Postoperative bleeding. Current nursing management

The critical care nurse caring for the postoperative bleeding patient must have a thorough knowledge of basic hemostatic principles and inherited and acquired disorders. Early recognition and treatment of bleeding problems reduces surgical morbidity and mortality; therefore astute clinical observations and a thorough understanding of selected laboratory testing are imperative. Because of the risk of disease transmission associated with homologous blood transfusion, new alternatives in blood therapy--autologous blood from preoperative and perioperative salvage; the conservative and individualized use of homologous blood and its components; blood substitutes to support oxygen transport (e.g., modified hemoglobin solutions and perfluorochemical emulsions); new pharmacologic approaches for minimizing blood loss (e.g., desmopressin); and increasing the body's ability to produce blood (e.g., recombinant erythropoietin)--must be considered and the patient response carefully assessed. A broad knowledge base and clinical expertise are requisite in meeting the critical needs of the postoperative bleeding patient in a climate of rapidly developing diagnostic and therapeutic alternatives.