- Surgical Devices and Techniques to Locate and Arrest Internal Bleeding:
- Electrocautery or Electrosurgery
- Laser surgery
- Argon beam coagulator
- Gamma knife radiosurgery
- Microwave coagulating scalpel
- Shaw haemostatic scalpel
- Endoscopy or Laparoscopy
- Arterial embolization
- Ultrasonic Scalpel
- Tissue adhesives
- Cryosurgery
- Techniques and Devices to Control External Bleeding and Shock:
- For bleeding:
(1)Applied direct pressure
(2)Ice packs
(3)Positioning of body
(4)Haemostatic agents (see No. 6.)
(5)Prompt surgery
(6)Tourniquet
- For shock:
(1)Trendelenburg/shock position (patient supine with head lower than legs)
(2)Medical Antishock Trousers (MAST)
(3)Appropriate volume replacement after bleeding controlled
- Operative and Anaesthetic Techniques to Limit Blood Loss During Surgery:
- Hypotensive anaesthesia
- Regional anaesthesia
- Maintain normothermia
- Acute normovolemic haemodilution
- Intraoperative and postoperative blood salvage
- Mechanical occlusion of bleeding vessel
- Meticulous haemostasis
- Trauma - Quick response and rapid re-warming
- Preoperative planning
(1)Enlarged surgical team/Minimal time
(2)Surgical positioning
(3)Staging of complex procedures
- Blood-Oxygen Monitoring Devices and Techniques that Limit Blood Sampling:
- Transcutaneous pulse oximeter
- Pulse oximeter
- Paediatric microsampling equipment
- Multiple tests per sample – Plan ahead!
- Volume Expanders:
- Crystalloids
(1)Ringer’s lactate, Hartmann’s solution
(2)Glucose (dextrose)
(3)Isotonic or hypertonic saline
- Colloids
(1)Gelatins
(2)Pentastarch
(3)Hetastarch
- Perfluorochemicals
(1)Oxygent
- Haemostatic Agents for Bleeding/Clotting Problems:
- Topical:
(1)Avitene
(2)Gelfoam
(3)Oxycel
(4)Surgicel
(5)Many others
- Injectable:
(1)DDAVP, Desmopressin
(2)E-Aminocaproic acid
(3)Tranexamic acid
(4)Vitamin K
(5)Recombinant Factor VIIa or VIII
- Other Drugs:
(1)Vasopressin
(2)Conjugated Oestrogens
(3)Aprotinin
- Therapeutic Agents and Techniques for Managing Anaemia:
- Stop the bleeding!
- Oxygen support
- Maintain intravascular volume
- Iron (Venofer®)
- Folic acid
- Hyperbaric oxygen chamber
- Mechanical ventilation
- Vitamin B12 intramuscular injection
- Immunosuppressive agents if indicated
- Recombinant Erythropoietin
- Granulocyte-Colony Stimulating Factor
- Granulocyte Macrophage-Colony Stim/Factor
- 10/30 rule for minimum red cell level has no scientific basis
- Nutritional support
- Anabolic androgenic hormones (Deca-Durabolin 100)
Jehovah’s Witnesses’ Position on Medical Treatment
Will accept all other kinds of medical treatment except blood
Are not exercising a right to die
Are keen to co-operate with medical professionals
Do not try to stop others having blood
What Jehovah's Witnesses Won’t Accept- Transfusions of whole blood
- Red cells
- Plasma
- Platelets
- White cells
- Predonated autologous blood
What Jehovah's Witnesses WillAccept
- Ringer's Lactate
- Normal Saline
- Hypertonic Saline
- Pentastarch
- Hetastarch
- Gelatins (Gelofusine/Haemaccel)
Matters of Conscience
- Fractions derived from any primary component of blood. e.g. anti-D
- Medical procedures involving the use of autologous blood that do not involve storage. e.g. Intra-operative cell salvage
- Organ transplant
The Role of the Hospital Liaison Committee
A network of over 1,400 Hospital Liaison Committees has been established worldwide. The prime role of these committees is to assist in avoiding confrontation between doctor and patient and to assist understanding on both sides.
The Hospital Liaison Committee can:
- Provide medical articles and information about the latest developments in bloodless surgical and medical management.
- Provide a contact list of consultant surgeons and physicians who are willing to work with Jehovah's Witnesses without the use of blood or major blood products.
- Put surgeons and physicians in contact with one another in order to share the benefits of experience and good practice.
“The local ‘Hospital Liaison Committee for Jehovah's Witnesses’ can also act as a local resource for information regarding the beliefs and practices of Jehovah's Witnesses. They have access to a great deal of reference material and information.” — Management of Anaesthesia for Jehovah's Witnesses (The Association of Anaesthetists of Great Britain and Ireland, 1999)
ADDITIONAL SOURCES OF INFORMATION
The following publications are recommended as essential reading for physicians and surgeons involved in treating Jehovah's Witnesses: —
- Code of Practice for the Surgical Management of Jehovah's Witnesses — The Royal College of Surgeons of England (1996)
Management of Anaesthesia for Jehovah's Witnesses — The Association of Anaesthetists of Great Britain and Ireland (1999)
LECTURE SERVICE
The Stoke on Trent Hospital Liaison Committee is pleased to offer a free lecture service to hospitals, medical schools, blood transfusion centres and postgraduate departments.
Lectures can be tailored to suit most requirements.
Also lectures can include the Video:-
TRANSFUSION – ALTERNATIVE
STRATEGIES
Simple Safe Effective
Alternatives to blood transfusion in surgery are possible and have proved safe and effective. Blood conservation and avoidance of allogeneic transfusion are fast becoming desirable end points in clinical practice. This video reviews the methods available to achieve this outcome and shows how they are applied in standard surgical practice. With emphasis on simple, cost-effective steps, it shows how to implement a comprehensive strategy that begins with preoperative management and inte- grates techniques in the domains of both the surgeon and the anaesthesiologist. Internationally renowned expert practitioners describe their experiences and explain how each method is used as part of an overall strategy based on three main principles. Health-care teams will appreciate this practical overview of multi-modal transfusion alternatives and explanation of how to combine them cost effectively and easily in the management of individual patients.
To arrange for a lecture and /or see video
Please contact:
Peter Warren on 01782 313014