All patients should be taught to compress a bleeding access, wash skin over access with soap and water daily and before dialysis, and also recognize signs and symptoms of infection. All patients should know to avoid carrying heavy items draped over the access arm, avoid wearing occlusive clothing, wear protective clothing over the exposed fistula vein if working around machinery or sharp tools [ 11 ].
Platelet biochemical abnormalities in ADP and serotonin compounds along with thromboxane A2 leading to defective platelet aggregation may contribute to increased bleeding tendencies in dialysis patients [ 32 , 33 ]. Platelet numbers are usually not low enough to cause increased bleeding [ 34 ]. Factor 8 and Von Willebrand factor alteration may also play a crucial role as can anemia by leading to defective platelet aggregation as demonstrated by in vitro studies [ 35 , 36 ].
Hemodialysis improves these hemostatic complications but use of heparin during dialysis may be a contributory factor to increased bleeding tendencies from dialysis access sites including petechial hemorrhages, blood blisters, ecchymosis, and hematoma. It is unusual for acute access blood loss to occur due to an underlying coagulopathy though theoretically it may prolong bleeding from any other reason.
Antiplatelet agents, such as dipyridamole and low-dose aspirin with or without sulfinpyrazone, aspirin plus clopidogrel, have been studied in an effort to decrease graft thrombosis but conflicting evidence exists in this regard and no real recommendations exist for the use of antiplatelet agents to prevent graft thrombosis [ 37 , 38 ]. In one clinical trial, role of aspirin plus clopidogrel versus double placebos was studied in preventing graft thrombosis [ 39 ], but the study was stopped because of a markedly increased risk of bleeding among those receiving active therapy hazard ratio of 1.
At study end, dual antiplatelet therapy was not associated with a significant benefit in preventing thrombosis. Similarly, administration of warfarin does not increase graft survival and is associated with significant bleeding [ 40 ]. The incidence and prevalence of depression among dialysis patients is unknown but estimates vary from 20 to 50 percent [ 41 ]. Approximately one-fourth of dialysis patients are depressed at some point in time.
Furthermore, about 1 percent of the dialysis patients commit suicide, especially the elderly population [ 42 ]. Risk factors for suicide include male gender, a preexistent psychiatric diagnosis, and addiction to drugs or alcohol [ 43 — 45 ]. Bleeding from a vascular access is rarely a result of a suicide attempt.
Aneurysms should be considered a risk factor for acute vascular access bleeding in chronic dialysis patients and should never be cannulated. If assessed to be at risk for rupture, a workup for associated access infection should be considered and a surgical consult for aneurysm repair initiated. Dual antiplatelet therapy should be avoided in patients with AV fistula aneurysms.
Patient education is important to avoid complications of access bleeding; patients should be taught simple techniques like putting direct pressure to minimize bleeding while seeking acute medical care.
Our patient should have applied direct pressure to his AV fistula and called for emergency services, thus potentially reducing the duration of his hospitalization. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Ramalingam, 1 Philip B. Johnson, 1 and Jean L. Academic Editor: Greg Tesch. Received 03 Jan Revised 10 Mar Accepted 24 Mar Published 30 May Abstract Little has been written about acute blood loss from hemodialysis vascular access.
Introduction Acute blood loss through vascular access can be a life threatening problem. Figure 1. Right upper arm AV fistula aneurysm of the patient. Causes of blood loss through AV fistula 1 Aneurysm formation 2 Stenosis and subsequent rupture 3 Infection 4 Trauma 5 Use of anticoagulants and antiplatelets 6 Suicide. Table 1. View at: Google Scholar W.
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Goldwasser, M. Avram, J. Collier, M. Finally, when all previous techniques have failed, surgical repair is probably necessary. Remember to place pressure above, below and in the bleeding site; also ideally use a non-cutting needle to treat the suture in order to avoid more bleeding. Tags: Uncategorized. Post Dialysis bleeding can easily be stopped simply by applying alcohol based disinfectant on gauge piece and firmly hold only for couple of minutes although the mechanism is not fully understood.
My dad is hemodialysis patient and he has hard time to stop bleeding. I have no idea what it is and it scare me. Home Login Join. Make an appointment. Visit now. Explore now. Choose a degree. Get updates.
Books and more Donate now. Bleeding from fistula puncture site: As a retire surgeon who has constructed and managed many dialysis fistulae I can assure you that a mature fistula several months old ,the skin and subq is so tightly adherent to the graft that all you have to do is figure eight the skin puncture site with a superficially placed suture.
Because the skin and subq are so tightly adherent you will NOT be creating a contained spreading hematoma. Also elevating the arm decreases the pressure in the fistula and helps make the compression more effective. Your email address will not be published. Save my name, email, and website in this browser for the next time I comment. Notify me of follow-up comments by email. Notify me of new posts by email.
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Contact us at editors emdocs. Ear Pain. Powered by Gomalthemes. Toggle navigation. Menu All Content. Previous Post. Next Post. Sep 18th, Erica Simon categories: practice updates. Topical Hemostatic Agents Gelfoam — While there are no trials or studies specifically assessing the utilization of gelfoam in the setting of vascular access hemorrhage, its use is extensively detailed in emergency medicine literature.
Focus on: dialysis access emergencies. Prevention of catheter-related bloodstream infections in patients on hemodialysis: challenges and management strategies. Int J Nephrol Renovasc Dis. Management and outcomes of dialysis access-associated steal syndrome.
J Vasc Surg. Am J Kidney Dis. Epidemiology of kidney disease in the United States. Type of vascular access and mortality in US hemodialysis patients. Kidney Int. Hodde L, Sandroni S. Emergency department evaluation and management of dialysis patient complications. J Emerg Med. Hemodialysis-related emergencies-part I. Venkat, A. Challenging and Emerging Conditions in Emergency Medicine.
Chichester, West Sussex: Wiley-Blackwell, Tintinalli, J. New York: McGraw-Hill, United States Food and Drug Administration.
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