Hemorrhage of AV fistula
Revision as of 14:41, 18 October 2015 by Neil.m.young (talk | contribs)
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
- 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