Emergency department evaluation and management of dialysis patient complications

Forensic issues in cases of fatal hemorrhage from arteriovenous dialysis access sites

“…Hemorrhage from vascular access sites may occur for a variety of reasons, sometimes influenced by underlying coagulation abnormalities related to anticoagulant therapy, or to bleeding diatheses caused by underlying renal failure [9]. Synthetic grafts as in case 3 are not self-sealing and defects may be associated with prolonged leakage of blood.…”

“…Obstruction or stenosis may be due to thrombosis or to anastomotic fibrointimal hyperplasia [2]. Failure of arterialization of venous walls may also predispose to vascular oozing after puncturing [9]. Other factors that may predispose to fistula compromise with significant hemorrhage are local sepsis, repeated trauma from venesection and hypertension [13].…”

“…Synthetic grafts as in case 3 are not self-sealing and defects may be associated with prolonged leakage of blood. Continued oozing of blood from a graft may be an indication of stenosis or obstruction that has resulted in increased intraluminal pressure within the graft or fistula [9]. Obstruction or stenosis may be due to thrombosis or to anastomotic fibrointimal hyperplasia [2].…”

“…Maintenance of the patency and viability of these catheters, grafts or fistulas is vital, and there are a number of complications that may occur that account for more days of hospitalization than from any other complication of hemodialysis [9]. In a prospective study of 1,380 adults from 47 centers in 16 European countries, 489 complications were noted over a one-year period [10].…”

The Challenge how to improve Post Dialysis Arterio Venous (Avf) Puncture Sites Haemostasis: Is Mozaik© Device New Solution?

“…The majority of hemodialysis literature advises against the application of excessive pressure as it may lead to iatrogenic fistula thrombosis. It is difficult to establish the right degree and duration of manual pressure [6,7].…”