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  1. #1
    Join Date
    07-30-06
    Location
    South Carolina
    Posts
    10

    Default How to treat hematoma from infiltration???

    While sticking my veinous return a few days ago, the tech pushed the needle through the vein and into the muscle of my bicep (my arterial is all the way down in my wrist). This is a 23 year old fistula, but it's in pretty good shape. I took the needle from her and pulled back until I felt it pop loose from the bottom wall, then re-threaded it properly. I then continued to bleed on and run with a BFR of 450... big mistake; duh! When I noticed my bicep swelling, I turned the BFR down to 350 and asked for an ice pack. Now, 4 days later, I have a painful hematoma and can't straighten my arm or curl it to my normal range of motion. Did I mention it hurts like hell!?
    I am on coumadin therapy and I was afraid my pro-time was high, so I only iced (no heat)for several days. I now know my pro-time is okay so I've switched to applying heat once in a while, and doing bicep curls with no weight a few times a day, just to keep the blood flowing. It's still very firm to palpate around the whole bicep area, and beginning to turn purple.

    Am I doing the right things? Am I doing the wrong things? Is there anything I can do to speed up the healing?

    I really want to be surf fishing, flounder trolling, and catching bluecrabs in 2 weeks. I need to be re-starting my physical therapy excersises on my old arthritic shoulder in at least 1 week from now, so I'll be able to do all that fun stuff.

    HELP anyone knowlegeable about such things.
    Thank you,
    Rusty

  2. #2
    Join Date
    08-17-04
    Posts
    2,124

    Default

    Rusty, I think you're doing the right things, but don't know for sure, so I sent an email off to a couple of cannulation guru's and will let you know what they say. They are both experienced HD nurses who are experts in fistula cannulation.

  3. #3
    Join Date
    07-30-06
    Location
    South Carolina
    Posts
    10

    Default

    Thanks Dori. If I can just get to where I can straighten my arm, then at least I could get back to work on my old shoulder. That's the most important thing, if not for that, I'd just be patient and wait it out.
    Be like Mister Natural... Lean into it and Keep On Truckin'

  4. #4
    Join Date
    02-19-07
    Posts
    291

    Default

    Wow, I learn something new every day. I've never seen a fistula where the venous and arterial accesses are so far apart -- venous near the bicep and arterial on wrist -- woe, what a pain.

    Rusty, I've got a couple of questions. It sounds like you're may be doing HHD, but I'm not sure because you refer to the person who cannulated the needle in the first place as a tech and not your caregiver/partner. But you did pull the needle back yourself and adjusted the BFR. Secondly, with being on dialysis for over 23 years (age of this fistula), I'm surprised you haven't had a hemotoma before. Thirdly, in my experience, it's pretty hard to get a hemotoma if you're using the buttonhole technique, and since you mentioned you had a fistula, it would seem most likely you wouldn't be using sharps and the step and ladder method.

    Getting back to your dilemma, in my experience you're just going to have to wait it out. Puttin an ice pack on it is a good idea -- heat doesn't help. I have had hemotomas a couple of times due to bad sticks and a couple times on other parts of my body, and I can sympathize in terms of the pain. There was one time I fe3lol before going into my old dialysis center, and a couple of hours into my tx, my thigh blew up to twice its size. I was in excruciating pain and couldn't move. The nurse had to stop my tx, call 911 and had an ambulance take me to the ER. I wanted them to admit me, but they waited a couple of hours, gave me a pain killer (it might have been vicodin - don't remember st this point), gave me a walker and released me.

    When I had hemotomas in my venous acceswsw acouple of times, once I ended up at the hospital's in-patient dialysis center to be examined by someone from vascular surgery and had and angioplasty of my access. Another time they didn't think it was necssary. Then once at another in-center during nocturnal, the staff just shrugged their shoulder being quire indifferent and just told me to go home after they continued my tx to my protests.

    Good luck with getting your pain to subside, and, more importantly, getting the hemotoma to go down. Just a warning though; it could and probably will take several weeks or more, for it to fully go down!!!!!!!!!!

  5. #5
    Join Date
    07-02-04
    Location
    USA
    Posts
    1,940

    Default

    Quote Originally Posted by Rusty View Post
    While sticking my veinous return a few days ago, the tech pushed the needle through the vein and into the muscle of my bicep (my arterial is all the way down in my wrist). This is a 23 year old fistula, but it's in pretty good shape. I took the needle from her and pulled back until I felt it pop loose from the bottom wall, then re-threaded it properly. I then continued to bleed on and run with a BFR of 450... big mistake; duh! When I noticed my bicep swelling, I turned the BFR down to 350 and asked for an ice pack. Now, 4 days later, I have a painful hematoma and can't straighten my arm or curl it to my normal range of motion. Did I mention it hurts like hell!?
    I am on coumadin therapy and I was afraid my pro-time was high, so I only iced (no heat)for several days. I now know my pro-time is okay so I've switched to applying heat once in a while, and doing bicep curls with no weight a few times a day, just to keep the blood flowing. It's still very firm to palpate around the whole bicep area, and beginning to turn purple.

    Am I doing the right things? Am I doing the wrong things? Is there anything I can do to speed up the healing?

    I really want to be surf fishing, flounder trolling, and catching bluecrabs in 2 weeks. I need to be re-starting my physical therapy excersises on my old arthritic shoulder in at least 1 week from now, so I'll be able to do all that fun stuff.

    HELP anyone knowlegeable about such things.
    Thank you,
    Rusty
    High Rusty, I had the same incident happend to me years back. The head nurse really stuck me quite bad and I yelled at her taking the needles away from her. It kep beeding inside my arm, getting bigger and bigger..worst of all the heparin just made it worse...as it got bigger the fistula is not visible anymore and the pain is quite hectic.

    There was no point for me to continue dialysis and had them discontinue treatment. Without treating the swollen area, the swelling and pain does last quite long. For the next several days you need to limit heparin and asprin or any blood thinners. Other helpful things to lower swelling is to use peels aloe leaves and wrap it around the swelled area with a flexible bandage....not too tight...you do this overnight........and you will see the swell go down sooner, but the dark purple will remain a bit longer.

    Now that I am home doing self-care those problems are a thing of the past. My suggestion is try learning to cannulate yourself, doing so will prevent these awful bad sticks from others....

    Take Care,
    Gus Castaneda
    Hemodialysis initial Start: 1978
    Home Hemodialysis: 11/2004 - Present
    Http://www.dailyhemo.org



  6. #6
    Join Date
    02-19-07
    Posts
    291

    Default

    Rusty, I went bck and read some of your earlier posts, and now understand that you still are dialyzing in-center. So I guess I answered one of my own questions. However, from your description, it seems like you are at a totally horrendous center, but it also appears you have an aversion to doing HHD. You said that your "current situation works" for you I don't think so. Your complaints about your center are actually worse than the ones I had, although I had to go through alot of the same. Man, you should really consider HHD, rather than just lurking. And if you go with NxStage, you'll be able to continue your active life style and travel when you want. The biggest issue my wife had during the first year was all of the boxes of supplies that took up our house, but now with PureFlow that has been alleviated.

    Just last week, I had a couple of adult children of a patient considering NxStage come over to my house to watch the process. They are now convinced their mother should start. They saw the set up, and all of the supplies, and asked a lot of questions. Perhaps there is someone in your area that would do the same. Once you see it (and bring your wife), I'm sure you'd be more comfortable in making a decision.

    As an aside to other HHD patients, we need to open ourselves up and share our experiences with those less fortunate in order to grow our HHD community.

  7. #7
    Join Date
    08-17-04
    Posts
    2,124

    Default

    Hi Rusty,

    Here's what one of my experts said:

    " Sounds like he ended up with quite a large infiltration. Unfortunately, it will take time for the body to resorb the clotted blood in his tissues. I doubt if there is anything he can do to "speed up" the process. When swelling begins after in infiltration, the secret is to stop the bleeding by removing the needle, not applying ice and continuing dialysis. While icing is the correct process for an infiltrate, its purpose is to slow down flow to the area, thus keeping swelling to a minimum. He'll probably have to check with his physician to see when he can resume working on that shoulder of his. He just needs to be careful not to cause any blood flow restrictions to the area of his hematoma."

    Dori

  8. #8
    Join Date
    08-17-04
    Posts
    2,124

    Default

    Oops, hate to reply to myself, but our other cannulation expert is out of the country. Beth Witten has found something that this person previously posted on this topic. Here's what the expert said:

    "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."

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