Increased Blood Loss From Access Cannulation Site During Hemodialysis Is Associated With Anemia and Arteriovenous Graft Use

Abstract

Blood loss from the access cannulation site during hemodialysis (HD) treatment is inevitable. Nevertheless, during HD, excessive blood loss from the cannulation site is not uncommon. The clinical characteristics associated with it and whether such blood loss could impact on patient outcomes is unknown. This pilot study aims to identify the prevalence and risk factors associated with excessive bleeding (≥ 4 mL/session) from dialysis access cannulation site during regular HD treatments. Stable end-stage renal disease patients receiving maintenance HD via arteriovenous fistula (AVF) or graft (AVG) were included in this study (N = 361). They were closely monitored for one month for the occurrence of excessive access bleeding during each HD session. A total of 4152 sessions of HD were performed during the study period and 143 patients (39.6%) had at least one episode of excessive bleeding from the vascular access (≥ 4 mL/session). Individuals experiencing excessive bleeding episodes had a significantly lower hemoglobin level, higher rate of diabetes, central venous stenosis, longer dialysis vintage, lower serum albumin level, longer hemostasis time and higher AVG and anti-platelet agent use (all P < 0.05). In the multivariable logistic regression model, longer dialysis vintage, central venous stenosis, lower hemoglobin level, and AVG usage were independently associated with occurrence of excessive access bleeding. AVG users also clustered with other risk factors for excessive access bleeding. Our study identified the novel associations between excessive cannulation site bleeding with dialysis vintage, anemia and AVG usage. The significance and impact of long-term chronic, intermittent bleeding from dialysis access should be further explored.

Enfermeiros atuantes em hemodiálise indicam diagnósticos de enfermagem relevantes na prática clínica

“…(13) In turn, bleeding can lead to bruising (13) and anemia. (17) Risk for shock was also considered relevant, in agreement with the findings of studies that identified this diagnosis with a prevalence of 100%. (9) Risk for falls has also been reported, (1,2) which can be caused by the hemodynamic oscillations that occur during hemodialysis.…”

Evaluation of Post-Puncture Bleeding Time of Arteriovenous Fistulas with IRIS® Bandage

“…A long delay significantly impacts the patient's quality of life by extending time to discharge, increases nursing workload, consumes valuable staff time usually dedicated to monitoring patient treatments and is likely to disturb the overall dialysis schedule organization of the hemodialysis unit. In addition, excessive post-dialysis puncture site bleeding estimated by the gauze weigh method has been recently found to be significantly associated with lower hemoglobin levels in an observational study ( 2 , 3 ). Conversely, excessive compression, especially with the use of hemostatic devices such as straps, tourniquets and rigid clamps, may damage vascular access walls and has been claimed by some authors to favor late fistula thrombosis ( 4 ).…”

Excessive Access Cannulation Site Bleeding Predicts Long‐Term All‐Cause Mortality in Chronic Hemodialysis Patients

“…. Indeed, our previous report using only the baseline data from this study showed that patients with excessive access bleeding are more likely to be anemic. In addition, we found that all five patients died from gastrointestinal bleeding during follow‐up experienced excessive access bleeding.…”

“…There is a well‐established method to evaluate the amount of blood loss during repeated HD access cannulation. Recently, our group reported the novel associations between excessive access bleeding with dialysis vintage, central venous stenosis, anemia and arteriovenous graft (AVG) usage . However, the association between excessive blood loss from access cannulation site and long‐term clinical outcomes remains unknown.…”