Hemorrhage of AV fistula: Difference between revisions
(Created page with "==Background== ==Clinical Features== ==Differential Diagnosis== ==Workup== ==Management== ==Disposition== ==See Also== *Dialysis complications ==External Links== =...") |
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==Background== | ==Background== | ||
*Potentially life-threatening | |||
*Can result from aneurysms, anastomosis rupture, or over-anticoagulation | |||
===Types=== | |||
*Aneursym (true) | |||
**Most are asymptomatic; rarely rupture | |||
*Pseudoaneurysm | |||
**Results from subcutaneous extravasation of blood from puncture sites | |||
**Bleeding from puncture site is usually controlled by digital pressure or subq suture (if placed deep will often ruin shunt) | |||
**Consider vascular surgery consultation for continued bleeding or infection | |||
**Arterial Doppler [[ultrasound]] studies can identify the aneurysm or pseudoaneurysm | |||
==Clinical Features== | ==Clinical Features== | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{AV shunt complications DDX}} | |||
== | ==Evaluation== | ||
*Consider Doppler [[ultrasound|US]] | |||
==Management== | ==Management== | ||
*Control bleeding with pressure applied to puncture site for 5-10min; observe for 1-2hr | |||
**Utilize fistula clamp to apply small focus of direct pressure | |||
**Bulky dressing with allow for continued bleeding | |||
*Correct [[coagulopathy]] | |||
**[[Protamine]] sulfate for severe [[Unfractionated heparin reversal]] | |||
**[[DDAVP]] for [[Uremic bleeding syndrome]] | |||
*Topical thrombin | |||
*QuikClot or similar product application | |||
*Purse string suture with 3-0 nylon suture<ref>Vesely TM. Use of a Purse String Suture to Close a Percutaneous Access Site After Hemodialysis Graft Interventions. JVIR 1998; 9:447-450. http://www.vascularaccessdoc.com/pdf/22.pdf.</ref> | |||
[[File:purse string.jpg|thumbnail]] | |||
*Figure-of-8 stitch with 3-0 nylon or 5-0 prolene | |||
*Can attempt desmopressin acetate 0.3 mcg/kg IV<ref>Calvert JH, Cline DM. End-stage renal disease. In: Tintinalli JE, Ma OJ, Yealy DM, et al., eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 9th ed. New York, NY: McGraw-Hill; 2020:(Ch) 90.</ref> | |||
*If can not be stopped with above measures, place upper extremity [[tourniquet]] and consult vascular surgeon vs IR. | |||
==Disposition== | ==Disposition== | ||
*Consider discharge if hemodynamically stable with minimal blood loss | |||
==See Also== | ==See Also== | ||
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==External Links== | ==External Links== | ||
https://www.youtube.com/watch?v=toFiGSfesZk&feature=youtu.be | |||
== | ==References== | ||
<references/> | <references/> | ||
[[Category:Renal]] | |||
[[Category:Vascular]] | |||
Latest revision as of 04:50, 31 December 2020
Background
- Potentially life-threatening
- Can result from aneurysms, anastomosis rupture, or over-anticoagulation
Types
- Aneursym (true)
- Most are asymptomatic; rarely rupture
- Pseudoaneurysm
- Results from subcutaneous extravasation of blood from puncture sites
- Bleeding from puncture site is usually controlled by digital pressure or subq suture (if placed deep will often ruin shunt)
- Consider vascular surgery consultation for continued bleeding or infection
- Arterial Doppler ultrasound studies can identify the aneurysm or pseudoaneurysm
Clinical Features
Differential Diagnosis
AV Fistula Complications
- Clotting of AV fistula
- Infection of AV fistula
- Hemorrhage of AV fistula
- Vascular insufficiency from AV fistula
- AV fistula aneurysm/pseudoaneurysm
- High-output heart failure from AV fistula
Evaluation
- Consider Doppler US
Management
- Control bleeding with pressure applied to puncture site for 5-10min; observe for 1-2hr
- Utilize fistula clamp to apply small focus of direct pressure
- Bulky dressing with allow for continued bleeding
- Correct coagulopathy
- Protamine sulfate for severe Unfractionated heparin reversal
- DDAVP for Uremic bleeding syndrome
- Topical thrombin
- QuikClot or similar product application
- Purse string suture with 3-0 nylon suture[1]
- Figure-of-8 stitch with 3-0 nylon or 5-0 prolene
- Can attempt desmopressin acetate 0.3 mcg/kg IV[2]
- If can not be stopped with above measures, place upper extremity tourniquet and consult vascular surgeon vs IR.
Disposition
- Consider discharge if hemodynamically stable with minimal blood loss
See Also
External Links
https://www.youtube.com/watch?v=toFiGSfesZk&feature=youtu.be
References
- ↑ Vesely TM. Use of a Purse String Suture to Close a Percutaneous Access Site After Hemodialysis Graft Interventions. JVIR 1998; 9:447-450. http://www.vascularaccessdoc.com/pdf/22.pdf.
- ↑ Calvert JH, Cline DM. End-stage renal disease. In: Tintinalli JE, Ma OJ, Yealy DM, et al., eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 9th ed. New York, NY: McGraw-Hill; 2020:(Ch) 90.