[HSF] Reclacitrant sternal bleeding

[Tea Acuff]

Unusual problem. No coart or other strange problem I presume. I would try placing a set of wires or sutures around the sternum and pack with a penrose filled with 4x4 or anything else that comes to mind. Close the sternum around the pack until the coagulopathy is over and remove the pack. If you use surgicell or some such you may not have to reopen, but this sounds diffuse. This might stop in 30-60 minutes intra op or you may have to come back the next day. Not done this, but seems worth a try.
Tea


----- Original Message ----
From: prasannasimha <prasannasimha at gmail.com>
To: "OpenHeart-L at lists.hsforum.com" <OpenHeart-L at lists.hsforum.com>
Sent: Tuesday, December 5, 2006 8:21:18 AM
Subject: [HSF] Reclacitrant sternal bleeding


Urgent suggestions - pt underwent surgery yesterday - bleeding from 
sternum - doesn't seem to stop with wax + cautery + blood products - 
chest open packed - no cardiotomy site bleeding - continuing to bleed 
(This fortnight has ruined by blood conservation record :-) ) -
Now open packed with gauzes after layering with surgicel  and gauze and 
compressed it with the sternal spreader but still oozing - tried to 
close twice hoping that it may compresss the sternal edges and stop the 
bleeding but hasn't worked. Just bleeds from multiple sites along the 
sternal (both edges , marrow and small fractures). Thinking of doing a 
sternectomy if a further round of platelets Cryo and fresh blood doesn't 
work as I am getting low on blood resources. Any suggestions - I do not 
have access to Novo seven /TEGetc. patient had received Aprotinin 
through surgery and surgical sites are dry.
Plan is to do sternectomy soon if this round of products is not 
controlling the hemorrhage. Any tricks etc are appreciated. This has 
been a pretty "interesting"  fortnight for me.
Prasanna
_______________________________________________
OpenHeart-L mailing list

Send postings to:
OpenHeart-L at lists.hsforum.com

To UNSUBSCRIBE, to CHANGE email address, or to view archives:
http://mmp.cjp.com/mailman/listinfo/openheart-l

All messages transmitted by the OpenHeart-L are subject to the policies and 
disclaimers posted at:
http://www.hsforum.com/listdisclaim
-----------------------------------------