DERBY HOSPITALS NHS FOUNDATION TRUST
DIVISION OF MEDICINE
PAEDIATRICS
GUIDELINES FOR THE MANAGEMENT OF POST OPERATIVE
HAEMORRHAGE FOLLOWING TONSILLECTOMY AND/OR
ADENOIDECTOMY
REF NO: CH CLIN S 09
Reference Version: 3 Status: Final Key Words:
Number:
CH CLIN S 09
Version / Version Date Author Reason
Amendment 1 Oct 05 Surgical specialist Original guideline
History nurses
2 Nov 10 Ward Sister Sunflower Review Due
3 Jan 14 Ward Sister Sunflower Review Due
Intended Recipients:
Paediatric Medical and Nursing staff
Training and Dissemination:
Email to Paediatric Consultants, Paediatric Medical staff, Matron, Senior sisters.
Distribution and Location of Guideline:
Published on Intranet
Documentation Control
Date of Issue Date: 14/01/2014
Review date and frequency Every 3 years Date: 14/01/2017
Key Contact Debbie Reynolds, Ward
Sister Sunflower
In Consultation With:
Paediatric Consultant, ENT consultants
Approving Signature (1) Lead Clinician Name: Dr J McIntyre
Signature:
Date:
Approving Signature (2) Head Of Nursing Name: L Keep
Signature:
Date:
. CH.CLIN. S.09 v3 Jan 14 Page 1 of 3
GUIDELINES FOR THE MANAGEMENT OF POST OPERATIVE
HAEMORRHAGE FOLLOWING TONSILLECTOMY AND/OR
ADENOIDECTOMY
REF CH CLIN S 09
Purpose
This guideline is formulated to ensure timely recognition of post operative
haemorrhage following tonsillectomy and/or adenoidectomy and prompt the
appropriate action by the health care professionals involved in the child/young
person’s care.
Aim & Scope
This guideline applies to all children and young people undergoing tonsillectomy
and/or adenoidectomy in the Derbyshire Children’s Hospital.
Definitions
Postoperative bleeding following tonsillectomy and/or adenoidectomy remains a
most serious complication. It is potentially an emergency situation and can result
in acute airway compromise.
Implementing the Guideline
Assess Bleeding
Check for excessive swallowing and raised pulse. Monitor visual blood loss,
evidenced by persistent spitting of fresh blood, constant nasal bleeding or
vomiting of fresh blood.
If present, IMMEDIATELY contact
On call ENT SHO/Registrar - (if unavailable, contact ENT consultant on
call).
On call Paediatric registrar
On call Anaesthetist mobile 07584407886 (Consultant during day, SR
nights/weekends) or via switchboard if unobtainable
Record and monitor blood loss. Keep all evidence of blood loss for review.
Record pulse, respiratory rate and blood pressure every 5 minutes until stable.
Monitor trend with observations (pulse, respiration and blood pressure,
pallor/colour and level of consciousness), indicative of hypovolaemic shock.
. CH.CLIN. S.09 v3 Jan 14 Page 2 of 3
Once stable, record as per post operative guidelines.
If airway significantly compromised or clinical condition warrants – consider
transfer to Dolphin Unit.
If the child is bleeding nasally encourage the child to sit as upright as possible,
and monitor.
Treatment
Nursing staff to ensure contact details of NOK are readily available if
required for consent purposes
Reassure patient
Ensure nil by mouth until otherwise instructed.
Ensure a patent intravenous cannula is in situ. FBC, group & save to be
performed.
In most cases an IV cannula will be inserted intra-operatively, however, in
the absence of a cannula, please assess the situation with regard to the
application of Ametop. In this emergency situation, it may be necessary to
obtain blood samples as soon as possible, therefore omitting the use of
Ametop).
If the child needs initial fluid bolus, resuscitation fluid 0.9% sodium chloride
to be commenced in a dose of 10 – 20 ml/kg. Infusion at a rate that is
recommended by the Derbyshire Children’s Hospital Resuscitation
Committee.
Otherwise commence intravenous maintenance fluids as per paediatric
guidelines.
If required, ensure the child is as prepared for theatre as possible, as per
protocol.
Ensure the team leader completes the red paediatric resuscitation form.
(Record of event).
. CH.CLIN. S.09 v3 Jan 14 Page 3 of 3
