protocol for achieving hemostasis

[urrRN]

Does anyone have a protocol for achieving hemostasis in a AVF or AVG after dialysis, addressing things like how long pressure is applied, what supplies to use for dressing, etc. Everyone here seems to do something different.

[southerngirl67]

Acute or chronic?

[urrRN]

Chronic

[southerngirl67]

I work in an acute unit. We use tipstops. Unfortunately, they are not usually available in the chronic units. They are cost prohibitive at $1 each.

I am not sure that the acute unit that I worked at had any protocols, it was everyone for themselves. I will try to remember to look at our p &p book tomorrow and get back to you.

[sueinga]

What are tipstops? We used sureseal bandaids for awhile but they were cost prohibitive- now we use superstoppers and most pts and staff love them- and they're cost effective

[southerngirl67]

Tipstops are small round pieces of gelfoam that are attached to foam tape. They are about the size of bandaids and were $1.00 each last time that I checked.

[MSLNT1.1]

I has this very situation happen to me yesterday. I had a pt. post dialysis who bled for well over an hour. The patient was in a hypertensive crisis. She had nausea, vomiting, headache, and BP with systolic >200 and diastolic>120

I paged the MD to make him aware of the pt's condition and by the time he arrived the patient BP dcreased to 159/78 and the bleeding had stopped but there is no official policy for how long you should wait. I would take a look at what your clinic policy and procedure is. But cover yourself and it it better to be safe than sorry send the pt. to the ER if you can't get the bleeding to stop.