Bleed Time For New Arterial Buttonhole

[PrimeTimer]

My husband had a new arterial buttonhole established nearly 2 weeks ago. It's been our experience that upon pulling the needle, new buttonholes bleed a little longer for the first few treatments but this newest one is still a bleeder after 7 treatments. Fistula was checked by the nurse, all ok there. Whether new or not, are some buttonholes bleeders and some not? We're going thru a lot of gauze but worse, poor hubby is trying to recover from anemia.

[Vt Big Rig]

I do not use buttonholes but my needles sites were still bleeding (an oozing) after 10 hours. When we cut back on heparin it seemed to have solved the problem. Is that an option?

[Charlie B53]

I have a serious paranoia of needles.  I haven't taken a 'nap' in over 20 years. (Thank God!)  Needles to say, I am on PD and know next to NOTHING about Hemo.

With that out of the way,  anytime someone brings up the subject of bleeding I have to revert to what I DO know.  Direct pressure.  I do O.K. with my monthly blood draws, but sometimes I used to bleed a bit afterwards.  My blood was VERY thin from 20 plus years of high dose aspirin use.  The Nurse, or I, would simply apply direct pressure to the site, sometimes at seemed almost FIVE whole minutes.  Now that the Dr has switched meds I no longer take aspirin, (whoo-hoo!)  and my arms and legs no longer look so battle-scarred and bruised.  I mean even the slighest bump would cause a blood blister.  No more!

I also have to ask, before needling, are you tiing off the arm like the Nurse does before drawing blood?

Is it possible to tie off the arm again and apply direct pressure until the bleeding stops then remove the band?  This may help relieve the high pressure pulse and quicken the seal.

It may be wise to ask you Dr or Nurse about trying that.  Just to be sure you are not doing any harm.

[PrimeTimer]

I don't know about reducing his Heparin, afraid of clotting during treatment but if this bleeding keeps up, might have to look into it. What use to bleed for only 4 minutes now bleeds for 10-12 minutes. Gotta be careful to not change out the saturated gauze too soon or to peek at it otherwise, becomes another gusher and you have to start the clock all over again. This new arterial buttonhole is closer to his venous than the last one was so we are having to be careful not to apply too much pressure while holding the venous (thus forcing/squishing all the blood down to the arterial) before pulling the arterial needle. Used firmer pressure on his arterial last nite and that cut down on the bleeding and didn't have to change out the gauze before taping. Hate using too much pressure tho, afraid over time it will damage the fistula (read up on what Dr. Agar says about that).

As for using a tourniquet, NO....we only use one when we are inserting needles to plump up the fistula to make sticking a little easier. Using a tourniquet on a fistula before pulling the needles out would probably only force MORE blood out the needle sites. There are however, some medical emergencies that may warrant the use of a tourniquet but even then, professionals say to avoid them if possible. That's a whole other story...

So, we are use to having to hold gauze/apply pressure for 4 minutes. New arterial buttonhole is taking 10-12 minutes. I don't like that but is it something I need to get use to now? Hope not.   

[Vt Big Rig]

Sorry to tell you that I have always held my needle sites for 10 minutes before "peeking". That is how we were trained.

That second site is the longest 10 minutes on earth !!!

[PrimeTimer]

Sorry to tell you that I have always held my needle sites for 10 minutes before "peeking". That is how we were trained.

That second site is the longest 10 minutes on earth !!!

It's certainly the longest when you watch gauze saturate. I noticed that unless it starts running out the sides to continue holding pressure 10-12 minutes before peeking and putting fresh gauze on. Scary watching it saturate like that tho.

[Simon Dog]

There are however, some medical emergencies that may warrant the use of a tourniquet but even then, professionals say to avoid them if possible. That's a whole other story...

Thinking on tourniquets has changed in recent years, and the "avoid at all possible" is no longer the mantra as long as the patient can be promptly transferred to an ER.   It takes at least a couple of hours for necrosis to set in after a tourniquet is applied.

The current EMT tourniquets are very nice - a 6" wide strip of rubber with printed rectangles that turn into squares when the right amount of tension is applied.   That, plus an Israeli bandage and quick-clot impregnated gauze will leave you well equipped to apply first aid to a wide variety of bullet holes.   I'd add a seal in case of a sucking chest wound to the kit.   After all, you never know if representatives of a peaceful religion will show up when you are around.

[PrimeTimer]

There are however, some medical emergencies that may warrant the use of a tourniquet but even then, professionals say to avoid them if possible. That's a whole other story...

Thinking on tourniquets has changed in recent years, and the "avoid at all possible" is no longer the mantra as long as the patient can be promptly transferred to an ER.   It takes at least a couple of hours for necrosis to set in after a tourniquet is applied.

The current EMT tourniquets are very nice - a 6" wide strip of rubber with printed rectangles that turn into squares when the right amount of tension is applied.   That, plus an Israeli bandage and quick-clot impregnated gauze will leave you well equipped to apply first aid to a wide variety of bullet holes.   I'd add a seal in case of a sucking chest wound to the kit.   After all, you never know if representatives of a peaceful religion will show up when you are around.

Or "Adventure Medical Kits Quick Clot" $26.88 on ebay. When you said you'd add a seal, my first thought was of a Navy SEAL. Wouldn't mind having one of them around too. They come in sets of seven but just one would be plenty.

[Charlie B53]

10 to 12 minutes seems like a l o   o   o  n  g  time, longer if you are either the holder or the holdee.

One of my many femoral cath's was 'held' instead of the Dr using any type of 'seal'.  It sure seemed like a very long time.  I don't doubt that lady Dr (Intern?) was glad when the clock finally came around.

To go through this at most every session, you are rapidly developing the patience of Job.

I'm Praying this is only a minor blip in your trials.

[Simon Dog]

The cop/EMT I took a first aid course from likes the QuickClot long gauze strips, so you can push the gauze into bullet holes or knife wounds with your finger to pack the wound.

[Charlie B53]

Simon,  Your comments about bullet holes reminds me of a scene in a movie, don't remember it's name.  The guy tosses the briefcase to the other guys.  They open it and instead of money, it's full of tampons.  I  don't remember the words but they were to stop the bleeding from the bullet holes they were about to receive.

Actually could work, maybe.

Didn't women's feminine pads come about as a result of wound bandages from WWI or WWII?

Slightly a little before my time.   I turned 62 last week.

[PrimeTimer]

Hope I'm not speaking too soon but seems we've gotten his new buttonhole under control now. Guess I got so use to having to hold his gauze for only 4 minutes that 10 minutes made me freak. Well, anything outside our norm concerns me but I see now that perhaps I worry too much or let fear get the better of me. I need to learn to get a grip. Use to be better at dealing with stuff. 


CharlieB53: Happy Belated Birthday! Hope you had a little fun and indulged! Well, as much as you could without getting into trouble with your nurse or doctor.   

[Charlie B53]

I am a bit 'heavier' than last week.  Was thinking I was going to hear about that at Clinic Monday.  When I got there they were wondering why I was there.  Like, my appointment?

Oh, you didn't get the message?  Dr switched all his clinic appts to NEXT Mondy.

Oh Really.  Nobody told me a thing.

  No phone call, message, email, nothing.

Secretary 'thought' that they told me before I left last month.  Nope.

Just so the hour + trip wasn't a total waste, the Nurse went ahead and drew blood for labs.  Called me later and said the Lab was only able to use one tube.  Something wrong with the other and will have to repeat those parts next week.  But that labs that did run were fine.  My usual middle of each range except protien, which is very good.

Wife never did get me a cake.  Not even a cup cake.  I would have even settled on a pie.  Nope.  We're both diabetic and don't need it.  Even though I'm so well controlled I don't need any fast acting insulin, just my 20 units of slow every evening and my #'s stay good.  If I don't eat cake.

[justagirl2325]

When we were using my hubby's buttonholes he always held pressure on them for 5 minutes.  Once it bled after five minutes and he had to hold that one for a further five minutes.  They always bled.