- Potentially life-threatening
- Can result from aneurysms, anastomosis rupture, or over-anticoagulation
- Aneursym (true)
- Most are asymptomatic; rarely rupture
- 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
- 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
- Topical thrombin
- QuikClot or similar product application
- Purse string suture with 3-0 nylon suture
- Figure-of-8 stitch with 3-0 nylon or 5-0 prolene
- Can attempt desmopressin acetate 0.3 mcg/kg IV
- If can not be stopped with above measures, place upper extremity tourniquet and consult vascular surgeon vs IR.
- Consider discharge if hemodynamically stable with minimal blood loss
- ↑ 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.