Diferencia entre revisiones de «Hemorrhage of AV fistula»
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**Bleeding from puncture site is usually controlled by digital pressure or subq suture (if placed deep will often ruin shunt) | **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 | **Consider vascular surgery consultation for continued bleeding or infection | ||
**Arterial Doppler | **Arterial Doppler [[ultrasound]] studies can identify the aneurysm or pseudoaneurysm | ||
==Clinical Features== | ==Clinical Features== | ||
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{{AV shunt complications DDX}} | {{AV shunt complications DDX}} | ||
== | ==Evaluation== | ||
*Consider Doppler US | *Consider Doppler [[ultrasound|US]] | ||
==Management== | ==Management== | ||
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**Utilize fistula clamp to apply small focus of direct pressure | **Utilize fistula clamp to apply small focus of direct pressure | ||
**Bulky dressing with allow for continued bleeding | **Bulky dressing with allow for continued bleeding | ||
*Correct coagulopathy | *Correct [[coagulopathy]] | ||
**Protamine sulfate for severe [[Unfractionated heparin reversal]] | **[[Protamine]] sulfate for severe [[Unfractionated heparin reversal]] | ||
**DDAVP for [[Uremic bleeding syndrome]] | **[[DDAVP]] for [[Uremic bleeding syndrome]] | ||
*Topical thrombin | *Topical thrombin | ||
*QuikClot or similar product application | *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> | *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]] | [[File:purse string.jpg|thumbnail]] | ||
*If can not be stopped with above measures, place upper extremity | *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== | ||
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==External Links== | ==External Links== | ||
https://www.youtube.com/watch?v=toFiGSfesZk&feature=youtu.be | |||
==References== | ==References== | ||
Revisión actual - 04:50 31 dic 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.