Difference between revisions of "Hemorrhage of AV fistula"

Line 29: Line 29:
 
*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>
 
[[File:purse string.jpg|thumbnail]]
 
[[File:purse string.jpg|thumbnail]]
 
*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 05:33, 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

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
  • Topical thrombin
  • QuikClot or similar product application
  • Purse string suture with 3-0 nylon suture[1]
Purse string.jpg
  • If can not be stopped with above measures, place upper extremity tourinquet and consult vascular surgeon vs IR.

Disposition

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.