Veterinary surgery _ Hemostasis

1. Prepared by:
① Abrahim Mohammed__________
②
②
② Badada Halake________________
③
③
③ Diba Wario ____________________
④
④
④ Kalid Juhar ____________________
⑤
⑤
⑤ Kalicha Jarso __________________
4735/13
0533/13
0865/13
1549/13
1544/13
4764/13
2414/13
1412/13
0011/15
2120/13
DVM 4th
Year
2023
ID №
College Of Veterinary Medicine
Vet. General surgery and Anaesthesiology ( Vetm 4121)
Submitted to : Ass. Prof. Dr. Chala M.

2. Vet. General Surgery and
Anaesthesiology
HEMOSTASIS

3. Hemostasis
 Introduction
 Advantages of Effective Hemostasis During Surgery
 Factors influencing surgical bleeding
 Characteristics of an ldeal hemostatic agents for clinical use:
 Hemostasic techniques
 Specific consideration
 Hemostasis in Trauma and Emergency Surgery
 Hemostatic Challenges in Emergency Cases
 Hemostasis Assessment Techniques
 Postoperative Care and Monitoring
Conclusion
References

4. Introduction
Hemostasis
 Definition:
 Derived New Latin 'haimo'- Blood & 'stásis' - Stasis
 Process to prevent & stop bleeding
1. Vascular endothelium
2. Platelets
3. Coagulation system
4. Fibrinolysis
 Main Components of Hemostasis

5.  Fewer transfusions
 Better visualization of surgical field
 Reduced surgical time
 Decreased morbidity and motality
Advantages of Effective Hemostasis During Surgery

6. Factors influencing surgical bleeding
 Type of procedure
 Patient position
 Surgical incisions
 Exposed bone
 Large surfaces of exposed
Capillaries
 Unseen sources of bleeding
 Tissues that cannot be sutured
or
 Low-pressure suture lines
 Adheions stripped during
suryery
Procedural factors
 Speciflc anatomical considerations
 Medications (eg Anticoagulants)
 Coagulopathies
 • Platelet dysfunction or deficiency
 • Fibrinolytic activity
 Coagulaton factor deficiencies
 Medical conditions
 Nutritional status

Patient factors

7.  capability to stop large vessel arterial and venous bleeding within minutes of application when
applied to an actively bleeding wound through a pool of blood;
 no requirement for mixing or pre-application preparation;
 simplicity of application
 Light weight and durable;
 long shelf life in extreme environments;
 safe to use with no risk of injury to tissues or transmission of infection;
 cost-effective
Characteristics of an ldeal hemostatic agents for clinical use:

8. Hemostasis Techniques
① Mechanical
② Thermal
③ Chemical
 The techniques for local hemostasis may be classified as :

9.  Direct pressure
 Sutures
 Staples
 Ligating clips
 Fabric pads
 Gauzes
 Sponges
 Blood component/replacement therapy
Techniques for Maintaining Hemostasis in Surgery'
 Mechanical techniques
 Cautery
 Electrocautery
 Hemostatic scalpel
 Laser
 Cryosurgery
 Argon -beam coagulator
 Thermal techniques
 Hypotensive anesthesia
 Epinephrine
 Vitamin K
 Protamine
 Desmopressin
 Aminocaproic acid
 Tranexamic acid

 Chemical techniques

 Fibrin sealants
 Synthetic glues
 Collagen
 Cellulose
 Gelatins
 Thronbins

 Pharmacotherapy
 Topical hemostats
 Topical sealants and adhesives

10.  Mechanical Hemostasis Techniques
 Involves physically stopping bleeding by applying pressure or using ligatures, sutures, clips, or
staples.
 simplest and most commonly used technique
 Applying direct pressure to the bleeding site.
 Helps to compress the blood vessels and promote clot formation.
 A sterile gauze or cloth is typically used to apply pressure, and it is
important to maintain continuous pressure until bleeding stops..
1. Direct pressure and compression methods:

11.  Involves using a needle and thread to close or repair wounds and secure blood
vessels.
 commonly used in surgical procedures to control bleeding.
2. Ligature and suturing techniques:
 Ligature
 Involve tying off blood vessels to stop bleeding.
 can be done using absorbable or non-absorbable sutures or
specialized devices such as hemoclips or vascular staples.
 Suturing
 Mechanical Hemostasis Techniques

12. 3. Hemostatic Clips and Staples
 Hemostatic clips and staples are used to occlude blood vessels during surgery.
 They provide a quick and efficient way to achieve hemostasis without the need for
sutures.
 A tourniquet is a device used to constrict blood flow to a limb.
 It is a mechanical method as it physically compresses the blood vessels,
preventing blood flow to the area beyond the tourniquet.
4. Tourniquet
 Mechanical Hemostasis Techniques

13.  Involves using heat energy to coagulate blood vessels and achieve hemostasis.
 commonly used in various surgical procedures.
 Thermal Hemostasis Techniques
 Utilizes an electric current to generate heat for coagulation.
 Involves using a heated probe or electric current to cauterize blood vessels and seal them
off.
 effective in controlling bleeding from small vessels.
1. Cautery and Electrocautery
 Cautery
 involves using a heated instrument (cautery pen) to burn tissue and seal blood vessels.
 Electrocautery

14.  is another thermal technique used for achieving hemostasis.
 Is focused on the bleeding site, causing coagulation of blood vessels without direct contact.
2. Laser Therapy
 Thermal Hemostasis Techniques

15.  involve the use of substances or agents that promote blood clotting to stop bleeding.
 These agents can be applied topically to the bleeding site or administered systemically (orally
or intravenously) to promote clot formation.
 They work by either activating the clotting cascade or enhancing the formation of fibrin, a
protein involved in clot formation.
Chemical Hemostasis Techniques

16. Chemical Hemostasis Techniques
 are substances applied directly to a bleeding site to promote clotting and stop bleeding.
 Examples: Gelatin sponges, oxidized cellulose, fibrin sealants.
 Benefits: Rapid action, easy application, minimal systemic effects.
 Considerations: Allergies, potential for infection.
1. Topical Hemostatics and Hemostatic Agents

17. Gelatin sponges oxidized cellulose fibrin sealants

18. Chemical Hemostasis Techniques
 Hemostatic powders and granules are used to control bleeding by promoting clot formation and accelerating
the coagulation process.
 Examples: Absorbable hemostatic powders, microfibrillar collagen, zeolite-based agents.
 Benefits: Effective in controlling severe bleeding, easy to apply, can be used in various surgical procedures.
 Considerations: Potential for tissue damage, risk of infection.
2. Hemostatic Powders and Granules

19. : Absorbable hemostatic
powders,
microfibrillar collagen,  zeolite-based agents.

20.  The hemostatic management may vary depending on the surgical procedure being
performed.
 For example, in orthopedic surgeries, bone wax or a bone-sealing agent may be used
to promote hemostasis in bone tissue.
 In soft tissue surgeries, ligatures, clips, or cautery may be used to control bleeding
from blood vessels.
Specific Considerations for Different Surgical Procedures:

21. Hemostasis Considerations in Specific Surgical Procedures
Spay and Neuter Procedures
Importance of hemostasis Techniques Considerations
 Prevent excessive bleeding during
and after surgery.
 Ligating blood vessels, using
hemostatic clips or sutures.
 Avoid excessive tissue trauma,
prevent post-operative hemorrhage.

22. Importance of hemostasis Techniques Considerations
 Minimize blood loss during
complex procedures.
 Use of bone wax,
electrocautery, and topical
hemostatics.
 Protect surrounding tissues,
prevent infection.
Orthopedic Surgeries

23. Importance of hemostasis Techniques Considerations
Soft Tissue Surgeries
 Control bleeding in delicate tissues.
 Use of sutures, ligatures,
and topical hemostatics.
 Preserve tissue integrity,
minimize scarring.

24. Importance of hemostasis Techniques Considerations
Abdominal Surgeries
 Prevent intra-abdominal bleeding.
 Ligation of blood vessels,
use of hemostatic agents.
 Avoid damage to surrounding
organs, prevent post-operative
complications.

25. Techniques
Importance of hemostasis Considerations
Cardiac and Vascular Surgeries
 Ensure blood clotting during and
after procedures.
 Use of sutures, clips,
and topical
hemostatics.
 Maintain blood flow,
prevent thrombosis.

26. Techniques
Challenges Collaboration
Hemostasis in Trauma and Emergency Surgery
 High-risk bleeding
situations, limited time for
intervention.
 Multidisciplinary approach
involving surgeons,
anesthesiologists, and
emergency medicine specialists.
 Rapid control of bleeding
using direct pressure,
tourniquets, and hemostatic
agents.

27. Coagulopathy Massive Hemorrhage Damage control surgery
Hemostatic Challenges in Emergency Cases
 Abnormal clotting function
due to trauma or underlying
medical conditions.
 Rapid and significant
blood loss requiring
immediate intervention.
 Temporary measures to
control bleeding before
definitive surgical repair.

28. Physical examination Vital signs monitoring Laboratory tests
Hemostasis Assessment Techniques
 Visual inspection for signs of
bleeding, bruising, or swelling.
 Frequent measurement of
blood pressure, heart rate, and
oxygen saturation.
 Hemoglobin and hematocrit
levels to assess blood loss
and clotting function.

29. Wound assessment Vital signs monitoring Laboratory tests
 Regular inspection for signs of
bleeding, infection, or poor
healing.
 Continual monitoring of
blood pressure, heart
rate, and oxygen
saturation.
 Regular assessment of
hemoglobin and hematocrit
levels to detect any ongoing
bleeding or coagulation
abnormalities.
Postoperative Care and Monitoring

30.  Hemostasis in veterinary surgery is a critical aspect of ensuring successful
surgical outcomes and patient safety.
 It involves the control of bleeding during surgical procedures.
 Various techniques and tools are used to achieve hemostasis, including
ligatures, electrocautery, hemostatic agents, and sutures.
 The choice of method depends on the nature and severity of the bleeding, as
well as the surgeon's preference and experience.
Conclusion

31.  Proper hemostasis not only prevents excessive blood loss but also promotes
optimal wound healing and reduces the risk of postoperative complications.
 Veterinary surgeons must have a thorough understanding of the principles and
techniques of hemostasis to effectively manage bleeding during surgical
procedures.
 By implementing appropriate hemostatic measures, veterinarians can enhance
patient safety and improve surgical outcomes in their practice.
Conclusion

32. References
 Bacek LM, Monnet E. Hemostasis and coagulation disorders. In: Tobias KM,
Johnston SA, editors. Veterinary Surgery: Small Animal. 2nd ed. St. Louis, MO:
Elsevier Saunders; 2017. p. 495-511.
 Boswood A, Brodbelt D, Oyama MA, et al. Management of acute severe hemorrhage
in dogs and cats. J Vet Emerg Crit Care (San Antonio). 2010;20(1):3-23.
 Ko JC, Henry CJ, Pascoe PJ. Principles of hemostasis. In: Fossum TW, editor. Small
Animal Surgery. 5th ed. St. Louis, MO: Elsevier Mosby; 2018. p. 18-29.
 McAnulty JF, Rozanski EA, Rush JE. Hemostatic disorders. In: Silverstein DC,
Hopper K, editors. Small Animal Critical Care Medicine. 2nd ed. St. Louis, MO:
Elsevier Saunders; 2014. p. 289-298.


33. THANK YOU
!!!!