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 | + | **Arterial Doppler [[ultrasound]] studies can identify the aneurysm or pseudoaneurysm |
==Clinical Features== | ==Clinical Features== | ||
| Line 17: | Line 17: | ||
{{AV shunt complications DDX}} | {{AV shunt complications DDX}} | ||
| − | == | + | ==Evaluation== |
| − | *Consider Doppler US | + | *Consider Doppler [[ultrasound|US]] |
==Management== | ==Management== | ||
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**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 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> | *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]] | [[File:purse string.jpg|thumbnail]] | ||
| − | *If can not be stopped with above measures, place upper extremity | + | *If can not be stopped with above measures, place upper extremity [[tourniquet]] and consult vascular surgeon vs IR. |
==Disposition== | ==Disposition== | ||
Revision as of 16:55, 16 October 2019
Contents
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
- 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
Evaluation
- Consider Doppler US
Management
- 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
- 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 with 3-0 nylon suture[1]
- 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
- ↑ 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.