Hemorrhage of AV fistula: Difference between revisions
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*Pseudoaneurysm | *Pseudoaneurysm | ||
**Results from subcutaneous extravasation of blood from puncture sites | **Results from subcutaneous extravasation of blood from puncture sites | ||
**Bleeding from puncture site is usually controlled by digital pressure or subq suture | **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 US studies can identify the aneurysm or pseudoaneurysm | ||
Revision as of 00:47, 21 October 2015
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
- Topical thrombin
- QuikClot or similar product application
- Purse string suture