Bleeding, but 1 hour after??

[nee]

Hello Everyone,

My Dad is on HD for 5 years and for the past few months a strange bleeding pattern happened to him.

Normally I'm with him in the center and I hold his sites for 5 mins before we go home (he uses his native fistulae and he is not a bleeder).
Then, recently and it happened twice already, his arterial site bled again in 1 to 2 hours after ?? The 1st time we did not catch it until he wondered why his upper arm was wet (how scary!!)
Then, 3 months later (yesterday nite) it happened again but I luckily caught it when the gauze started to get wet.

Did this happen to any of you and is this unusual??

Thank you.
Nee

[goofynina]

Hi Nee,   I can remember this happening to be a couple of times when i was on Hemo.  They just say that for some reason the clot (scab) breaks and it starts to bleed, they would just recommend that i not lift anything or move around too much for a couple of hours after i get off the machine, i really dont think they know the answer themselves, i just hope it doesnt happen to your dad anymore.  Take care 

[nee]

Hello Nina,

Thanks for the postback. No, normally he does not lift or do anything too much with his left arm
after dialysis (he's 84 and weak). Also, he's 80% blind, he cannot see his blood, he can only feel the
wetness but of course he is not sure if it is sweat or blood !!!

I'm nervous because I dont when it will happen again ... I'm not lucky every time catching it on time.
Last nite it happened at my bedtime (9:30 pm) but luckily I was still up watching American idol, and I
caught the bleeding because I took the bp for him after he said he suddenly felt tired ....

I dont know what to avoid.

Nee

[jbeany]

nee,

Have they changed any of his meds?  Are they giving him more heparin?  Any other blood thinners?

How old is his fistula?  I read somewhere that when they have been used a long time, it may damage the surrounding tissue and make it more prone to bleeding.  I can't think where I read that, but if anyone else has any info on that, please add it.

I've had my needle sites start bleeding again hours after the session.  I had usually done something to bump the tiny scab.  I don't think it's horribly unusual, but it can certainly be scary.

[Sluff]

Hello nee,

Could you please post an itroduction post in the introduce yourself section so we can get to know you a little better?

Easy link here: http://ihatedialysis.com/forum/index.php?board=14.0


Thanks

Sluff, Moderator

[nee]

Hello Jbeany and Sluff,

Sluff:  sure I will create an introduction post. I like this forum just as I like "dialysis on line" from brumley.com before -- still not know why they shut down that wonderful dialysis forum -- I miss it.

Jbeany: His fistulae is actually 6 years old and it has been doing good. One nite, he bled considerably because one of the techs had shaking hand when pulling the needles out. And so that nite I held his sites for more than one hour but when I released it bled again. Scary. He bled from 9 pm until 10:30 pm unless I kept holding still. That of course did not work and my sister & I took him to the emergency at 11 pm. We took turn using the clamp and hold his site until 3 hours later when the vascular surgeon came and gave him stitches at 3 am in the morning !!!
After that nite, I do not allow that tech to put him or take him off. However, that tech insists on pulling the needles since we dont allow him to put in the needles. In order not to hurt his feeling (which can make him mean to my Dad) I learn how to pull the needles myself. So if I'm the daughter pulling the needles, he does not have a reason to get mad, and we still do not let him put the needles in.
About the blood thinner, I hope they follow the binder but good precaution -- I'll check with them the next time.

Nee

[AlasdairUK]

How much if any clotting of blood is there left in the dialyzor after the washback, you could increase the stop time on the heparin. There is also a fairly simple test they can do to see how quickly your fathers blood clots.

How much heparin does he receive during the session and is he on any other blood thinning meds?

If clotting is not the issue then there may be too much blood comming out of the exit site. I hope you get to the bottom of this.

[renal30yrs]

Platelet count checked?

[nee]

Hello,

I did check his platelet -- it has been low!

About the heparin, it's only 1,500 units provided that they stick to the binder.

I suspect if this had anything to do with the rate they return the blood to him. Some tech takes
reasonable amount of time, but on the incident night, that tech was kinda in a rush and returned the blood
quite in a short time and I dont like it. Thats another thing I have to find out -- I do think returning the blood
within too short a time is not at all good for patients, because other than the bleeding that happened that
night he also felt suddenly and unusually tired and his diastolic was sky high 99 !! (bp read 137/99  pulse: 75)

I do suspect that the very short time in blood return did play a role in this incident.

Nee

[renal30yrs]

Renal disease and aging both greatly weakens one's vessels.  Techs and nurses should be extra cautious.

[nee]

I suspect if this had anything to do with the rate they return the blood to him. Some tech takes
reasonable amount of time, but on the incident night, that tech was kinda in a rush and returned the blood
quite in a short time and I dont like it.

Hello Board,
Well, I'm now back after a few days and I quote myself above since what I suspected was 95% true ??
I guess I share the info I find out here ...

So on my Dad's next session of dialysis, I talked to a good tech there and we have been like friends. I learned
from him that the rate of blood returning to the patient should be no more that 200-220. Guess what, my Dad
was in the spot of the tech the other night when bleeding occurred to Dad later. So of course I observed her;
and bam I did catch something !! -- same hasty manner (I observed her hastiness couple of times), she returned the blood at the rate of 300 and asked me to sit my Dad up when the blood was still returning. Of course I surprised her this time. I requested that she lower the rate to 220 and told her it is safer for my Dad to sit up after all the blood had been returned.
That might explain the weird reading of my Dad's diastolic and the sudden afterward bleeding the other nite, although
I do not have full proof ... anyhow, so long as sticking to the correct way of doing things will ensure patients safety
thats all it counts.

HTH.

Nee

[goofynina]

Good for you Nee    Your dad is very lucky to have you,  I hope this helps cease the problem of him bleeding.  Good luck to both of you