Intervention
The main author adopted the common techniques that are utilised in other
otolaryngology and head and neck surgery procedures to develop the
following multi-step approach to the haemostatic check at the final
stage of a tonsillectomy:
- Pack wound with swab, relax gag, and neutralise neck position for one
minute.
- Re-extend the Boyle–Davis mouth gag (BDG), remove swabs and wash the
site with a saline-soaked swab.
- Valsalva manoeuvre if allowed by airway device.
- Trendelenburg position.
To ensure patient safety was not compromised during the second cycle, we
carried out a researched, evidence-based approach to the implementation
of a change in practice for achieving and checking haemostasis in our
tonsillectomy cases. Recent studies have shown that the Trendelenburg
position can detect a significantly higher number of bleeding vessels in
head and neck surgery compared to the Valsalva manoeuvre alone, with one
study reporting additional bleeding points identified in 68% of
patients with the use of the Trendelenburg tilt following Valsalva[4]. In this same study, it is also important to
note that in five cases, there was significant bleeding that required
suturing which were not identified using the Valsalva manoeuvre alone.