Difference between revisions of "Hemorrhage of AV fistula"

(Created page with "==Background== ==Clinical Features== ==Differential Diagnosis== ==Workup== ==Management== ==Disposition== ==See Also== *Dialysis complications ==External Links== =...")
 
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==Background==
 
==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 [[ultrasound]] studies can identify the aneurysm or pseudoaneurysm
  
 
==Clinical Features==
 
==Clinical Features==
  
 
==Differential Diagnosis==
 
==Differential Diagnosis==
 +
{{AV shunt complications DDX}}
  
==Workup==
+
==Evaluation==
 +
*Consider Doppler [[ultrasound|US]]
  
 
==Management==
 
==Management==
 +
*Control bleeding with pressure applied to puncture site for 5-10min; observe for 1-2hr
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**Utilize fistula clamp to apply small focus of direct pressure
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**Bulky dressing with allow for continued bleeding
 +
*Correct [[coagulopathy]]
 +
**[[Protamine]] sulfate for severe [[Unfractionated heparin reversal]]
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**[[DDAVP]] for [[Uremic bleeding syndrome]]
 +
*Topical thrombin
 +
*QuikClot or similar product application
 +
*Purse string suture with 3-0 nylon suture<ref>Vesely TM. Use of a Purse String Suture to Close a Percutaneous Access Site After Hemodialysis Graft Interventions. JVIR 1998; 9:447-450. http://www.vascularaccessdoc.com/pdf/22.pdf.</ref>
 +
[[File:purse string.jpg|thumbnail]]
 +
*If can not be stopped with above measures, place upper extremity [[tourniquet]] and consult vascular surgeon vs IR.
  
 
==Disposition==
 
==Disposition==
 +
*Consider discharge if hemodynamically stable with minimal blood loss
  
 
==See Also==
 
==See Also==
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==External Links==
 
==External Links==
  
==Sources==
+
==References==
 
<references/>
 
<references/>
  
 
+
[[Category:Renal]]
===[[Hemorrhage of AV fistula]]===
+
[[Category:Vascular]]
*Potentially life-threatening
 
*Can result from aneurysms, anastomosis rupture, or over-anticoagulation
 
*Control bleeding w/ pressure applied to puncture site for 5-10min; observee for 1-2hr
 
*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
 
***Consider vascular surgery consultation for continued bleeding or infection
 
***Arterial Doppler US studies can identify the aneurysm or pseudoaneurysm
 

Revision as of 16:55, 16 October 2019

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 ultrasound studies can identify the aneurysm or pseudoaneurysm

Clinical Features

Differential Diagnosis

AV Fistula Complications

Evaluation

  • Consider Doppler US

Management

Purse string.jpg
  • If can not be stopped with above measures, place upper extremity tourniquet and consult vascular surgeon vs IR.

Disposition

  • Consider discharge if hemodynamically stable with minimal blood loss

See Also

External Links

References

  1. Vesely TM. Use of a Purse String Suture to Close a Percutaneous Access Site After Hemodialysis Graft Interventions. JVIR 1998; 9:447-450. http://www.vascularaccessdoc.com/pdf/22.pdf.