CRNFA Hemostasis and Tissue Management 2 — Questions and Answers
Question 1: Which absorbable hemostatic agent is derived from oxidized regenerated cellulose and works by absorbing blood to form a gel clot?
- Gelfoam (gelatin sponge)
- Surgicel (oxidized regenerated cellulose) (Correct answer)
- Avitene (microfibrillar collagen)
- FloSeal (gelatin matrix)
Correct answer: Surgicel (oxidized regenerated cellulose)
Surgicel is made of oxidized regenerated cellulose which, when wet with blood, forms a dark gelatinous mass that promotes clot formation and is absorbed within 1–2 weeks.
Question 2: When applying electrosurgical coagulation to a bleeding vessel, the CRNFA should use which technique for optimal hemostasis?
- Apply the electrode directly to the vessel while activating for 10 seconds
- Grasp the vessel with forceps and touch the active electrode to the forceps briefly (Correct answer)
- Activate the electrode in the air near the bleeding point
- Use the coagulation setting at maximum power for all vessels
Correct answer: Grasp the vessel with forceps and touch the active electrode to the forceps briefly
Coaptive coagulation — grasping the vessel with metal forceps and briefly touching the active electrode to the forceps — concentrates energy at the vessel and produces reliable hemostasis.
Question 3: What is the primary risk of placing an ESU dispersive pad over a bony prominence or scar tissue?
- Reduced electrical resistance leading to burns at the active electrode
- Increased impedance causing inadequate current return and burns under the pad (Correct answer)
- Excessive current density at the active electrode
- Generator malfunction
Correct answer: Increased impedance causing inadequate current return and burns under the pad
Bony prominences and scar tissue have poor contact area, increasing impedance at the dispersive pad, which can cause current to concentrate and produce a burn under the pad.
Question 4: The CRNFA notes active arterial spurting from a 3 mm vessel during dissection. The MOST appropriate immediate action is to:
- Apply topical thrombin and pack with gauze
- Apply direct digital pressure immediately and notify the surgeon (Correct answer)
- Activate the ESU at maximum coagulation
- Apply a hemostatic clip blindly to the bleeding area
Correct answer: Apply direct digital pressure immediately and notify the surgeon
Direct digital pressure is the safest and most immediate first response to control active arterial bleeding while preparing for definitive hemostasis with the surgeon.
Question 5: Which suture technique is most appropriate for ligating the pedicle of the appendix at its base?
- Figure-of-eight suture
- Purse-string suture
- Simple ligation with a free tie (Correct answer)
- Running locking suture
Correct answer: Simple ligation with a free tie
The appendiceal stump is typically managed with a simple free tie (ligation) or endoloop at its base to secure the mesoappendix vessels and prevent bleeding.
Question 6: Microfibrillar collagen hemostats (e.g., Avitene) work by which mechanism?
- Providing thrombin exogenously
- Activating the intrinsic pathway by attracting and aggregating platelets on collagen fibers (Correct answer)
- Physically tamponading vessels with a wax matrix
- Converting fibrinogen to fibrin chemically
Correct answer: Activating the intrinsic pathway by attracting and aggregating platelets on collagen fibers
Microfibrillar collagen attracts and aggregates platelets on its surface, activating the intrinsic clotting cascade and forming a platelet plug reinforced by fibrin.
CRNFA Hemostasis and Tissue Management 2
Which absorbable hemostatic agent is derived from oxidized regenerated cellulose and works by absorbing blood to form a gel clot?