Fistula Bleed

[ODAT]

My mother ended up in ER the other night. Her fistula started to bleed excessively around 8:30pm Friday night. My sister got to her house and called 911. The EMTs put a tourniquet on and said she needed to go to ER so a doctor could be the one to take it off and see if there was still bleeding.

This happened to her at dialysis center a while ago. There was more blood then, but there was enough this time that my sister felt we might not be able to stop without proper attention.

The doctor left the bandage on for a few hours. When he checked it, one needle hole was still oozing. They put on another bandage and came back again to check in about an hour. There was no bleed-through so the doc sent mom home. Told her to leave bandage on til next afternoon (it was 2am at this point). I spent the night with her and when took it off it had bled more but had stopped. Put on a few bandaids and a bit of gauze.

One of the ladies where my mom lives said that once a tourniquet is put on, a doctor has to be the one to remove it. ??

The other thing I was wondering is if her doing a ton of dishes could have caused the bleed. She had dialysis that day about 4 hours prior to doing dishes. I mean there was a lot of dishes - heavy pans and such.

The doctor told her to rest her arm. That's another reason I'm thinking she may have done too much that day. She also had someone new bandage her at dialysis. Mom said they did a good job - nothing different.

Mom has calmed down, but she was actually doing good during this (when she was with me at least). I didn't down-play the situation, but I did remind her that she knew this happened occasionally.

[jbeany]

A couple of random thoughts -

Yeah, it will happen occasionally - and yes, all the lifting probably didn't help.  No point in panic - it just speeds up the heart rate and pumps the blood faster.

There's a powder they can sprinkle on the exit sites that helps clotting.  Getting it from center is a rare thing, but it's possible.  Anyone know the name of it? I've totally blanked out.  I was prone to bleeding and having to hold for ages after D.  When they had problems with a machine and didn't get me on in time, the head nurse would pull some for me - more for their convenience than mine, but still.  If you could get some to keep at home, you could apply it if this happens again.  It came in a tiny brown glass jar.  Darn, I hate it when I can't think of names.

Leafy greens like lettuce are supposed to have coagulant properties.  You might want to push a few more salads her way!

[del]

We have what is called surga seal (think that's what it's called). It's like a tiny piece of gauze that the nurse puts on the needle hole when the needle is taken out. Stops the bleeding faster. Hubby didn't use it because he doesn't have a long bleding time.

Doing all the dishes could have helped cause the bleeding but I think sometimes it just happens to some people.  If she is on blood thinners that could make the bleeding worse as well.

[sullidog]

If this continues you may also wanna get a fistulagram to check for stenosis as this could also cause unusual bleeding.

[ODAT]

Thanks for all your responses!

Mom isn't on blood thinners. She had a fistulagram not too long ago. How often do they do them or is it based on how well it is working?

I believe she does get the seal put on when needles are taken out.

By the time I met up with mom at the ER, she was calm. Blood pressure was ok I guess 160/70?

[looneytunes]

Fistulagrams are normally done on an "as needed" basis.  But the abnormal bleeding could certainly have been because of the heavy lifting and also the warm water she was naturally using to wash dishes in. 

Here's hoping it's an isolated incident because it can be scary, for sure! 

[texasstyle]

I may not be correct, but I VERY VERY STRONGLY believe that dark, leafy greens are to be AVOIDED. The vitamin K in them I think has something to do with the effect of coagulation. I'm only saying this because my younger brother is on blood thinner and has to AVOID the dark leafy greens. My husband bleeds sometimes on his off day from his fistula. It concerns me because I know there is a lot of force going through there and they give him Heprin in his line. Isn't Heprin "short lasting"? Anyone know?...I think about the torniquet, if you have one on for a long time you are cutting off total blood supply to rest of the area and it usually used as a last resort. Applying pressure DIRECTLY to the area is probably your best bet. Any thoughts on this appreciated!  Gosh, it's amazing how much stuff we have to learn isn't it? Who would have ever thought..

[jbeany]

I may not be correct, but I VERY VERY STRONGLY believe that dark, leafy greens are to be AVOIDED. 

I think you are only supposed to avoid them if you are on blood thinners for a serious medical condition.  I've never heard them counter-prescribed for a D patient. 

[texasstyle]

Ok, I'm going with you then. It concerned me though and I just had to bring it to atttention. I was having an out patient surgery once, and it was told on the list of things to do before hand was not to eat any garlic. Apparently that's a blood thinner. Wierd how some foods effect you in different ways. I'm glad we got this straightened out jbeany. I've always known you are very knowledgeable but something hit me, and I was wrong about it. Good thing we've got each others backs because sometimes I'm ditzy lol.

[jbeany]

Well, I may be wrong, too!  But I figure if you are clotting on the machine, they just up the heparin.  After you come off - they want you to clot and stay that way.  (Just ask any of my grumbling nurses and techs who wanted to go home while I was still hanging around bleeding.)  On D, it's only two needle sticks - surgery is a whole other risk.

(And I've never been told to avoid garlic before surgery.  They have stopped my aspirin for a week, but no mention of diet at all.  Huh.)

[lmunchkin]

I could have sworn you were doing NxStage at home, Jbeany!  Oh well!

I think maybe the dishes also!  Does she have anyone at home to help her with the heavy stuff!  Like a man or something!  Boy if that aint wishful thinking, a Man doing the dishes!  So lame!!!!  What was I thinking??   

lmunchkin   

[jbeany]

I could have sworn you were doing NxStage at home, Jbeany!  Oh well!

You haven't lost your mind, I promise!  I was on NxStage for a while, in between stretches in-center.  Now I've got a transplant.

[lmunchkin]

Thats right, I remember now, and it wasnt that long ago either. Must of had a Blonde moment, oops, Im not blonde!  How has it been going for you so far? There are so many to have a transplant lately, and I think it is the best treatment of all!  I know it comes with some perks, but it aint D is it? And you can do so much more things in life!

I forgot what this thread was about!  Sign of being tired.  Got to go to bed now!  Work comes at sunrise!

Good Night and love you all,

lmunchkin     

[jbeany]

  How has it been going for you so far? There are so many to have a transplant lately, and I think it is the best treatment of all!  I know it comes with some perks, but it aint D is it? And you can do so much more things in life!

It was almost two years ago now.  It was a bumpy ride.  I recently covered most of the gory details here:

http://ihatedialysis.com/forum/index.php?topic=24048.msg389029#msg389029

[ODAT]

lmunchkin, yes mom has an aide every day from 7am to 9am. Funny thing is, she didn't want the aide to face all those dishes! My sister had been there and cooked dinner. Sis went to do dishes and mom said to leave them for aide, then ends up doing herself!