1. Apply pressure. Application of pressure is always a good first choice.
It prevents further blood loss and may allow the vessel to clot,
thereby stopping the bleeding. Try this technique for at least 5–7 minutes.
If it is unsuccessful, the following alternatives should be tried.
2. If you have access to an electrocautery unit. If the vessel is a vein or
small (1–2 mm) artery, grab it with the tips of a metal clamp and
touch the clamp with the cautery device. Be sure that your gloves
are intact and that the clamp is applied only to the vessel.
3. If you do not have access to an electrocautery unit or if the vessel is
a larger vein or larger (3–4 mm) artery, the end of the vessel should
be tied off with a suture for secure hemostasis. There are two basic
techniques for tying off a vessel (see figures on following pages).
Regular Tie
Regular ties are adequate for most veins and small (2–3 mm) arteries.
Grasp the end of the vessel with a small clamp, and gently hold the
vessel away from the surrounding tissues. Pass a piece of 3-0 or 4-0 silk
or Vicryl suture material (the needle is not needed) around the vessel
and under the clamp. Tie the suture securely, placing at least 3 or 4 knots.
Four major steps (A–D) in tying off a vessel with the regular stitch. (From
Edgerton M: The Art of Surgical Technique. Baltimore, Williams & Wilkins,
1988, with permission.)
Stick Tie
A stick tie is a more secure technique to control bleeding from a blood
vessel. It is especially useful for arteries, because the thicker wall and
increased interior pressure of an artery can cause a regular tie to come
off of the vessel.
Grasp the end of the artery with a small clamp, and gently lift the
vessel. Use a 3-0 or 4-0 silk or Vicryl suture with a needle (a tapered
needle is best). Pass the needle through the center of the vessel just
under the clamp. Bring both ends of the suture toward yourself (again,
under the clamp), and tie the suture securely (just once).
Now take one of the suture ends and pass it completely around the vessel,
making sure to pass the string under the clamp. Again, tie the suture. As
you are tightening it, remove the clamp. Finish with 3–4 more knots.
Stick tie: a more secure way to control bleeding from a blood vessel. (From
Edgerton M: Art of Surgical Technique. Baltimore, Williams & Wilkins, 1988,
with permission.)
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