How to detect excessive postoperative bleeding?
A small amount of bleeding is inevitable during surgery, and excessive postoperative bleeding usually manifests as an increased amount of fluid draining from the neck drain and the formation of a hematoma in the surgical area. With a small gap in the neck area and the trachea at the back of the thyroid, a large amount of bleeding can compress the trachea, which can lead to breathing difficulties and even asphyxia in severe cases.
What are the causes of postoperative bleeding? How can you prevent it?
Surgical factors
The thyroid gland has a rich blood supply, and the muscles and subcutaneous tissues of the head and neck are also densely packed with small blood vessels.
During surgery, the surgeon will properly dispose of any “severed” blood vessels by ligating or coagulating them to stop the bleeding. They are also carefully examined before the procedure is completed. Even so, about 1% to 5% of patients will have blood or bleeding in the area after surgery. In addition, factors such as a large surgical area and dislodged ligature knots can also cause postoperative bleeding.
Patient factors
Primarily, the local pressure in the neck is too high, causing ruptured blood vessels to bleed. Broadly, this can occur as follows:
- General anesthetic medications may cause postoperative nausea and vomiting, and intense vomiting may cause excessive pressure in the neck.
- Exertional breath-holding during defecation, resulting in increased neck pressure.
- If the patient has chronic bronchitis, or a history of smoking, coughing vigorously before the wound is fully healed may cause postoperative bleeding.
- Patients with hypertension who have not taken care to control their blood pressure postoperatively, allowing blood to leak from the severed end of the ligated vessel.
- The patient accidentally tugged on the drainage tube, causing a rupture of the vessel at the drainage tube fixation line.
So, after surgery, you need to be careful to avoid causing increased pressure in the neck, for example, by not holding your breath too hard when relieving stool. If vomiting and coughing are more severe, ask your doctor to handle them. If you have chronic bronchitis or high blood pressure before surgery, please cooperate with your doctor to actively control your condition with medication. If you smoke, please quit.
Protect the drainage tube to avoid tugging and pulling. You also need to carefully monitor the amount and color of the neck drainage to detect early signs of postoperative bleeding.
How to deal with postoperative bleeding?
If you notice any signs of postoperative bleeding, such as a rapid increase in the amount of fluid draining from the neck in a short period of time and a change from dark red to bright red, you need to be evaluated by your doctor immediately.
If the bleeding is small and slow, it is usually bleeding from the surgical wound, which the surgeon can reduce with negative pressure suction, ice pack compression, and possibly intravenous hemostatic medication; if the bleeding is large and rapid, there may be a larger vessel that has not been completely ligated. It is possible that a second surgery is needed to open the incision completely and ligate the bleeding vessels.
Co-written by Dr. Jiaqian Hu, Cancer Hospital of Fudan University