At the end of any surgical procedure, and according to the guidelines from the WHO, we need to work out an estimated blood loss.
A straighforward enough job, you would have thought. But it’s not as simple as that.
For many surgeons, losing only a small amount of blood is a matter of pride. Blood transfusions are to be avoided except in life threatening circumstances, and patients will recover better if they aren’t too anaemic. So, they will tend to underestimate how much the patient has bled during the procedure. They will often confidently state “three teaspoons!” Or “fifty red blood cells!”, to which the anaesthetist will usually respond with raised eyebrows. We are the ones who have had to deal with the patient’s altered physiology due to any haemorrhage – a drop in blood pressure, an increase in heart rate. Also, our position at the top of the bed, and freedom to walk around the room, gives us a greater appreciation of the bigger picture than the surgeon has been able to see, focused as they are on the wound in front of them. In addition, we’ve usually heard the surgeons complain for the last hour about how much the patient is bleeding due to the poorly managed anaesthetic – blood pressure too high, CO2 too high, too much blood thinners, etc etc. We will usually see the surgeons fifty red blood cells and raise them 500 mls, leaving the surgeons outraged.
It is then up to the nurses to keep the peace, and provide objective evidence. They are the ones who weigh the blood soaked swabs, measure the fluid levels in the suction canisters, remembering to subtract any wash used during the procedure, and also estimate how much blood there is on the operating table, on the floor, on the surgeons gown, etc. They will provide a figure purporting accuracy to within a few mls.
Of course, in the end, it’s been scientifically proven that all these means of estimating intraoperative blood loss are completely inaccurate. We try, but in the end, the best we can do is give IV fluid , check the blood count in the morning, and hope for the best.
