0007-1226/90:0043-049’7/$10.00
Brfri.sh Journnlof Plasfic Surger_v (1990). 43,497-498 SD 1990 The Trustees of British Association of Plastic Surgeons
Ideas and Innovations Assessing blood loss in cleft lip and palate surgery K. J. HERBERT, R. EASTLEY andT. M. MILWARD Department
of Plastic
Surgery,
Leicester
Royalinfirmary,
Leicester
Summary-A method of continuously assessing peroperative blood loss is presented. A calibrated trap which collects all the blood loss is placed in the suction tubing. Bipolar diathermy and suction maintain a bloodless wound. A test using 20 ml of fresh venous blood showed that approximately 5 ml remained clotted in the tubing and 15 ml entered the trap. The method is particularly applicable to cleft lip and palate surgery.
Many methods have been described to monitor peroperative blood loss: weighing swabs (Wangensteen, 1942), calorimetry (Gatch and Little, 1924) and more recently the osmolality dilution technique (Kaplan, 1978). In this paper a simple, cheap and effective method appropriate to cleft lip and palate surgery is described and assessed. Method The method has been used for 10 years in cleft lip and palate surgery at our hospital. To decrease bleeding, the operative site is infiltrated with 0.5% lignocaine and 1 : 100,000 adrenaline. Apart from cleaning up the site, no further swabs are used during the procedure; instead, bipolar diathermy and suction are used to maintain a bloodless field. A bronchoscopy suction collector (manufactured by H. G. Wallace Ltd., UK), calibrated in millilitres preoperatively, is inserted into the suction line (Fig. 1) to trap and measure blood loss. The suction tubing between the cannula and the trap is 3 metres in length with an internal diameter of 5 mm. In an attempt to assess the hidden blood loss caused by clotting in the suction tubing, a test was performed using fresh venous blood from the author , 30 ml being aspirated into the apparatus over 4 minutes. No anticoagulant was added. The test was performed five times and the results are shown in Table 1. On average, 15 ml entered the trap leaving 5 ml clotted in the tube. Discussion Babies undergoing cleft surgery weigh between 5 and 8 kg and have blood volumes from 400 to 497
Fig. 1 Figure l-Trap
positioned
in suction tubing
700 ml, so as little as 30 ml of blood loss may need to be replaced. In this situation precise assessment of blood loss is vital to strike the balance between over-transfusing and unnecessary transfusion. The trap can be attached to the end of the operating table with tape to maintain its upright position and disposed of at the end of the procedure. Prior to using the present trap a calibrated glass cylinder (Thornton et al., 1963) was used; unfortunately there were a number of noisy breakages. The new trap, being plastic and disposable, overcomes this drawback. The length of tubing between suction cannula and trap obviously influences the amount of blood it will contain. Our 3 metre tube has been shown to
498 Table 1
BRITISH JOURNAL Test
results
showing
blood volumes in the trap
Test (20 ml initial volume)
Blood in trap (ml)
1 2 3 4 5 Average
16 15 14 15 15 15
contain between 5 and 6 ml and evaporative loss does not affect the accuracy of the method. Oral secretions are initially removed with swabs, which are then discarded. Further secretion during the procedure is considered to be negligible. We feel that this technique is especially applicable to cleft lip and palate surgery. Acknowledgements We wish to thank Mrs A. Money for preparing the manuscript and Mrs J. Corbett for the illustration. We especially thank Sister Mary Towers for all her help.
OF PLASTIC SURGERY
References Gatch, W. D. and Little, W. D. (1924). Amount of blood loss during some of the more common operations. Journal of the American Medical Association, 83, 1075. Kaplan, S. (1978). Method of measuring blood loss. Anaesthesia, 33, 191. Thornton, J. A., Saynor, R., Schroeder, D. G., Taylor, D. G. and Verel, D. (1963). Estimation of blood loss with particular reference to cardiac surgery. British Journal OfAnaesthesia, 35, 91. Wangensteen, 0. H. (1942). The controlled administration of fluid tosurgical patients, includingadescriptionofgravimetric methods of determining status of hydration and blood loss during operation. Minnesota Medicine, 25,783.
The Authors K. J. Herbert, FRCSI, SHO in Plastic Surgery R. Eastley, FFARCS, Consultant Anaesthetist T. M. Milward, MA, FRCS, Consultant Plastic Surgeon Department of Plastic Leicester, LEl 5WW. Requests
for reprints
Surgery,
to Mr Herbert
Paper received 28 July 1989. Accepted 29 September 1989.
Leicester
Royal
Infirmary,
at the above address
Brfri.sh Journnlof Plasfic Surger_v (1990). 43,497-498 SD 1990 The Trustees of British Association of Plastic Surgeons
Ideas and Innovations Assessing blood loss in cleft lip and palate surgery K. J. HERBERT, R. EASTLEY andT. M. MILWARD Department
of Plastic
Surgery,
Leicester
Royalinfirmary,
Leicester
Summary-A method of continuously assessing peroperative blood loss is presented. A calibrated trap which collects all the blood loss is placed in the suction tubing. Bipolar diathermy and suction maintain a bloodless wound. A test using 20 ml of fresh venous blood showed that approximately 5 ml remained clotted in the tubing and 15 ml entered the trap. The method is particularly applicable to cleft lip and palate surgery.
Many methods have been described to monitor peroperative blood loss: weighing swabs (Wangensteen, 1942), calorimetry (Gatch and Little, 1924) and more recently the osmolality dilution technique (Kaplan, 1978). In this paper a simple, cheap and effective method appropriate to cleft lip and palate surgery is described and assessed. Method The method has been used for 10 years in cleft lip and palate surgery at our hospital. To decrease bleeding, the operative site is infiltrated with 0.5% lignocaine and 1 : 100,000 adrenaline. Apart from cleaning up the site, no further swabs are used during the procedure; instead, bipolar diathermy and suction are used to maintain a bloodless field. A bronchoscopy suction collector (manufactured by H. G. Wallace Ltd., UK), calibrated in millilitres preoperatively, is inserted into the suction line (Fig. 1) to trap and measure blood loss. The suction tubing between the cannula and the trap is 3 metres in length with an internal diameter of 5 mm. In an attempt to assess the hidden blood loss caused by clotting in the suction tubing, a test was performed using fresh venous blood from the author , 30 ml being aspirated into the apparatus over 4 minutes. No anticoagulant was added. The test was performed five times and the results are shown in Table 1. On average, 15 ml entered the trap leaving 5 ml clotted in the tube. Discussion Babies undergoing cleft surgery weigh between 5 and 8 kg and have blood volumes from 400 to 497
Fig. 1 Figure l-Trap
positioned
in suction tubing
700 ml, so as little as 30 ml of blood loss may need to be replaced. In this situation precise assessment of blood loss is vital to strike the balance between over-transfusing and unnecessary transfusion. The trap can be attached to the end of the operating table with tape to maintain its upright position and disposed of at the end of the procedure. Prior to using the present trap a calibrated glass cylinder (Thornton et al., 1963) was used; unfortunately there were a number of noisy breakages. The new trap, being plastic and disposable, overcomes this drawback. The length of tubing between suction cannula and trap obviously influences the amount of blood it will contain. Our 3 metre tube has been shown to
498 Table 1
BRITISH JOURNAL Test
results
showing
blood volumes in the trap
Test (20 ml initial volume)
Blood in trap (ml)
1 2 3 4 5 Average
16 15 14 15 15 15
contain between 5 and 6 ml and evaporative loss does not affect the accuracy of the method. Oral secretions are initially removed with swabs, which are then discarded. Further secretion during the procedure is considered to be negligible. We feel that this technique is especially applicable to cleft lip and palate surgery. Acknowledgements We wish to thank Mrs A. Money for preparing the manuscript and Mrs J. Corbett for the illustration. We especially thank Sister Mary Towers for all her help.
OF PLASTIC SURGERY
References Gatch, W. D. and Little, W. D. (1924). Amount of blood loss during some of the more common operations. Journal of the American Medical Association, 83, 1075. Kaplan, S. (1978). Method of measuring blood loss. Anaesthesia, 33, 191. Thornton, J. A., Saynor, R., Schroeder, D. G., Taylor, D. G. and Verel, D. (1963). Estimation of blood loss with particular reference to cardiac surgery. British Journal OfAnaesthesia, 35, 91. Wangensteen, 0. H. (1942). The controlled administration of fluid tosurgical patients, includingadescriptionofgravimetric methods of determining status of hydration and blood loss during operation. Minnesota Medicine, 25,783.
The Authors K. J. Herbert, FRCSI, SHO in Plastic Surgery R. Eastley, FFARCS, Consultant Anaesthetist T. M. Milward, MA, FRCS, Consultant Plastic Surgeon Department of Plastic Leicester, LEl 5WW. Requests
for reprints
Surgery,
to Mr Herbert
Paper received 28 July 1989. Accepted 29 September 1989.
Leicester
Royal
Infirmary,
at the above address
