New Perm caths and bleeding issues...

It's a pretty big line! It's not hard to believe they can bleed pretty good, but I've not seen too many of them bleed like that, so maybe it's the surgeon at your facility and his technique. Maybe they have a practise of not checking coags before insertion. It's hard to say. If it bleeds so bad you need to put pressure on then maybe the pt needs platelets! If it's just a gentle ooze then a decent pressure dressing with some semi-occlusive dressing like Tegaderm might be the trick. Most of the time they should not bleed once they're inserted.

When patients get a temp cath placed at the hospital and come to the clinic for dialysis there is usually some blood on the dressing. The next few treatments they usually have some dried blood on their dressing and around the insertion site. I think temp caths are in such an odd/uncomfortable position for the patient and I think moving around/moving the wrong way and the way it is taped causes it to bleed some. I have never seen one constantly ooze though or had to get another stitch put in. If it keeps oozing I would think IR would want to re -examine. You could ask dialysis to put some sterile gauze under the catheter dressing to hold pressure. The good thing is temp catheters are not used very long before they want to put a permanent one in.

I haven't seen too many perm-caths that needed that much intervention. I have had a couple of ESRD pts that bled like crazy after a line placement or sugery, but they probably had some underlying liver disease. Makes me wonder if there's an issue with the technique or something.

Go Clemson!

Its that good old surg. get them in and get them out esp. on replacements. Those guys are slam bam thank you mam.You`d bleed too with the way I have sem some are.

About a year ago our hospital started using a product called Bioseal, we use it on all oozing or bleeding lines, it seals the site and eliminates the need for multiple dressing changes and cuts down on infections risks. We are thinking of using it on these large bore dialysis catheters, anyone have experience in this arena?

I work on a renal/medical floor. I work with many ESRD patients everyday. One common problem I encounter is bleeding after temporary tunneled caths are placed. They either bleed from the stitch, the insertion site, or the up high in the neck..... They usually get their catheter and then go to dialysis. Whether they get heparin or not it seems like they always bleed. Some are easy to stop but I have had a few here lately that constantly ooze. Interventional Radiology will come put another stitch in occasionally. But usually I have to hang out in their room all shift holding pressure. Surgiceal works pretty good occasionally.

What is the deal? Usually their coags will be fairly normal and they still bleed. It is very time consuming and frustrating for the patient and all involved.

Does anyone have any tips to get the bleeding to stop?

Tiger

Are these "new" dialysis patients who are uremic?

Bleeding diatheses are characteristic findings in patients with end-stage renal disease (ESRD). The pathogenesis of uremic bleeding tendency is related to multiple dysfunctions of the platelets.

There could also be liver involvement too.

The best thing to do is get them stitched if possible, put a pressure dressing on it and apply a sand bag. These patients should not be receiving heparin with their dialysis treatments on the same day of catheter insertion. These are large bore catheters going into large vessels.

If all else fails and the pt's are critical - have the MD order for some DDAVP or vitamin K.

Quick update, we started using the BioSeal CVC and Advanced powder products on our large bore dialysis catheters that ooze/bleed and the stuff works very well. Little bit of a learning curve but after several applications nothing to it. Rarely do we need to change the dressing sooner than 7 days. This has saved us lots of time and dressing change kits. Hope this helps.