Difference between revisions of "Hemorrhage of AV fistula"

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**Bleeding from puncture site is usually controlled by digital pressure or subq suture (if placed deep will often ruin shunt)
 
**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
 
**Consider vascular surgery consultation for continued bleeding or infection
**Arterial Doppler US studies can identify the aneurysm or pseudoaneurysm
+
**Arterial Doppler [[ultrasound]] studies can identify the aneurysm or pseudoaneurysm
  
 
==Clinical Features==
 
==Clinical Features==
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{{AV shunt complications DDX}}
 
{{AV shunt complications DDX}}
  
==Diagnosis==
+
==Evaluation==
*Consider Doppler US
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*Consider Doppler [[ultrasound|US]]
  
 
==Management==
 
==Management==
*Control bleeding w/ pressure applied to puncture site for 5-10min; observe for 1-2hr
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*Control bleeding with pressure applied to puncture site for 5-10min; observe for 1-2hr
 
**Utilize fistula clamp to apply small focus of direct pressure
 
**Utilize fistula clamp to apply small focus of direct pressure
 
**Bulky dressing with allow for continued bleeding
 
**Bulky dressing with allow for continued bleeding
*Correct coagulopathy
+
*Correct [[coagulopathy]]
**Protamine sulfate for severe [[Unfractionated heparin reversal]]
+
**[[Protamine]] sulfate for severe [[Unfractionated heparin reversal]]
**DDAVP for [[Uremic bleeding syndrome]]
+
**[[DDAVP]] for [[Uremic bleeding syndrome]]
 
*Topical thrombin
 
*Topical thrombin
 
*QuikClot or similar product application
 
*QuikClot or similar product application
*Purse string suture
+
*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>
*If can not be stopped with above measures, place upper extremity tourinquet and consult vascular surgeon vs IR.
+
[[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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<references/>
 
<references/>
  
[[Category:Nephro]]
+
[[Category:Renal]]
 
[[Category:Vascular]]
 
[[Category:Vascular]]

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.