If bleeding occurs after having surgery for lung cancer, what are the next steps?

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GarrettWalshMD (Physician - Surgery - Thoracic (Verified) ) - 06 / 18 / 2013

Following a resection of a lung cancer, chest tubes are placed in the region of the surgical resection to both drain any ongoing oozing that may occur after these major operations and also evacuate any air that may result from a raw surface of the lung that may bubble air for a while after a lobectomy is performed. A typical pulmonary resection for lung cancer entails the tying off or stapling of major arterial and venous branches that supply that particular portion of the lung. As well, lymph nodes areremoved from several sites within the chest cavity for the complete staging of the lung cancer. Typically the intraoperative blood loss from these procedures is less than 300 cc of blood with many cases having blood losses less than 100 cc. Patients are monitored in a recovery room for several hours after major pulmonary resections to evaluate the patient for both adjustment of the pain medications and equally importantly to observe them closely for any evidence of delayed bleeding. Chest tubes are typically left in place for 2-5 days after a pulmonary resection until the drainage from the chest tube is sufficiently low and there are no air bubbles when the patient coughs. 

It is quite common for there to be some oozing from the surgical bed typically in the region of the lymph node dissection that mixes with the fluid that is in the chest cavity that gives a slightly blood tinged fluid in the drainage systems. Significant hemorrhage, however following a pulmonary resection can be a serious event that requires immediate surgical re-intervention. Bleeding often occurs from small chest wall vessels or small vessels in the area of the dissection of the lymph nodes and frequently is self-limited. A major hemorrhage,however,may imply bleeding from either the surgical ties of the branches of the pulmonary artery or from the staple line or ligation of the pulmonary veins. The patient’s vital signs are closely monitored in the recovery room and the fluid draining from the chest is closely observed for concentration and color of the blood and the quantity of the output. If a patient bleeds more than 1 liter in the first hour following surgery or becomes hemodynamically unstable,then they are usually returned directly to the operating room for a re-exploration for a bleeding source. This often requires removal of a large clot and a thorough examination of all of the sites of surgery to rule out bleeding from major vessels or small arteries in the area of the lymph node dissection. In another patient, if bleeding persists at a rate of 500 cc for 2 hours or 250 cc for four hours without signs of slowing then this would be an automatic indication to return to the OR for re-exploration. Patients will also have blood tests to evaluate to see if they have any abnormalities in their clotting system and coagulation factors may also be given with blood products to help correct any bleeding that may occur.
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