Medical Surgical Nursing

Devascularization and Transection

 Devascularization and staplegun transection procedures to separate the bleeding

site from the high-pressure portal system have been used in the emergency

management of variceal bleeding. The lower end of the esophagus is reached

through a small gastrostomy incision; a staple gun permits anastomosis of the

transected ends of the esophagus. Rebleeding is a risk, and the outcomes of

these procedures vary among patient populations.

Nursing Management

 Monitoring the patient‘s physical condition and evaluating emotional responses

and cognitive status.

 Monitor and record vital signs

 Assess the patient‘s nutritional and neurologic status.

 This assessment will assist in identifying hepatic encephalopathy resulting from

the breakdown of blood in the GI tract and a rising serum ammonia level.

Manifestations range from drowsiness to encephalopathy and coma.

 Complete rest of the esophagus may be indicated with bleeding, so parenteral

nutrition is initiated. Gastric suction usually