UMEM Educational Pearls

Category: Vascular

Title: Bleeding AV Fistulas

Keywords: AV fistulas, bleeding (PubMed Search)

Posted: 2/21/2009 by Michael Bond, MD (Updated: 8/12/2020)
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Bleeding AV Fistulas

It is not an uncommon complaint for dialysis patients to present with bleeding from their fistula.  They can lose a large amount of blood in a short period of time if not treated promptly, and if treated too agressive their fistula can clot off. Some tips on how to control the bleeding.

Most of the bleeding occurs at the site that the needle puntured the fistula. If it is due to an ulcer eroding into the fistula these tips may not be effective.

  • The easiest and safest way to control the bleeding is with simple diret pressure directly over the site of bleeding with a single finger. No guaze.  [Gown up and wear goggles or eye protection]. The use of a big wad of guaze or a pressure dressing tends to just hide the continued bleeding or result in the clotting off of the fistula.
  • Injecting lidocaine with epinephrine at the site can also help and helps set you up for the next step,
  • A figure eight stitch at the puncture site can help close the puncture wound.
  • Of course you should call your vascular surgeon if you are having trouble controlling the bleeding, want close follow up or finger is going numb from holding pressure.

I typically check a CBC and coags.  Once the bleeding is controlled observe the patient for awhile [typically the hour to hour and half to get the labs back] and then road test them with a walk around the Emergency Department to ensure it does not start bleeding again.