Rant: Oh NO you did it just like we told you.

[BigSteve]

Ever since I knew I was headed for dialysis I have tried to inform myself and pay
attention to what would be best.  I had my fistula put in months before my labs
went down, but the vein never raised and so I had to have a vein repositioning.
Then after I went on dialysis  I took care of my arm just like the unit nurse told
me too.  Monday I went to the unit, and the tech couldn't find any pulse because
it was clotted. So off we go the next day to the hospital radiology unit to first
clean out the clot, and then later to have a temporary cather installed.
What really gripes me is some new nurse tells me that what might have caused the
problem is the pads put on the needle sticks were too tight with the tape and
that they should be taken off after I get home because the pressure may have
caused the vein problem. The regular nurse told me at the start to leave the bandages
on for 5-6 hours. It really pisses me off when I'm being accused for mistreated my
access when I was faithfully following instructions. Maybe the unit staff should try
talking to each other.

[boxman55]

what do you mean when you say pads. if I would guess they are what we call balls at are clinic. A ball of absorbant gauze. Anyway I don't use them just a sureseal bandaid and I pull them off when I get home. If one is still bleeding a little I will put another on for a while...Boxman

[bolta72]

I do the same

[BigSteve]

What happens is that the techs put on a "tower" of gauze and then tape it down
tightly with multiple strips of tape. The problem is that possibly that pressure for
a number of hours caused the vein and the fistula to clot. I am back in surgery next
Tuesday to either revise the fistula or give me a new one. Hopefully he will also
change the catheter to sub clavical if he can't fix the old fistula.
When I get back to using the fistula I will take the "towers" off when I get home.

[Black]

No way they should be taping "towers" of gauze on that tight.  They are rushing and/or lazy.      The gauze pad is NOT to stop bleeding.  It is to protect the needle opening until it scabs over.  You should be completely stopped bleeding BEFORE it is taped.  Be sure to let your neph, the surgeon, and the clinic director know what they have been doing to you!!!!  And insist that they get you some sureseals.

I am so sorry this happened to you.  Hang tough.   

[Loretta]

My unit does that!  They tape a huge pad of guaze that has been folded and rolled up super tight.  They use six or seven pieces of tape to hold it on tight, and have told me not to take it off until the next morning.  I can not stand it on that long and have always had it off in four or five hours.  From what I understand here I could take it off much sooner, is that right?

[BigSteve]

Now I am really concerned. What is the proper procedure for post dialysis bandaging?
If Black is right I should wait for the bleeding to stop (clotting) and then have a simple
bandage put on to protect the clot. I have to discuss this with my neph and the unit.

[qwerty]

Personally I use a 1- 2x2 gauze folded up under a bandaid, then use 1- 4x4 gauze folded over twice on top of the bandaid when I pull the needle. I found this seems to help more than just the bandaid then piling loads of more gauze and tape.  I use manual pressure if the person is unable to hold themselves for at least 5  min then clamp if they are ordered. (Personally I prefer to hold until clotted but when I'm the only RN it's sometimes impossible as I hate clamps since use in themselves can cause problems). If the person can hold I have them hold while I pull the needle. Once clotted I then tape it securely NOT to go all the way around the arm and not removing the gauze so I dont disturb the clot but enough to apply some pressure directly on the site to help ensure it's not going to start bleeding again. Once they are home and they are sure they have clotted they can remove the outer gauze leaving the bandaid/2x2 to thier own descretion of when to take it off. Generally they are able to remove the last of the bandaid by next morning. Most units have a "take off dressing policy" although most tend to use what works for them. Personally I listen to the patient's preferances and most seem to like the way I do it. Speak up and let the pct/nurse what works for you and insist on it. So I use a total of 1 piece of 2x2; 1 piece of 4x4 and one bandaid to each site. Usually just enough tape to cover it securely is plenty.

[jbeany]

I hold gauze until it clots, then put on a band aid, and leave that for the rest of the night.  I did that in clinic as well.  The clinic nurses would give you the option of a band-aid or a pad of gauze taped on the site after it stopped clotting, but nothing was ever taped down to make it clot - jut held with enough pressure that the thrill could still be felt.

[Roadrunner]

We fold a 2x2 gauze pad into quarters, clamp it for 10 minutes and then remove clamps and cover gauze with 3 pieces of paper tape. 

How long do you leave on the tape.  We leave it on about 8 hours and it is almost impossible to remove it.

Any suggestions?

Roadrunner

[Krisna]

My unit uses 4 x 4's folded in half then in thirds to hold pressure.  I hold my own punctures, one at a time for abt 10 minutes each.  Then they change the 4 x 4 out with a clean one and put 3-4 strips of paper tape tight but do not wrap it completely around the arm.  Some people use band aids under the final 4 x 4 too but I don't like them.

I have been a Northwest Kidney Patient (NKC) since I was very young and I have had my fistula since I was 15.  That's almost 21 yrs!  NKC and the surgeon said the same thing, "Leave the bandages on NO longer than 6 hrs.   

[Roadrunner]

Krisna,

Thanks for the advise.  We do dialysis at night so the needles come out around 11pm and we don't get up until 7 or 8 am.  What is the shortest time you can safely take off the bandages?  We are usually up till midnight or later. 

Dick used to bleed easily and we had a hard time with bleeding and he is afraid to remove the bandages early.  Our nurse suggested that we stop heparin.  We have been doing this about a month and he doesn't clot the filter and the bleeding has practically stopped when the needles come out.  You don't know how happy that makes me.  It is bad enough when one buttonhole is bleeding but when the second one begins running through the gauze I go crazy.  Dick has a hard time helping since his fistula is on the inside of his upper right arm and he can't see it.  I have to place his finger on the exact spot. 

I am grateful for NxStage every snow storm we get.  We can sit in our new home and watch the snow come down instead of driving one hour through it in the dark.

Roadrunner

[Krisna]

Krisna,

Thanks for the advise.  We do dialysis at night so the needles come out around 11pm and we don't get up until 7 or 8 am.  What is the shortest time you can safely take off the bandages?  We are usually up till midnight or later. 

Dick used to bleed easily and we had a hard time with bleeding and he is afraid to remove the bandages early.  Our nurse suggested that we stop heparin.  We have been doing this about a month and he doesn't clot the filter and the bleeding has practically stopped when the needles come out.  You don't know how happy that makes me.  It is bad enough when one buttonhole is bleeding but when the second one begins running through the gauze I go crazy.  Dick has a hard time helping since his fistula is on the inside of his upper right arm and he can't see it.  I have to place his finger on the exact spot. 

I am grateful for NxStage every snow storm we get.  We can sit in our new home and watch the snow come down instead of driving one hour through it in the dark.

Roadrunner

I never take the bandages off before at least two hours just to make sure.  But I don't get hourly heparin so I could probably take them off sooner.  Sometimes I get busy and forget to take them off till the next morning but I wouldn't recommend that.  When I got hourly heparin it took me 15-20 minutes to stop bleeding and I had to leave bandages on for 4-6 hours.  But everybody is different!

When I take the bandages off I put Neosporin on the punctures and all the old sites as well and put a large Nexcare waterproof band aid on it.  They are made with Tegaderm and they seal around the pad part!  I love them and putting the ointment on the wounds helps them heal and helps reduce scarring. 

Oh yeah, by putting a clean gauze on after bleeding has stopped you can tell when you go to take it off if it bled anymore after you wrapped it up!  That was how I determined how long to hold pressure and how long to leave the bandages on afterward.

[BigSteve]

I reread the patients' manual yesterday. It appears the techs are finishing me off with
the "towers" in opposition to the procedures in the manual. After my surgery tomorrow
I intend to speak to the administration in the unit and determine what the correct
post dialysis technique is supposed to be.

[Cincygrandma]

At my center the usual method is when the needle is pulled, the bandaid that was on the needle is left in place.  Gauze folded in quarters is placed over the needle & bandaid, and I hold that after the needles are removed and bleeding stops.  Typically for me it's about 10 minutes but can be up to 30, depending on how "occupied" the tech is.  Then new folded gauze is taped on "tightly" with minimum of 3 strips each.  Some go a little crazy and can't seem to stop with the tape.   Most also tape it so tight they fold my skin up under the tape, and have left bruises from their fingertips.  No one ever told me there could be problems from the taping process and this is the first I've heard about it.  After my first few treatments, I got brave enough to begin removing all the tape and gauze and the bandaid as soon as I got home which is about 1 hour later.  Had to in order to stop the pinching and discomfort in my arm.  I then re-tape gauze loosely with one strip of tape for overnight, and remove it first thing next morning.  After reading this topic, I'm thinking the tight taping and leaving it on overnight may have contributed to my fistula problems.  Once again, thanks to the Power of IHD!!!

[MattyBoy100]

Everyone is different with the amount of type it takes to stop bleeding.

At my unit, they put one - sometimes 2 layers of gauze if the bleed is heavy then clamps go on the arm.  For me, it takes about 5 mins to stop bleeding.  The clamps come off and we use small plasters to cover the holes.  It takes me 10 mins to get home and usually I will have the plasters off within an hour.

We are all told specifically to take the plasters off within 2hrs anyway.

[kidney4traci]

I guess I am lucky as I don't take heprin so I really don't bleed.  That and the buttonhole is what helps me.  I use a 4x4 and then paper tape because the bandaids are too sticky.  I hold the site for about 30 seconds each, then tape and go.  I usually take off the tape and gauze about 2 hours later.  The buttonhole has a "flap" and that keeps it from bleeding so much.