bleeding at needle sites

Hello - I'm a dialysis tech and new to the field. I've learned a great deal from all of you more experienced people and appreciate it. I have a problem I'm hoping someone can advise me on. I often have patients bleed around their needle sites - fairly profusely. The needle placement appears to be good, and the blood flow rates are good, and the patient rarely complains of any discomfort. Anyone have any idea about what I'm doing to cause this? The nurses I work with have not been able to come up with anything.

Thanks,

Sandra

You may want to speak with the Md about making some changes in heprinaztion, Also the age of the access may mean that it could be stenoising. The may need a angiogram.

I recently had a similar problem. We started by reducing the heparin. He actually is down to a 2k bolus and that is it. He continued to have bleeding so we sent him for an ultrasound. He had central stenosis and had an angiogram, but still had problems with bleeding. We started using button-hole technique and have only had two episodes of bleeding during the initial establishment of the button-holes when we were still using sharp needles. He has not had anymore bleeding since then. We have been using this for two months now.

Another pt we found that her skin is so thin over her AVF that if we stick directly over the top she bleeds profusely, but if we stick slightly on the side she has no bleeding. (She doesn't have a pseudoaneurysm)

I've been on hemo for 10 years, and every so often I also bleed around my needle site-- in my case, it's because the needles were put in on top of a recent puncture, widening the hole and allowing bleeding.

Most times I find that bleeding from around the cannula insertion site is from people using the same area time and time again. Scar tissue is created and the usual elasticity of the skin is lost so it so the skin fails to "seal" around the needle. Exploring new cannula insertion sites is a must but is this is impossible due to a poor fistula then "buttonholing" may be the answer. :)

I would also recommend buttonholing technique if you have addressed the issues of heparin and fistulagrams. Another thing we do, simply to slow the bleeding is to apply gelfoam and reinforce it with tape. It works wonderfully but again is only a quick fix.