Acid-base balance, or pH, which is critical to the functioning of body systems, also can affect coagulation.3 Successful achievement of hemostasis through mechanical or systemic methods can avert the need for transfusion, which is associated with a high risk of adverse clinical outcomes.1, 2 and 13 A prospective, multicenter,

observational cohort study of nearly 5,000 patients in intensive care found that the number of red blood cell transfusions a patient received during the study period was independently associated with an extended length of stay in the intensive care unit, a longer total hospital length of stay, a greater number of complications, and an increased risk of mortality.1 The leading cause of transfusion-related morbidity and mortality is transfusion-related acute lung ABT-888 chemical structure injury, which occurs in approximately one of 500 platelet transfusions and one of Olaparib in vitro 1,000 to 5,000 plasma and red blood cell transfusions.2 and 13 Other leading causes of transfusion-related

morbidity and mortality include bacterial contamination of platelets, which occurs in one of every 2,000 to 3,000 transfusions, as well as transfusion-related immunomodulation and transfusion-associated circulatory overload.2 and 13 Achieving and maintaining hemostasis is further complicated in the trauma surgery setting, during which hypothermia, acidosis, and coagulopathy, typically known as the “lethal triad” of trauma, interact in a vicious cycle to compromise patient outcomes.14 Trauma patients are often hypothermic on arrival to the surgical suite, which Resveratrol exacerbates coagulopathy and interferes with hemostasis.14 Acidosis that results from hemorrhagic shock also promotes coagulopathy and impairs blood

clotting mechanisms.14 Hypothermia and acidosis further potentiate coagulopathy, with ongoing bleeding leading to continued hypothermia and acidosis.14 Perioperative nurses should give special consideration to this subset of conditions to effectively manage trauma patients. The presence of these conditions tends to increase the hemostatic challenge and may affect the choice of adjunctive topical agent. As discussed in the following section, certain agents rely more than others on the integrity of the patient’s own coagulation cascade. In these more critical clinical scenarios, the patient’s own coagulation system may not be able to effectively contribute to the formation of a clot. Topical hemostats are agents that may allow surgical teams to achieve hemostasis when traditional surgical methods are ineffective or inappropriate, but they are not a substitute for adequate surgical technique. In other words, they will not work effectively when the bleeding should be controlled by suture or electrosurgery.