SECTION 13.00 HAEMOSTASIS

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13.01 CHECK HAEMOSTASIS

Check:
   The anastomotic lines.
   The vessels around the upper anastomosis.
   The inferior mesenteric artery.
   The lumbar arteries.
   The vena cava and iliac veins.
   Bleeding vessels in the abdominal wound edges.
   Anywhere else.
The ideal of a bloodless field can usually be obtained with an elective operation.
Accept a moderate amount of bleeding from a retroperitoneal haematoma in an emergency case.
Do not accept bleeding from anastomoses. Persevere with efforts to obtain haemostasis.

13.02 INSERT A DRAIN

This is often omitted.
Use a medium Portovac drain.
Pass the spike introducer through the abdominal wall from inside out in the left iliac fossa.
Check that the drain:
   Does not damage the sigmoid colon.
   Does not pass through the loops of the Finocietto retractor.
Pull the drain through the abdominal wall until the black localising mark appears at skin level.
Cut the drain at the end of the perforations.
Tuck the drain into the aneurysm sac.
Suture the drain in place in the skin.
Use No 1 silk on a hand needle (Ethicon W9173).
Make a bite into the nearby skin.
Tie the suture with 4 throws.
Wrap the silk 4 times round the drain.
Tighten the suture to make a waist in the tubing.
Tie the suture with 4 throws.
Cut the ends 4cm long.