Sure Seal Bandaids

[JerseyGirl]

You know, I get the message with cutting the clotting time, etc but the real problem to me is, why is it taking everyone so long to stop bleeding post treatment?  Are you are correctly anticoagulated?  If you are using the proper amount of heparin and staff are rotating your sites correctly, it should take 10-15 minutes to stop bleeding.  Heparin has a half life of 4 hours - it doesn't stay around long in your system - have you all looked into what heparin dosage you are receiving?  Are you clotting the fibers in your dialyzer?  Do you get good rinsebacks?  Are your kt/v's good?  Ask the staff to check your KECN on the Fresenius K machine if you use them - staff are taught to monitor this anyway for trends when they use the amp lights on the K's. If the KECN changes +/- 20 mm then the staff should look for clotted fibers, etc because when this value changes clearances decrease as well.  If your blood pressure is too high post treatment, that too will cause you longer to clot.  I understand the need to want to go home quickly but there are other things that should be evaluated in this situation.  As for cost containment,  there isn't any corporation, dialysis setting, hospital setting or otherwise that isn't looking for ways to do that.  There was alot of pork and waste for many years in health care that are making us all look for cost control now.  Believe me,that isn't going to go away anytime soon.  Our heparin protocol was 1000U per 10 kg of body weight - that was standard unless the patient was post op, etc.

[kitkatz]

I think that the clot time depends on the age of the graft, too. As mine gets older, I have found it takes longer to get it to clot.  This may not hold true for fistulas, because they are made with your own vein and not a piece of plastic in the arm.

[jedimaster]

I have a fistula, almost brand new (6 months!) and I do the buttomhole technique. Since day one I had to wait AT LEAST 10 minutes per site...that is 20 minutes total. My wife found the blotters...I asked my doctor and nurse and they didn't have a problem me using them. Now my waiting time is 5 minutes per site...sometimes even 4. My heparin dosage is correct and works for me, but to me saving 10 to 15 minutes, at the end of dialysis is a big gain...small victories I guess.

[angieskidney]

I worry about mine as my dialyzer never is white after the runback /rinseback like the guy next to me. And I stop bleeding really fast now. My Heoglobin is 118 g/L (11) and I heard that I clot well but when I asked if they would change (raise?) my Heparin they just say no they won't.

They used to adjust mine .. at one time it took over 10 min for me to stop bleeding. But now they won't adjust it at all. They prefer me to clot instead of bleeding  which I can understand but I worry about clotting since Jamie died from a blot clot just this year in my city

[Panda_9]

Angie, if you are clotting your dialyser frequently then you do need more heparin, otherwise you wont be dialysing properly. How clotted/streaked is it?
I didnt know Jamie died from a blood clot, I was told that is rare in hemo patients 
I get clots in my needles when I cannulate, so I put 1ml diluted heparin into a 10ml flush, and withdraw blood (and discard) before flushing. That does help.

[RichardMEL]

My sites take 2 minutes each to stop bleeding! Wow I feel good now... I'd hate waiting 10 or more minutes per site! I feel for you guys with longer times..

[jedimaster]

2 minutes??...and I was happy with 5!!!!...do you use sureseal?....how much heparin?

[angieskidney]

Angie, if you are clotting your dialyser frequently then you do need more heparin, otherwise you wont be dialysing properly. How clotted/streaked is it?
I didnt know Jamie died from a blood clot, I was told that is rare in hemo patients 
I get clots in my needles when I cannulate, so I put 1ml diluted heparin into a 10ml flush, and withdraw blood (and discard) before flushing. That does help.

put it this way .. there is NO streaking .. it is all pink .. no white at all. The guy next to me .. now HIS is streaked with lots of white. Oh well .. the nurses don't seem to worried and they don't listen to me anyway (at least that is the serious impression I have been getting from them lately).

[Panda_9]

Hmm so you mean it seems to be completely clotted? Is there any clotting in the venous bubble trap?

[angieskidney]

Hmm so you mean it seems to be completely clotted? Is there any clotting in the venous bubble trap?

The nurse said not to worry as there are no clot clumps in the venous bubble trap. I am still learning and nervous but I guess I will take her word for it.

[RichardMEL]

I have no idea how much hep they put in. Can I tell from the machine? And we just use these "dots" - I don't think they have another name.. I don't think I've seen a sureseal. They work pretty well.. only once or twice have I bled when I take them off the next morning, and even then it's pretty minor

[Black]

Currently when I take the needles out of Mike's buttonholes (still using sharps - has only been 5 days) the training nurse has me cover the hole immediately with a folded gauze pad.  He has to hold each one for ten minutes and then we cover the holes with band-aids covered by a snug 6" piece of paper tape.  The arterial takes the full 10 minutes to clot, but the venous would probably be OK in 6 or 7 minutes.  (He's getting 4,000 units of Heparin in the line before he's hooked up to the machine.  We tried 3,500 but he had to come off 15 minutes early the second day because the filter was starting to clot.)

If we use the sure seals we bought, WHEN do we use them?  Do they replace the gauze pads and go on immediately as the needle is pulled and then apply pressure over the Sure Seal?  (Wouldn't that be a bloody mess?)  Or do you remove the gauze after just a minute or two and immediately replace with a Sure Seal, while it is still bleeding, and then apply pressure to the Sure Seal?  (More bloody mess?)  Or do you just substitute for the band-aid at the end of the 10 minutes?  (What's the advantage of that?)

One of the nurses said not to leave the Sure Seal on for more than 6 hours as the clotting chemical can cause skin irritation in some patients.   (She is not the training nurse but obviously did not like them.)  Mike already has a slight rash from the regular band-aids and the paper tape -- they suggested cortisone or generic Benedryl cream.  Has anyone seen skin irritation from the Sure Seals?  Anyone have any thoughts on which would be better cortisone or generic Benedryl cream?

[Bajanne]

They always use SureSeal Bandaids at our hospital.  But like everything else we use - Epogen, etc. it is all considered part of the service.  Everything is free if you don't have insurance, and if you do, the insurance pays, but a set sum in which all extras are included.

[jedimaster]

I had skin irritation fro  REGULAR band aids!...so I use micropore  with a gauze folded instead. And I use blooters to shorten the "holding the site" time. It works for me.  My nephrologyst has approved the blooters...and I use them everyday no problems....

[boxman55]

I do not like the sound of this. I do not have a working fistula yet put when I do I will be a little nervous because number one I am alergic to heperan so how will I stop the bleeding will this sure seal be good for me? They have me on cumidan also  Boxman55

[kitkatz]

Sure seals I find I can leave them on overnight and have had no ill effect from them at all. The tip stops which are bigger and not like bandaids they told me to peel off after four to five hours.

[angieskidney]

I don't think my unit has tip stops

[silverhead]

All the techs at my wifes center are trained to pull the needle back about a quarter inch, they then apply the Sure Seal so it is centered over the opening (usually covers a very small portion of the butterfly),  they put a pad folded in 4 on top of it, then pull the needle, we usually put a clamp on the site and wait anywhere from 5-8 minutes, I then pull the top pad off and apply a pad folded in half and 2 pieces of paper tape to hold it on for a few hours, she pulls the Sure Seals off the next day.....
Tom

[Black]

Thank you, Tom!  That looks like a useable method to me.  I'll try it on Tuesday when I get back to Charleston and then see what the training nurse has to say.

Anyone else have a different method of using the Sureseals?

[Panda_9]

I dont see the need for all these fancy bandaids. To stop bleeding I use 2 peices of folded gauze then once stopped I put one peice of folded gauze over the site with tape. And it would work out cheaper as well, seen as I am using gauze from the dressing pack that is otherwise thrown out.

[Black]

I don't see the need for all these fancy bandaids. To stop bleeding I use 2 pieces of folded gauze then once stopped I put one piece of folded gauze over the site with tape. And it would work out cheaper as well, seen as I am using gauze from the dressing pack that is otherwise thrown out.

Yes, that is MUCH cheaper!  How long does it take for you to clot using that method?

[Zach]

I dont see the need for all these fancy bandaids. To stop bleeding I use 2 peices of folded gauze then once stopped I put one peice of folded gauze over the site with tape.

You're absolutely correct, Panda 9. That's all most of us need.  Holding some gauze on the site. It's not fancy, but it works.

If it takes too long to clot, maybe an adjustment to the heparin is called for.  If the center reuses the filters, they tend to give the patients more heparin (maybe too much), so the filter doesn't clot and can be reused 40+ times.

Sure Seals are just pressure bandaids.  Nothing more, nothing less.

They do not have any special "clotting" additive, like Gelfoam.  Instead, it's a bandaid with a cellulose sponge (just like the one in your kitchen).  When it gets wet, it expands, and creates pressure on the site.  It's good in stopping the oozing, but it will not prevent bleeding out, say, if you stand too soon.  People sometimes have too much confidence in them.

There is such a myth surrounding Sure Seals.

The company that makes them did a real good job in their marketing of the product.         

[Panda_9]

I hold for 8 minutes each site, it sometimes takes longer, sometimes less. If Ive only done a short run its about 5 minutes.