Post Operative Bleeding

Any surgical procedure comes with risks, including bleeding. Many factors play into the risk of bleeding post-operativley, including the severity, location, type, and planning of the surgery, and planning or pre-operative interventions. The risk of post-op bleeding goes down the better the pre-op planning is. for instance, if a person is taking aspirin or anti-coagulant drugl like coumadin, that these be stopped prior surgery for a number of days. Bleeding risk is thus reduced for this situation, versus a person needing emergent surgery and currently taking these type of drugs.

After surgery is completed most people will stay in the hospital for a certain period of time, depending on the type of surgery performed. initial monitoring of the post-operative patient can identify signs and symptoms of bleeding. If the bleeding is severe, in the case of bleeding from an artery, the s/s of bleeding with usually be identified quickly. Positive signs and symptoms of bleeding include:

Blood Pressure – A steady decline or sudden drop will indicate bleeding. Most surgeons begin to be concerned witha systolic b/p of less than 100 mm. This is a guideline, the real factor is to trend the blood pressure. If the patient starts with a systolic b/p of 140, and after 2 hours it is 90, this is an indicator. If the patient immediately arrives from surgery with a systolic b/p of 90 and this maintaines, typically not a sign.

Blood Work – Monitor blood counts at a certain interval can indicate if the patient is bleeding. The hematocrit and hemaglobin are monitored closely to identify if they start to trend down or maintain levels. This does not always indicate bleeding, due to the hydration factor. Often times this can be diluted with IV fluids received in the operating room and in recovery. A high number can indicate concentration and then can drop after the patient is hydrated with fluids. This lab should be used in conjunction with other positive symptoms of bleeding.

Heart Rate- As the body loses blood, the heart has to beat faster to circulate a lower volume. A typical heart rate is between 60 to 100 bpm in an average adult. If this begins to increase, this can indicate bleeding. Again, a fast heart rate can also indicate pain or agitation.

Skin Color – The patient has a pale complection and becomes cooler to touch. Most times this may be normal initially after surgery, however the body should not remain pale. if there is a sudden change in color, this could indicate a rapid arterial bleed.

Area Of Surgery – The area of surgery becomes firm to touch, hard, and/or painful, this is an indicator of post-op bleeding.

Excessive or massive bleeding is defined as blood loss of 100 – 200 ml per hour, on average, for the first four hours, or more than 2 liters in 24 hours following surgery. Such measurements will vary depending on the size of the patient and other comorbidities like diabetes and renal failure as well as any nursing interventions—including repositioning or bathing—that may have been performed.