To Control Bleeding A Nursing Assistant Should

Controlling Bleeding: A Comprehensive Guide for Nursing Assistants

Controlling bleeding effectively is a crucial skill for any nursing assistant. From minor cuts and scrapes to more serious injuries, knowing how to respond quickly and appropriately can significantly impact a patient's outcome and prevent further complications. This article provides a detailed guide on how nursing assistants should manage bleeding, covering various types of wounds, appropriate techniques, and important safety considerations. This guide will equip you with the knowledge and confidence to provide effective first aid and contribute to the best possible patient care.

Understanding Different Types of Bleeding

Before diving into control techniques, it's crucial to understand the different types of bleeding. This understanding will help you assess the severity and determine the appropriate response. Bleeding is categorized based on the type of blood vessel involved:

• Capillary Bleeding: This is the most common type, resulting from minor cuts and abrasions. It involves the smallest blood vessels and typically oozes slowly, clotting relatively easily. The blood is bright red.

• Venous Bleeding: This type of bleeding originates from veins. Venous blood is dark red and flows steadily. While less forceful than arterial bleeding, it can still be significant and requires attention.

• Arterial Bleeding: This is the most serious type, stemming from damaged arteries. Arterial blood is bright red, spurts rhythmically with each heartbeat, and can be life-threatening if not controlled quickly.

Steps to Control Bleeding: A Practical Guide

The steps to control bleeding depend on the severity of the injury. However, certain principles remain constant across all situations. Remember to always prioritize safety for both yourself and the patient. Wear appropriate personal protective equipment (PPE), including gloves, to prevent the transmission of infectious diseases.

1. Assess the Situation:

• Evaluate the wound: Determine the location, size, and depth of the wound. Note the type of bleeding (capillary, venous, or arterial).
• Check for other injuries: Look for any other signs of trauma, such as broken bones or head injuries.
• Assess the patient's condition: Observe their level of consciousness, breathing, and pulse. If the patient is unconscious or showing signs of shock (pale skin, rapid pulse, shallow breathing), seek immediate medical assistance.

2. Direct Pressure: This is the cornerstone of bleeding control.

• Clean the wound: If possible, gently clean the wound with clean gauze or a sterile dressing to remove any visible debris. Avoid scrubbing, as this can further damage the tissues.
• Apply direct pressure: Place a clean, sterile dressing directly over the wound. Apply firm, continuous pressure for at least 10-15 minutes. Do not remove the dressing to check the bleeding; if it becomes soaked, add another dressing on top and continue applying pressure.
• Elevate the injured limb: If possible, elevate the injured limb above the heart to reduce blood flow to the area. This is particularly helpful for bleeding in the extremities.

3. Pressure Points: If direct pressure alone is insufficient to control bleeding, you may need to apply pressure to a pressure point. Pressure points are locations where major arteries lie close to the surface of the skin. Applying pressure here can help restrict blood flow to the injured area. Common pressure points include:

• Brachial artery: Located on the inner aspect of the arm, above the elbow.
• Femoral artery: Located in the groin area.
• Temporal artery: Located in front of the ear.

Important Note: Applying pressure to pressure points should be done only after applying direct pressure to the wound itself. Improper application of pressure to pressure points can cause damage to nerves or blood vessels.

4. Tourniquet (Only as a Last Resort): A tourniquet should be used only as a last resort to control severe, life-threatening bleeding from a limb that cannot be controlled by other methods. Incorrect application can lead to serious complications, including limb loss. If you are unsure how to apply a tourniquet, seek immediate medical assistance.

• Placement: A tourniquet is placed approximately 2-3 inches above the wound, but not over a joint.
• Tightening: Tighten the tourniquet until the bleeding stops. Note the time of application.
• Monitoring: Regularly monitor the patient's condition and the limb distal to the tourniquet for signs of impaired circulation (coldness, numbness, discoloration).

5. Wound Dressing and Bandaging: Once the bleeding is controlled, properly dress and bandage the wound to prevent further bleeding and infection.

• Wound dressing: Use a sterile dressing of appropriate size to cover the wound.
• Bandaging: Secure the dressing with a bandage, ensuring it is snug but not too tight to prevent further constriction of blood flow.

6. Documentation and Reporting: Thoroughly document the incident, including the time, location, type of injury, steps taken to control bleeding, and the patient's response. Report the incident to the appropriate personnel, such as a registered nurse or supervisor.

Scientific Explanation of Hemostasis

The body has a remarkable natural mechanism to stop bleeding called hemostasis. This process involves a complex interplay of several factors:

• Vascular Spasm: When a blood vessel is injured, it constricts, reducing blood flow to the area. This is an immediate response that helps minimize blood loss.

• Platelet Plug Formation: Platelets, small cell fragments in the blood, adhere to the injured vessel wall and aggregate, forming a temporary plug to seal the break. This plug is reinforced by fibrin, a protein that forms a mesh-like structure, further strengthening the clot.

• Blood Coagulation (Clotting Cascade): This is a complex series of biochemical reactions that lead to the formation of a stable blood clot. Several clotting factors participate in this process, culminating in the conversion of fibrinogen to fibrin, the main component of the blood clot.

Understanding the process of hemostasis is important because it helps explain why direct pressure is so effective in controlling bleeding. Applying direct pressure helps compress the injured vessel, promoting vascular spasm and encouraging platelet aggregation and clot formation.

Frequently Asked Questions (FAQ)

Q: What should I do if the bleeding doesn't stop after applying direct pressure for 15 minutes?

A: If bleeding persists despite applying direct pressure for 15 minutes, seek immediate medical attention. The bleeding may be more severe than initially assessed, requiring further intervention.

Q: What should I do if I suspect arterial bleeding?

A: Arterial bleeding is a medical emergency. Apply direct pressure immediately, and if possible, elevate the injured limb. Seek immediate medical attention. Consider applying a tourniquet only if other methods fail and the bleeding is life-threatening.

Q: Can I use a homemade tourniquet?

A: While improvising a tourniquet might be necessary in extreme situations, it's best to use a commercially available tourniquet if possible, as these are designed for optimal safety and effectiveness. Improper application of a homemade tourniquet can cause serious complications.

Q: What are the signs of shock?

A: Signs of shock include pale, cool, clammy skin; rapid, weak pulse; rapid breathing; dizziness or lightheadedness; and altered mental status. If you suspect shock, seek immediate medical attention.

Q: What should I do if the wound is deeply embedded with debris?

A: Do not attempt to remove deeply embedded objects. Apply direct pressure around the object and seek immediate medical attention. Attempting to remove the object can cause further injury and bleeding.

Q: Should I use antiseptic solutions on the wound before applying pressure?

A: Applying antiseptic solutions before applying direct pressure to the wound is generally not necessary, and may delay the application of pressure leading to greater blood loss. The priority is to control the bleeding first; cleaning the wound can be performed after the bleeding is controlled. Focus on using sterile dressings.

Q: When should I call emergency medical services (EMS)?

A: Call EMS immediately if the bleeding is severe, uncontrolled, or accompanied by other signs of serious injury, such as loss of consciousness, difficulty breathing, or signs of shock.

Conclusion

Controlling bleeding effectively is a fundamental skill for any nursing assistant. This comprehensive guide provides a step-by-step approach to managing various types of bleeding, highlighting the importance of assessment, direct pressure, pressure points, and the appropriate use of tourniquets. Understanding the underlying physiological mechanisms of hemostasis further enhances the understanding of effective bleeding control. By mastering these techniques and prioritizing patient safety, nursing assistants play a crucial role in providing timely and effective first aid, significantly impacting patient outcomes. Remember, ongoing training and regular review of these procedures are essential to maintain proficiency and confidence in managing bleeding emergencies. Always consult with your supervisor or other healthcare professionals for any questions or concerns.