The number of patients being placed on hemodialysis seems to be increasing. And the ED is where they will go when there is a any complication from their fistula or graft.
Hemodialysis shunts require cannulation with large bore instruments. This combined with heparinization may lead to prolonged bleeding from puncture sites.
What to do when a patient shows up in the ED with persistent bleeding from a fistula puncture site:
Simple pressure may be all that is required in many cases.
If this doesn't work, place a single circular suture around the puncture site/incision. In some small studies this has been shown to be very useful in stopping persistent oozing
References
Vorwerk D, et al. A simple trick to facilitate bleeding control after percutaneous hemodialysis fistula and graft interventions. Cardiovasc Intervent Radiol 1997.
