Fistula - bleeding warning signs and what to do

It is rare for a fistula /graft to bleed excessively after dialysis, but it does happen and can lead to rupture.

The good news is that there are often warning signs. You need to know them and be ready to respond.

Warning signs to be aware of:

You have a higher risk of excess bleeding from your fistula or graft if it:

• Is not healing
• Is infected
• Is bulging and noticeably increasing in size
• Feels firmer than usual
• Has very thin or shiny skin

Or if you have:

• High venous pressure on dialysis
• Longer time taken for your blood to clot because of blood thinning medications.

Important information for you and your partner to know:

 How should I stop my fistula or graft bleeding?

• Use at least 2 fingers to hold the gauze
• Apply firm, continuous pressure
• Wait at least 10 minutes before checking to see if bleeding has stopped
• When bleeding stops apply fresh gauze and tape or a clean pressure pad
• If bleeding restarts, reapply pressure and Get Help
• Inform the dialysis unit staff of all instances of bleeding at home from your fistula or graft.

Emergency kit to keep at home

You should have an emergency kit available, containing:

• 4 packets of gauze
• 1 roll adhesive tape (micropore)
• 4 pressure pads
• 2 clean paper towel cloths
• 1 pair of large gloves
• 1 tourniquet

What should I do if my fistula or graft starts to bleed after I have left dialysis?

• Stay Calm. There may be a lot of blood, but putting pressure on the spot should control the bleeding.Call for help from anyone who is around.
• Apply firm pressure to the area that is bleeding, using gauze from your emergency kit if available.
• Hold the spot for at least 10 minutes. If the bleeding stops, apply fresh gauze and tape or a clean pressure pad.

• If it is still bleeding, use your fingers to again apply pressure to the bleeding spot and ring 000 for an ambulance.
• If the bleeding is uncontrollable and will not stop, as a last straw, apply put the tourniquet over the bleeding area, tighten it and then use your fingers to put more pressure on the spot. Ring 000 for an ambulance.