Hemorrhage of AV fistula: Difference between revisions
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*QuikClot or similar product application | *QuikClot or similar product application | ||
*Purse string suture | *Purse string suture | ||
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*If can not be stopped with above measures, place upper extremity tourinquet and consult vascular surgeon vs IR. | *If can not be stopped with above measures, place upper extremity tourinquet and consult vascular surgeon vs IR. | ||
Revision as of 05:28, 16 February 2016
Background
- Potentially life-threatening
- Can result from aneurysms, anastomosis rupture, or over-anticoagulation
Types
- Aneursym (true)
- Most are asymptomatic; rarely rupture
- Pseudoaneurysm
- Results from subcutaneous extravasation of blood from puncture sites
- Bleeding from puncture site is usually controlled by digital pressure or subq suture (if placed deep will often ruin shunt)
- Consider vascular surgery consultation for continued bleeding or infection
- Arterial Doppler US studies can identify the aneurysm or pseudoaneurysm
Clinical Features
Differential Diagnosis
AV Fistula Complications
- Clotting of AV fistula
- Infection of AV fistula
- Hemorrhage of AV fistula
- Vascular insufficiency from AV fistula
- AV fistula aneurysm/pseudoaneurysm
- High-output heart failure from AV fistula
Diagnosis
- Consider Doppler US
Management
- Control bleeding w/ pressure applied to puncture site for 5-10min; observe for 1-2hr
- Utilize fistula clamp to apply small focus of direct pressure
- Bulky dressing with allow for continued bleeding
- Correct coagulopathy
- Protamine sulfate for severe Unfractionated heparin reversal
- DDAVP for Uremic bleeding syndrome
- Topical thrombin
- QuikClot or similar product application
- Purse string suture
- If can not be stopped with above measures, place upper extremity tourinquet and consult vascular surgeon vs IR.