I finish my treatments by 2:30. At what time should I remove the tape and bandaids from my fistula? I read that a fistula should not be taped too tightly... is this true?

Fred,

Great questions. A fistula can take 5-15 minutes to form a small clot at the needle exit site within the fistula. A fistula is your own vein and can form a clot on the vessel wall quickly.

A graft takes longer 10-20 minutes because graft material is not a native vein.

Other factors influence how fast a vascular access takes to stop bleeding. Blood thinners such as aspirin, Coumadin and heparin cause prolonged bleeding. Many over the counter food additives or herbal supplements can also contain a blood thinner. If you take any of these products, please make sure you bring in the bottle to show your dialysis nurse and nephrologist.

Bleeding times can vary from day to day. If you are given heparin with your dialysis for a 4 hour treatment, and for some unexpected reason you get off early at 3 � hours then
prolonged bleeding can occur.

Holding both needle sites at one time can also prolong the bleeding. The best pressure is held with two fingers to one site at a time. You will gradually let up the pressure to the site as your fingers hold the site. Holding two sites at once will not allow the best direct pressure and the gradually release of pressure. Excessive bleeding and prolonged bleeding may result from holding both sites at once.

If you get off at 2:30 pm, hold the first needle for 10 minutes and then check to see if the bleeding is done. Hold the second needle for 10 minutes and check if the bleeding is done. If the bleeding is totally finished at 10 minutes, you can decrease the time of holding by 1 minute each treatment until you reach 5 minutes. If the bleeding is not totally finished at any of the lower time, increase back up by 1 minute. Always hold as least 5 minutes per site to prevent re-bleeding once you get up and move the arm. A
light dressing with just a Band-Aid or 2x2 and light tape strips (don�t wrap tape all the way around the arm) should be fine. Proper needle holding to make sure the vessel wall has a good clot formed will eliminate the need for a large tight dressing. It will also help to protect your �lifeline�, your fistula.

Direct pressure on your vascular access is thought to cause clotting of the access. The idea is any thing that causes a low flow within the vascular access, can lead to clot formation at the arterial inflow of the vascular access. Low blood pressure, excessive pressure (watch, purse, heavy items or direct pressure with post dialysis needle holding), poor heart function or sleeping on the extremity can all cause a transient decrease in the blood flow within the vascular access. The vascular access can then form a clot at the arterial anastomosis, which causes the vascular access to be thrombosed (clotted). A vascular access that already has a low blood flow or a stenosis (narrowing) is at a higher risk to thrombose (clot) if any transient event occurs that lowers the blood flow even more. So if you wrap tight tape around your fistula it may or may not clot. Fistulas can tolerate a much lower access blood flow and still not clot. But to be safe, it is best not to
place excessive pressure on your fistula.

A patient with a graft is at a higher risk for the graft to clot from excessive pressure on the graft arm. Grafts need a higher access blood flow to stay patent (open). Grafts also can develop stenosis (narrowing) more often than a fistula. This narrowing at the venous anastomosis or outflow vein can cause a decrease in the access blood flow. Grafts with an access blood flow less than 600ml/min has a higher risk of clotting than a graft with an access blood flow greater than 600 ml/min. (NKF DOQI Guideline 10). To learn more about this topic, see the Topic page for Patient Education.

Hope I answered your question. Please post any additional questions. As always, talk with your dialysis personal about your specific vascular access.

Deborah Brouwer

Thank you for your good answer deborah! I have been holding my sites for 10 min, each. I am glad to learn that in time I may be able to reduce that by half. Every little bit helps : )