How much pressure are you supposed to use when holding your bandages post D?

[iolaire]

I find myself pushing fairly hard on my arm when I’m holding my bandages over my fistula post dialysis.  Is there some sort of rule as far as how much pressure you are supposed to use?  Today I’ll also ask at my center.

[cassandra]

Enough pressure to not have blood coming out. Sometimes more than 'moderate', sometimes not much at all. Well, that's what I do, and always have done, even with a 'never been perfect' fistula.

[PrimeTimer]

Thought I read somewhere (maybe one of Dr. Agar's articles) that only "gentle" pressure using two fingers should be applied because repeated "hard" pressure can damage a fistula and/or the force of pressure in one spot (the needle site) causes blood to build up in the fistula and when you let up on the pressure, whoosh! More blood rushes out. I don't know if I've explained this properly but I do think there's some truth to it because ever since I've been applying more gentle pressure, my husband's buttonholes bleed less and for a shorter time. I think we all go through the experience of when the bleeding becomes profuse but I've learned that as scary as it seems and even if the gauze should become saturated, to continue holding pressure because sometimes letting up just to apply fresh gauze only makes the bleeding continue some more. Couple of times I've applied gauze only to discover that I wasn't even over the needle site..but there was no bleeding (thank goodness).

[kitkatz]

I know I hold a lot lighter than the techs do. But then they are trying to get a giant needle out and I take over from them.  I have to ask them sometimes to let up the pressure because it hurts. 
My two cents of advice: Hold as hard as you feel comfortable and the bleeding has stopped.  You can always get help from the techs and nurses if you  need it in center.  It is hit and miss until you learn your access sites.

[Alex C.]

FWIW, I also ALWAYS hold my sites for a FULL 10 minutes (I use the stopwatch feature on my cell phone to time it) before I even stand up to weigh myself. I then sit back down, release my sites, then wait until 15 minutes have passed before I start to stow my stuff into my bag. I do this to prevent ever bleeding all over the floor again....

[iolaire]

Thanks for the reply.  The tech also said since I'm not a bleeder I could hold it very lightly.

Last night I tried to hold my bandages very softly, say soft enough to hold slightly cool butter, and they looked very good afterwards.  There was no dribble of blood when the bandages were changed at 8-12 minutes after pulling the needles and no dribble of blood or blood on the bandages when I removed them two hours after treatment (to put on Band-Aids for the rest of the overnight).

FYI: This is my choice of Band-Aids that I'm happy with "McKesson Performance Bandage Adhesive Fabric Strip, 100 Count " for  $5.74 or $0.06 each:
http://www.amazon.com/gp/product/B002C5CG1M

[casper2636]

I, too, have heard that too much pressure can damage the fistula. I generally hold lightly for 10 min. before I get up, and then put a second piece of tape over the gauze slightly snug (pulling one end tightly) ends NOT meeting on the back of my arm. This works for me, but then, I'm not  bleeder.

[PrimeTimer]

I, too, have heard that too much pressure can damage the fistula. I generally hold lightly for 10 min. before I get up, and then put a second piece of tape over the gauze slightly snug (pulling one end tightly) ends NOT meeting on the back of my arm. This works for me, but then, I'm not  bleeder.

You bring up another good point: Tape   -In order to avoid putting too much pressure on the fistula, I learned to not tape down the gauze that is directly over the needle sites too hard either. My husband uses buttonholes and I only have to hold his sites 4 minutes each and we leave the gauze on for at least 2 hours (he never sleeps with the gauze on overnite to avoid moisture from forming and bacteria, which could lead to infection.

[OlManRivah]

Our Center allows clamps to hold the bandage.  This allows uniform pressure all the time.  Some Centers don't allow clamps for various reasons.  Who knows what is correct?

[noahvale]

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[OlManRivah]

Apparently you didn't read the note at the bottom of your instructions...Submitted by the National Vascular Access Improvement Initiative. While we hope you find
this tool helpful, nothing on QualityHealthCare.org is meant to serve as a substitute for your
own professional judgment

[OlManRivah]

Actually, there is no one rule or procedure that works for everyone.  Some can't use a clamp and some can use two.  Some can't use tape, some can.  Some can't feel good enough or steady enough to hold their own access spots.  You can't expect to tie up a nurse to hold your bandage when she is more useful helping another patient, and you don't need her.

[noahvale]

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[noahvale]

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[monrein]

I was advised by my vascular surgeon to never use clamps and I never did. I did mostly home hemo and a self care clinic but also in hospital briefly. Never were clamps an option and when patients asked about them the explanation was that clamps can cause a fistula to be damaged and that is a risk not worth taking.