With infiltration, we are told to apply ice, then heat. It is pretty uncomfortable. Do you have any tips on how to best do this and how long should each be applied?

Cindy,

Ice should be applied immediately after an infiltration has occurred. The ice can help decrease the size of the infiltration and control the pain. Apply the ice for 15-20 minutes and then remove the ice pack. A washcloth, blue pad or towel should be used between the skin and the ice pack to help protect the skin. The ice can be re-applied for short periods (10-20 minutes) over the first 12-24 hours. Make sure the application of ice does not interfere with the blood flow through the vascular access. Excessive pressure and ice could cause the fistula or graft to clot. Always check for the bruit/thrill above and below the application of pressure and ice.

Often heat can help resolve the bruising after the first day. Care must be taken with both ice and heat applications to prevent any skin damage. This is especially important for diabetics and anyone with nerve damage. Heat must be from a safe source. Heating pads can get too hot and lead to burns. A warm washcloth or compress can be enough to help resolve the infiltration. The heat can also help reduce the pain.

A severe infiltration will take days to even weeks to fully resolve. The bruising and pain is from the pooling of blood into the soft tissue. When in infiltration occurs, quick response can help decrease the severity of the infiltration. The correct application of direct pressure is very important. If an infiltration occurs after the heparin is administered, the bleeding can be excessive. The vascular access may need to be rested until the bruising resolves.

If blood collects in a small area a hematoma can form. The hematoma can be under the graft or fistula if the needle goes through the backwall of the vascular access. The hematoma can be large enough to impede the vascular access blood flow and lead to clotting of the access. A hematoma can also form on top of the access and lead to difficulty with cannulation of the access. If a fistula needle goes through the hematoma for subsequent dialysis treatments, clots can be aspirated from the needle. The clots are from the old pooled blood that makes up the hematoma, not from the vascular access itself. Sequent cannulations should not occur in the area of a hematoma or ecchymotic (bruised) area until the infiltration is resolved.

I wish dialysis needle cannulation were a pain free and complication free procedure. I hope someday we will have a better way. I hope this information helps to answer your question.

Deborah