Removing needles---help!!

Direct manual pressure with your hand in a C clamp position, one 4x4 sponge with enough pressure to stop the bleeding but not so much to occlude the graft. At least a couple extra 4x4's. No peeking for first 5 minutes. Palpate on the venous side with your other hand to confirm flow. When removing a needle remember it is beveled and can cut on removal. A slight hesitation in applying pressure upon removal lessens the possibility of cutting. Make sure the patient's BP is under control and they are confortable. Factors you can't control are stenosis of the graft, anti coagulants, low platelet counts, infection, low calcium levels, etc...

But what about when your 4x 4 is getting soaked? Switch it? Put another on top?

I think I have been switching it but then that momentary switch is enough to let the blood fly. When I just pile more on too then I'm not necessarily covering the hole.

This is giving me crazy anxiety. The other day the patient started screaming "don't let me bleed out!!!!" Her INR was 4.9. Arghhhhhgg

Elevate the extremity.

If you have soaked through you need to change the dressing. Roll the old one off as you roll the new one on and press a little harder. Always know where the puncture hole is because that is where you need to be pressing.

Sometimes we just dont hold the guaze in the right spot. If the patient is really a bleeder, hold a piece of non-folded gauze over it, with a folded pressure gauze in the other hand. The flat, unfolded will tell you exactly where the bleeding is coming from without it shooting up at you. Then quickly put your folded pressure gauze over the site where the bleeding is the strongest. You shouldn't have soaked gauze if you're holding it in the right place. Although some people really are bleeders and they may have super bad, uncontrolled hypertension. In that case, just have some extra gauze on standby and wear your PPE. But it won't shoot out at you if you learn how to properly use your gauze.

Thank you for all the tips. Those damn needles seriously give me extreme anxiety.

If anyone else has tips please keep them coming! I'll definitely be trying these out this week.