To Control Bleeding A Nursing Assistant Should

To Control Bleeding: A Nursing Assistant's Essential Guide

Controlling bleeding effectively is a critical skill for any nursing assistant. From minor cuts and scrapes to more serious injuries, knowing how to respond swiftly and appropriately can significantly impact a patient's outcome. This comprehensive guide outlines the steps nursing assistants should take to manage bleeding, emphasizing safety, accuracy, and the importance of following established protocols. We'll cover different types of bleeding, appropriate responses, and when immediate medical attention is necessary.

Understanding Types of Bleeding

Before diving into control techniques, it's crucial to understand the different types of bleeding:

1. Capillary Bleeding:

• Characteristics: This is the most common type, characterized by slow, oozing bleeding from small blood vessels. The blood is typically dark red and clots relatively easily. Minor cuts, scrapes, and abrasions usually result in capillary bleeding.
• Management: Often manageable with direct pressure and wound cleaning.

2. Venous Bleeding:

• Characteristics: Blood flows steadily from a vein, appearing dark red or maroon. Venous bleeding is usually easier to control than arterial bleeding because veins are under lower pressure.
• Management: Direct pressure is generally effective. Elevation of the injured limb can also help reduce blood flow.

3. Arterial Bleeding:

• Characteristics: This is the most serious type of bleeding. Blood spurts rhythmically from an artery, bright red in color, and is difficult to control. Arterial bleeding indicates damage to a major artery and requires immediate medical attention.
• Management: Direct pressure is crucial, along with elevation and potentially pressure points. This type of bleeding often necessitates immediate medical intervention.

Steps to Control Bleeding

The following steps provide a systematic approach to controlling bleeding in various situations. Remember to always prioritize safety and adhere to your facility's protocols.

1. Assess the Situation:

• Safety First: Ensure your own safety and the safety of the patient and those around you. If the environment is unsafe (e.g., a hazardous chemical spill near the injury), prioritize moving the patient to a safer location if possible and without compromising their condition.
• Assess the Wound: Determine the type and severity of the bleeding. Note the location, size, and depth of the wound. Is the bleeding arterial, venous, or capillary? Is it profuse?
• Patient Assessment: Check the patient's vital signs (pulse, respiration, blood pressure, and level of consciousness) to assess their overall condition.

2. Initiate Control Measures:

• Direct Pressure: This is the most fundamental method. Apply firm, direct pressure to the wound using a clean dressing or cloth. Do not remove the initial dressing even if it becomes saturated; simply add more on top. Continue applying pressure for at least 15-20 minutes.
• Elevation: If possible, elevate the injured limb above the heart. This helps reduce blood flow to the injured area by gravity.
• Pressure Points: In cases of severe bleeding, applying pressure to pressure points can help reduce blood flow. Major pressure points include the brachial artery (inside of the upper arm) and the femoral artery (in the groin). Only use pressure points when direct pressure isn't sufficient and you have received appropriate training.
• Tourniquet: A tourniquet should only be used as a last resort for severe, life-threatening arterial bleeding that cannot be controlled by other methods. Improper use of a tourniquet can cause serious complications, including limb loss. You must receive specific training in tourniquet application before attempting to use one.

3. Monitoring and Further Actions:

• Continuous Monitoring: Continuously monitor the patient's vital signs and the bleeding. Look for signs of shock (pale skin, rapid pulse, shallow breathing, dizziness, confusion).
• Wound Cleaning and Dressing: Once the bleeding is controlled, clean the wound gently with sterile saline or water. Apply a clean dressing and bandage to protect the wound.
• Documentation: Meticulously document the incident, including the time, location, type of bleeding, actions taken, and the patient's response. Note the patient's vital signs before, during, and after the incident.
• Seek Immediate Medical Attention: If the bleeding is severe, uncontrollable, or accompanied by signs of shock, call for immediate medical assistance.

Specific Considerations for Nursing Assistants

Nursing assistants play a vital role in immediate response to bleeding incidents. Their responsibilities extend beyond simply controlling the bleeding; they also include:

• Observing and Reporting: Alert the nurse or other qualified healthcare professional immediately. Provide a detailed report of the situation, including the patient's condition and the steps taken.
• Comforting the Patient: Provide reassurance and emotional support to the patient, which can help reduce anxiety and stress.
• Maintaining Sterility: Always use clean or sterile materials to prevent infection.
• Adhering to Protocols: Follow your facility's established protocols and procedures for managing bleeding injuries. Never deviate from these protocols without direct supervision from a qualified healthcare professional.
• Continuing Education: Regularly update your knowledge and skills through continuing education courses and training sessions on wound care and bleeding control.

Common Mistakes to Avoid

Several common mistakes can hinder effective bleeding control and even worsen the patient's condition. Nursing assistants must be aware of these errors and take steps to avoid them:

• Insufficient Pressure: Applying inadequate pressure to the wound can prolong bleeding and may lead to further complications.
• Removing Dressings: Removing a blood-soaked dressing disrupts the clotting process and can restart bleeding. Instead, add more dressings on top.
• Improper Tourniquet Use: Improperly applied tourniquets can cause severe damage to tissues, nerves, and blood vessels. Only use a tourniquet when absolutely necessary and with appropriate training.
• Ignoring Signs of Shock: Failure to recognize and address signs of shock can lead to serious complications and even death.
• Lack of Documentation: Insufficient or inaccurate documentation can impede effective medical care and contribute to legal issues.

Different Bleeding Scenarios and Appropriate Responses

Let’s examine specific scenarios and how a nursing assistant should respond:

Scenario 1: Minor Cut on the Finger

• Response: Apply direct pressure using a clean cloth or gauze. Elevate the finger above the heart. If bleeding stops within a reasonable timeframe, clean the wound with mild soap and water, and apply a clean bandage. Monitor for signs of infection.

Scenario 2: Deep Laceration on the Leg with Profuse Bleeding

• Response: Apply direct pressure to the wound using a clean dressing. Elevate the leg. If bleeding continues, consider (after receiving appropriate training) applying pressure to the femoral artery pressure point. Call for immediate medical assistance. Monitor vital signs and look for signs of shock.

Scenario 3: Bleeding from a Nosebleed

• Response: Have the patient sit upright, leaning slightly forward. Pinch the nostrils firmly just below the bony bridge of the nose. Apply ice to the bridge of the nose. Continue pinching for 10-15 minutes. If bleeding persists, seek medical attention.

Scenario 4: Head Injury with Bleeding

• Response: Do not attempt to stop the bleeding yourself. Call for immediate medical attention. Monitor the patient's breathing, pulse, and level of consciousness. Support the patient's head and neck to prevent further injury.

Conclusion: Preparedness and Professionalism

Effective bleeding control is a fundamental skill for any nursing assistant. This guide has outlined crucial steps and considerations, emphasizing the importance of safety, accurate assessment, and adherence to protocols. By mastering these techniques and staying updated on best practices, nursing assistants can significantly contribute to positive patient outcomes and maintain the highest standards of professional care. Remember, continuous learning and practice are essential for proficiency in this critical area of healthcare. Always prioritize patient safety and seek immediate medical assistance when necessary.