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Management of post-operative haemorrhage in thyroid and parathyroid surgery

Post-operative haemorrhage is a recognised complication following thyroid, parathyroid and neck dissection surgery. It may develop quickly and result in acute respiratory distress. If the haemorrhage it is not dealt with quickly in a structured manner it may in rare instances be fatal or lead to anoxic brain damage.

This topic was recently discussed at the AGM of the BAETS and the feedback and comments from all members at the meeting are reflected in the construction of this page.

It is clear that individual surgeons and units will have their own techniques for closing the wound after thyroid and parathyroid surgery and therefore there is no “One rule fits all” scenario. However, there are a few steps that surgeons can undertake to try and ensure that patient safety remains paramount at all times.

The BAETS recommends the following actions:

  1. All units undertaking these operations should have a clear written protocol detailing how acute postoperative haemorrhage should be managed.
  2. First responders, ward nursing staff, FY’s, Registrar’s, Crash Team (including anaesthetic registrar’s), should all be aware of the protocol and the potential critical urgency of post-operative haemorrhage, understand the local protocol and the actions needed to secure a safe airway.
  3. The protocol ensures that locum or agency staff who do not work regularly in the hospital but may be looking after these patients have an understanding of the measures needed. This may be in the form of a poster on the ward or written instructions on how to open the wound in the event of an acute post-operative haemorrhage causing airway compromise.

Detailed below (and available to all surgeons to download) are examples of local protocols of how the members of the Executive address the issue of post-operative haemorrhage in their own units. Please review them, adapt them and use them for your own local practice as you see fit.

This is an interactive educational page, with a view to making thyroid and parathyroid surgery safer for patients. The Executive welcomes any input on this and if you have a protocol or teaching aid that you use and think that other units would benefit please contact the BAETS Secretary and we will endeavour to make this available as well.

Improved patient safety will only be achieved through structured regular education for First Responders, the cohort of which will change frequently!

 

Posters and PowerPoint Presentations

Links

These are very useful for placing in the Recovery Unit or on the ward as a reminder of the actions needed. They are especially useful in helping first responders act and where agency or locum staff may be working for the first time.

The presentations have been used at Trust Induction for all junior doctors in a few of the Exec Trusts. Additionally, they can be e mailed out to all doctors to raise awareness across the Trust.

 

Instructions for Opening the Wound

Links

These link to a JPG file which can be printed as a colour A4 sheet and attached to a patient’s operation note to return to the ward with the patient. The original PSD file is also available to download (20MB). This can be downloaded, altered and adapted to suit individual surgeon’s closing technique (e.g. staples, clips, beads). This ensures that first responders (nurses/juniors doctors) who may be agency or locums who have not been briefed to the local protocol, will have a clear guide available in an emergency.

In Oxford the use of the SCOOP acronym has been invaluable as a teaching aid to remembering the steps involved in opening the neck urgently and ensures that all nurses and doctors know exactly we are referring to. Several hospital across the UK are now adopting this acronym and are using the colour A4 sheet attached to the operation note or patient records.

 

YouTube Video on how to open the neck

This has been extremely useful as a teaching aid for nurses and doctors in understanding the steps needed to secure the airway. It can be watched very quickly (even in an urgent situation) on any device by simply going to YouTube and typing “Scoop Thyroid” in to the search engine.

We will endeavour to update it with a more professional look!