Bleeding Dialysis Fistula?

Ever see a patient in the ED c/o "my fistula won't stop bleeding"? If you haven't, you probably will in the future.

Here are some helpful tips on getting these bad boys to stop oozing:

• Local pressure for 10 minutes will stop many of these bleeders
• Can also try locally applied gel foam/thrombin
• Pharmacologic adjuncts may be required, especially if the patient has missed dialysis-DDAVP can be given (makes platelets stickier by causing endothelial cells to release von Willibrand Factor). You can also give platelets, since platelets don't work well in a uremic state. Many dialysis patients are on coumadin because of chronic line clots, so don't forget to reverse this if present
• Probably as a last resort you can tie a superficial circular suture at the puncture site. This works quite well.