Читать книгу Emergency Medical Services - Группа авторов - Страница 488

Patients undergoing hemodialysis have a high‐capacity vascular structure punctured multiple times weekly, leading to increased risk of bleeding. Grafts and fistulas have high blood flow and pressure compared to peripheral veins. Aneurysms are rare, but can occur, and may rupture catastrophically, causing exsanguination [4, 28]. More common is persistent bleeding after dialysis from the needle insertion site. The patient’s underlying platelet dysfunction, daily use of anticoagulants, and heparin use during dialysis can contribute to difficulty obtaining hemostasis. Typically, hemorrhage from the puncture site will respond to firm digital pressure directly over the bleeding site for 10‐20 minutes. If available, a thin layer of commercially available dressing with hemostatic agents (e.g., QuikClot®, HemCon®) or gauze with topical biological agents (e.g., thrombin, TXA) can also be used with direct digital pressure. Layers of gauze and compressive bandages should be avoided as they serve only to soak up blood and often do not provide the adequate direct pressure needed for hemostasis. Proximal tourniquet application should be used only in life‐threatening circumstances as a last resort, as this may result in permanent damage or loss of the patient’s dialysis access. It should be considered in only critical situations [4, 28].