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Padjadjaran of Nursing Journal

Case

Vol. 12 No. 1 (2024): Jurnal Keperawatan Padjadjaran

Post-operative nursing bleeding management in mitral valve repair-re-exploration patient during early post-operative period: A case report

DOI
https://doi.org/10.24198/jkp.v12i1.2363
Submitted
August 30, 2023
Published
2024-04-30

Abstract

Background: One of the first targets of post-operative care for cardiac surgery is to control bleeding. Significant bleeding can affect cardiac function as it can lead to hemorrhagic shock, severe anemia, and cardiac tamponade. Valve surgery has a mortality rate of 3.4%. Mitral valve repair surgery has a mortality rate of 1.2% compared to a valve replacement mortality rate of 4.5%. A quick and appropriate decision in the management of bleeding is one of the factors determining the patient's outcome. This study aims to report on nursing bleeding management in mitral valve repair-re-exploration patient during early postoperative period. This research is qualitative research using the case study method. Case: 59-year-old female with a medical diagnosis of mitral valve prolapse with severe mitral regurgitation of non-significant coronary artery diseases performed mitral valve repair surgery. This case has a score of 1 on the Papworth scale, which means low risk of bleeding. During treatment in the ICU, there was an increase in blood production from the chest tube of 1,670 ml within six hours post-surgery. PT APTT value was within normal range. Bleeding management during early post-operative period was carried out, namely conducting supporting laboratory tests, monitoring hypotension, monitoring urine production, performing chest tube maintenance, giving blood transfusions, fluid management and collaboration for re-exploration. Re-exploration surgery was performed at the sixth hour of post-operative care. Conclusion: The application of post-operative nursing bleeding management in mitral valve repair-re-exploration patient during the early post-operative period provides good clinical outcomes. Effective collaboration (multi-disciplinary teams) between cardiac surgeon, perfusionist, anesthetist, clinical pharmacist, and nurse is required to prevent and manage post-operative bleeding.

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References

  1. Bignami, E., Guarnieri, M., & Gemma, M. (2017). Fluid management in cardiac surgery patients: Pitfalls, challenges and solutions. Minerva Anestesiologica, 83(6), 638–651. https://doi.org/10.23736/S0375-9393.17.11512-9
  2. Bowdish, M. E., D’Agostino, R. S., Thourani, V. H., Desai, N., Shahian, D. M., Fernandez, F. G., & Badhwar, V. (2020). The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2020 Update on Outcomes and Research. Annals of Thoracic Surgery, 109(6), 1646–1655. https://doi.org/10.1016/j.athoracsur.2020.03.003
  3. Colson, P. H., Gaudard, P., Fellahi, J. L., Bertet, H., Faucanie, M., Amour, J., Blanloeil, Y., Lanquetot, H., Ouattara, A., & Picot, M. C. (2016). Active bleeding after cardiac surgery: A prospective observational multicenter study. PLoS ONE, 11(9), 1–14. https://doi.org/10.1371/journal.pone.0162396
  4. D’Agostino, R. S., Jacobs, J. P., Badhwar, V., Fernandez, F. G., Paone, G., Wormuth, D. W., & Shahian, D. M. (2018). The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2018 Update on Outcomes and Quality. Annals of Thoracic Surgery, 105(1), 15–23. https://doi.org/10.1016/j.athoracsur.2017.10.035
  5. Elassal, A. A., Al-Ebrahim, K. E., Debis, R. S., Ragab, E. S., Faden, M. S., Fatani, M. A., Allam, A. R., Abdulla, A. H., Bukhary, A. M., Noaman, N. A., & Eldib, O. S. (2021). Re-exploration for bleeding after cardiac surgery: revaluation of urgency and factors promoting low rate. Journal of Cardiothoracic Surgery, 16(1), 1–11. https://doi.org/10.1186/s13019-021-01545-4
  6. Engelman, D. T., Ben Ali, W., Williams, J. B., Perrault, L. P., Reddy, V. S., Arora, R. C., Roselli, E. E., Khoynezhad, A., Gerdisch, M., Levy, J. H., Lobdell, K., Fletcher, N., Kirsch, M., Nelson, G., Engelman, R. M., Gregory, A. J., & Boyle, E. M. (2019). Guidelines for Perioperative Care in Cardiac Surgery: Enhanced Recovery after Surgery Society Recommendations. JAMA Surgery, 154(8), 755–766. https://doi.org/10.1001/jamasurg.2019.1153
  7. Huang, J., Firestone, S., Moffatt-Bruce, S., Tibi, P., & Shore-Lesserson, L. (2021). 2021 Clinical Practice Guidelines for Anesthesiologists on Patient Blood Management in Cardiac Surgery. Journal of Cardiothoracic and Vascular Anesthesia, 35(12), 3493–3495. https://doi.org/10.1053/j.jvca.2021.09.032
  8. Kolodziej, T., Maciejewski, T., Mendrala, K., Darocha, T., Weglarzy, A., Budziarz, B., Kiermasz, K., & Kucewicz-Czech, E. M. (2019). Enhanced recovery after cardiac surgery. Kardiochirurgia i Torakochirurgia Polska, 16(1), 32–36. https://doi.org/10.5114/kitp.2019.83943
  9. Lopes, C. T., dos Santos, T. R., Brunori, E. H. F. R., Moorhead, S. A., de Lima Lopes, J., & Leite de Barros, A. L. B. (2015). Excessive bleeding predictors after cardiac surgery in adults: Integrative review. Journal of Clinical Nursing, 24(21–22), 3046–3062. https://doi.org/10.1111/jocn.12936
  10. Madhavan, S., Chan, S. P., Tan, W. C., Eng, J., Li, B., Luo, H. D., & Teoh, L. K. K. (2018). Cardiopulmonary bypass time: Every minute counts. Journal of Cardiovascular Surgery, 59(2), 274–281. https://doi.org/10.23736/S0021-9509.17.09864-0
  11. Mazzeffi, M., Zivot, J., Buchman, T., & Halkos, M. (2014). In-hospital mortality after cardiac surgery: Patient characteristics, timing, and association with postoperative length of intensive care unit and hospital stay. Annals of Thoracic Surgery, 97(4), 1220–1225. https://doi.org/10.1016/j.athoracsur.2013.10.040
  12. McIsaac, D. I., Abdulla, K., Yang, H., Sundaresan, S., Doering, P., Vaswani, S. G., Thavorn, K., & Forster, A. J. (2017). Association of delay of urgent or emergency surgery with mortality and use of health care resources: A propensity score-matched observational cohort study. Cmaj, 189(27), E905–E912. https://doi.org/10.1503/cmaj.160576
  13. Miles, L. F., Pac Soo, V., Braat, S., Bade-Boon, J., Heritier, S., Klein, A. A., Myles, P. S., Richards, T., Symons, J., Burbury, K. L., & Story, D. A. (2022). Associations between non-anaemic iron deficiency and outcomes following elective cardiac surgery (IDOCS): a prospective cohort study. The Lancet Haematology, 9(7), e514–e522. https://doi.org/https://doi.org/10.1016/S2352-3026(22)00142-9
  14. Moraes, A., Giordani, J. N., Borges, C. T., Mariani, P. E., Costa, L. M. da, Bridi, L. H., Santos, A. T. L. dos, & Kalil, R. (2021). Transfusion of Blood Products in the Postoperative of Cardiac Surgery. International Journal of Cardiovascular Sciences, 34(5), 499–505. https://doi.org/10.36660/ijcs.20190192
  15. Myles, P. S., Smith, J. A., Forbes, A., Silbert, B., Jayarajah, M., Painter, T., Cooper, D. J., Marasco, S., McNeil, J., Bussières, J. S., McGuinness, S., Byrne, K., Chan, M. T. V., Landoni, G., & Wallace, S. (2017). Tranexamic Acid in Patients Undergoing Coronary-Artery Surgery. New England Journal of Medicine, 376(2), 136–148. https://doi.org/10.1056/nejmoa1606424
  16. Pearse, B. L., Rickard, C. M., Keogh, S., & Lin Fung, Y. (2019). A retrospective explanatory case study of the implementation of a bleeding management quality initiative, in an Australian cardiac surgery unit. Australian Critical Care, 32(2), 92–99. https://doi.org/10.1016/j.aucc.2018.01.001
  17. Reisdorfer, A. P., Leal, S. M. C., & Mancia, J. R. (2021). Nursing care for patient in post operatory heart surgery in the Intensive Care Unit. Revista Brasileira de Enfermagem, 74(2), e20200163. https://doi.org/10.1590/0034-7167-2020-0163
  18. Roekaerts, & Heijmans. (2012). Early Postoperative Care After Cardiac Surgery. Perioperative Considerations in Cardiac Surgery, 1. https://doi.org/10.5772/27516
  19. Urden, L. D., Stacy, K. M., & Laugh, M. E. (2014). Critical Care Nursing, Diagnosis and Management. Seventh Edition. In Elsevier (seventh). Elsevier Inc.
  20. Zhou, X., Lui, C., & Whitman, G. J. R. (2020). Bleeding and Re-exploration After Cardiac Surgery. In S. G. Raja (Ed.), Cardiac Surgery, A Complete Guide (First, pp. 763–768). Springer Nature Switzerland AG 2020. https://doi.org/10.1007/978-3-030-24174-2