining an inventory of whole blood for possible massive transfusion during DCR creates significant challenges for blood banks. Lastly, as the primary principle of management of life-threatening hemorrhage is surgical or angiographic control of bleeding, DCR must not eclipse these definitive interventions.

A Randomized Controlled Study on the Use of Tourniquet in Primary Total Knee Arthroplasty

2022 ◽  
Author(s):  
Chaofan Zhang ◽  
Chun Hoi Yan ◽  
Ping Keung Chan ◽  
Henry Fu ◽  
Kwong Yuen Chiu
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Loss ◽  
Knee Arthroplasty ◽  
Primary Total Knee Arthroplasty ◽  
Skin Incision ◽  
Randomized Controlled Study ◽  
Controlled Study ◽  
Randomized Controlled ◽  
Total Knee ◽  
Primary Total Knee

Abstract Background The use and the optimal timing of tourniquet during primary total knee arthroplasty (TKA) is controversial. Most previous studies failed to show clinically significant differences in different strategies. The aim of this study was to determine how three strategies of tourniquet application affect the outcome in TKA patients. Methods This was a prospective randomized controlled study. Patients who undergo TKA were randomized into one of the three groups (1:1:1 ratio): tourniquet inflated from skin incision to cement hardening, tourniquet from cement application to hardening, and tourniquet from skin incision to skin closure. The perioperative blood loss, limb swelling, and complications were recorded. The level of hemoglobin, hematocrit, C-reactive protein (CRP), interleukin (IL)-6, creatine kinase (CK), and lactate dehydrogenase (LDH) were determined. Patients' thigh and TKA wound pain, Knee Society knee score (KSKS) and Knee Society functional assessment (KSFA) scores, and rehabilitation parameters were evaluated. Results A total of 90 patients were enrolled. The baseline characteristics were comparable. We only found significant difference in the intraoperative blood loss (skin to cement: 58.7 ± 36.1 mL, cement-only: 147.8 ± 107.9 mL, skin to skin: 16.3 ± 13.1 mL, p < 0.0001). There were no statistical differences in postoperative drainage, thigh/knee circumference, change of hemoglobin/hematocrit, CRP, IL-6, CK, and LDH on day 1 to day 4 after surgery. The thigh/TKA wound Visual Analogue Scale scores, KSKS score, KSFA score, and rehabilitation parameters were not significantly different at up to 6-month follow-up. No thromboembolic events were noted. Conclusion Our results revealed that there was no best tourniquet strategy in TKA. Different tourniquet methods can be utilized based on surgeon preference without affecting outcomes.

scholarly journals Primary free fibula reconstruction in life-threatening haemorrhage from high flow arteriovenous malformation of mandible

2018 ◽  
Vol 51 (02) ◽  
pp. 222-230
Author(s):  
Parvathi Ravula ◽  
Srikanth Rangachari ◽  
Rammurti Susarla ◽  
Laxman Sambari ◽  
Srinivas Saraswathi Jammula
Keyword(s):  
Arteriovenous Malformation ◽  
Curative Resection ◽  
High Flow ◽  
External Carotid ◽  
Primary Reconstruction ◽  
Free Fibula Flap ◽  
Definitive Therapy ◽  
Free Fibula ◽  
Life Threatening ◽  
Selective Embolisation

ABSTRACT Background: High flow arteriovenous malformation (AVM) of the mandible is rare, but it can present as a life-threatening emergency with severe intraoral bleeding for the first time. The gold standard of treatment for an AVM of the mandible is selective embolisation combined with resection and subsequent reconstructions. With the advent of advanced multidisciplinary techniques aimed at definitive therapy, surgical resection and primary reconstruction can provide an ideal anatomical and functional cure. There are no previous reports on primary resection and reconstruction for life-threatening haemorrhage from high flow AVM of the mandible. Aim: We discuss our approach aimed at definitive therapy in life-threatening intraoral bleeding from large high flow AVM of the mandible. Subjects and Methods: Four patients were managed for life-threatening intraoral bleeding during 2015–2017. Compression was applied over the bleeding point before the airway could be secured by endotracheal tube. Under general anaesthesia, the external carotid artery (ECA) was temporarily occluded using an umbilical tape loop ligature to control the bleeding. Emergency selective embolisation was done, followed by curative resection and primary mandible reconstruction using free fibula flap. Outcome assessed. Results: Temporary occlusion of the ECA successfully controlled the bleeding immediately and facilitated selective embolisation and definitive therapy. All the four cases were successfully reconstructed with a good outcome. There was no recurrence during the follow-up period. Conclusion: In life-threatening intraoral bleeding from large high flow AVM of the mandible, emergency selective embolisation followed by curative resection and primary reconstruction is safe in achieving an ideal cure.

Proximal Radial Artery Ligation after Distalization of a High flow Brachio-Cephalic Fistula. A Novel Approach to Inflow Reduction

2008 ◽  
Vol 9 (4) ◽  
pp. 291-292 ◽  
Author(s):  
J.B. Smith ◽  
F.R. Calder
Keyword(s):  
Radial Artery ◽  
Vascular Access ◽  
High Flow ◽  
Artery Ligation ◽  
Novel Technique ◽  
Novel Approach ◽  
Brachiocephalic Fistula

High flow fistulae present a common challenge to vascular access (VA) surgeons and many strategies have been described, each with their benefits and limitations. There are no NK-DOQI guidelines for the management of high flow fistulae or indeed the management of those refractory to more conventional approaches. We discuss a novel technique to inflow reduction in a previously distalized brachiocephalic fistula and recommend the technique of proximal radial artery ligation.

Brachio-brachial arteriovenous fistula combined with superficialization of the brachial artery using a short skin incision for hemodialysis

2020 ◽  
pp. 112972982094408
Author(s):  
Tsuyoshi Takashima ◽  
Yui Nakashima ◽  
Atsuhiko Suenaga ◽  
Yuki Yamashita ◽  
Yasunori Nonaka ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Brachial Artery ◽  
English Literature ◽  
Invasive Procedure ◽  
Skin Incision ◽  
Related Data ◽  
One Stage ◽  
Long Time ◽  
Brachial Vein

A brachio-brachial arteriovenous fistula with superficialization of the brachial vein and superficialization of the brachial artery are useful vascular access techniques for hemodialysis patients. However, both typically require a long skin incision from the antecubital fossa toward the axillary fossa. In addition, the brachio-brachial arteriovenous fistula in particular, which is created with not a one-stage but a two-stage procedure, requires a relatively long time of 2–3 months before it can be used for hemodialysis. Furthermore, superficialization of the brachial artery usually requires nonarterialized superficial veins for blood return. In cases where patients have no adequate superficial veins for creating an arteriovenous fistula, we have adopted a one-stage operative technique to create a brachio-brachial arteriovenous fistula with superficialization of not only the brachial vein but also the brachial artery using a short skin incision. This technique of a brachio-brachial arteriovenous fistula with superficialization of the brachial artery has several advantages over traditional approaches, including a minimally invasive procedure and early use for vascular access. To our knowledge, the presently described technique and the related data have not been previously reported in the English literature. We herein report the steps of this technique and the midterm follow-up outcomes.

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