Clotting techniques post dialysis

[lovearenalcaretech]

I don't know if this is the right thread but I want to know what technique you folks use to help stop bleeding post dialysis (both grafts and fistulas).  I have had my share of bleeders (light and heavy).  I have used clamps (although it's my last resort), betadine on puncture sites, manual occlusion time of at least 10 minutes (some patients also request tight dressings but I try to discourage that), etc.  All is welcome to post, the more info, the better!  Please feel free to move this to the appropriate thread!  Thanks!!!      

[petey]

Marvin has always, always just held his sites (grafts and fistulas) with a folded-over gauze.  It usually takes him about 10-15 minutes to stop bleeding completely.  Then, we stick on two band-aids.  We were told by his surgeon to never, never, never use a clamp and never, never, never use a pressure bandage.  (Of course with the permcaths, it was just disconnect and re-cap.)  When he's been in the hospital or had surgery on his "other" arm and couldn't hold the sites, I would hold them for him.

[boxman55]

I don't think there is any magical tricks. I think petey covered all the bases except some techs use what they call "balls" under a sureseal bandaid and guaze on top of that. I will not allow a tech to use clamps...Boxman

[G-Ma]

I hold my own but am also afraid I hold too tight....is there a feel for this?

[jbeany]

G-ma - I hold really hard the first couple of seconds, just to make sure I'm centered and actually stopping the blood.  After I'm certain I've got the right spot, I ease off, and hold it firmly, but not so hard that I can't still feel the graft pulsing under my fingers.

[G-Ma]

ok..thanks jb...then I have to ease off a bit...

[Rerun]

I use 2 gauze folded in quarters.  The tech puts this over the needle and pulls it out.  He holds until he gets the needle put away in the container and then he lets me take over.  I hold firmly, but not too hard for 10 minutes.

[monrein]

I hold for ten minutes with a folded gauze, check and then put on a sureseal bandaid or if my problem with glue is acting up I use a bandage that wraps around the arm and sticks to itself.  Not very tight though.  I was also told to never use clamps or tight bandages.

[flip]

I clamp  mine with a folded 4x4. I wait exactly 10 minutes and then add a bandaid over a folded 2x2. I've never had a leaker since I started doing it that way.

[Adam_W]

I'm a bad li'l boy because I use a clamp. Fortunately my arms are so skinny, I've never had a problem with the clamp being too tight. I pull the needle out about half way, stick a piece of tape over the hub to keep it from popping out, and I put a sureseal over the site when the needle is still in, then I put a folded 2x2 over the sureseal and tape it in place, and I put the clamp over that. I then remove the tape holding the needle, and pull the needle. I actually have to push down on the clamp for a minute or two, then I keep the clamp on for ten min. and then check. I usually don't have a problem doing it that way.

Adam

[flip]

I've tried the sureseals and the super stoppers. I found that they both had a tendency to stick and would pull the scab when I removed them.

[Robby712]

The tech puts a regular band aid over the 1/2 pulled out needle, the places a folded 4x4 over that then pulls the needle completely.  Then I hold both sites myself.  Something I learned awhile back...if you hold tight at first (about 15 seconds), then slowly release pressure, they aren't going to bleed as long.  I attribute this to kind of a breaking the "dam" effect that takes place if you hold them too tight or clamp them for several minutes.  There is NO blood pumping through, then all of a sudden you let that fistula start pumping blood through it at full force again...it's just going to bust right through any clot you may have formed.

I rarely hold my sticks over 3-5 minutes...and typically just throw a folded 4X4 over the site and put a little tape on it as a security blanket til I get home.

[flip]

The nurses have always told me that there shouldn't be any pressure on the site until the needle is out. I use clamps because it gives me the freedom to pack up my stuff and get the bandaids ready. I prefer to keep my in center time to a minimum because I have better things to do.

[Robby712]

I hear ya there flip.  Taking a 10 minute clot time down to 5 minutes is 15 minutes a week and an hour a month more of me getting to do what I want to do...(Usually taking naps)

[lovearenalcaretech]

Thanks for all the replies!  I too use the bandage & folded gauze technique.  It's a little bit more difficult with bleeders since the bandage gets soaked faster.  I used to use a folded 2 x 2 then a bandage over the needle site but I found that for some people the 2 x 2 used to stick to the scab and it would pull it right off and start bleeding again.  Thank you all, please keep posting!   

[Treasure]

i hold a folded  4X4 on one...and clamp on the other...and i still bleed out sometimes... especially if they use a 14 gauge on me. i think we need to reconsider the heparin again...  i hate, though, when the techs are anxious to go home and try to wrap it up before i'm really done. (they usually pay for it, though, because i end up coming right back in...hehehe)

[lovearenalcaretech]

i hold a folded  4X4 on one...and clamp on the other...and i still bleed out sometimes... especially if they use a 14 gauge on me. i think we need to reconsider the heparin again...  i hate, though, when the techs are anxious to go home and try to wrap it up before i'm really done. (they usually pay for it, though, because i end up coming right back in...hehehe)

They try to rush you out so they can rush home... they're supposed to think about patient safety first!  That's good that you go right back in, let them work another 10 to 15 minutes more!  That's what they get for shooing you out!       

[flip]

If you really have a problem, you may want to reduce the 2 hr. heparin.