The scabs on my father’s fistula have recently been scratched off, even inadvertantly, and resulted in alot of bleeding from the scab site. Any suggestions on preventing scabs from breaking off so easily and preventing the excessive bleeding?
If you haven’t talked with the home training nurse about this problem, you might want to. It’s possible that heparin used to thin the blood during dialysis or another blood thinner he may be on for another condition could be making him more susceptible to bleeding. If so, there may need to be some adjustments.
If your dad is scratching his fistula area because he’s itching, find out if his phosphorus is high. If so, he may need to adjust his phosphate binder and/or limit his phosphorus intake more.
To avoid scratching off the scabs, most patients wear a Band-aid or gauze over the site for a few hours after dialysis. Ask the training nurse how long to leave on a protective covering.
My instructions are to leave the bandage on for 4 hours. Heparin gets metabolized out of the body pretty quickly, so it should not cause bleeding in between treatments. Is your father on anything else that might increase bleeding, like coumadin or something? It could be a structural problem with the fistula needle sites also (too thin). That would require a consultation with the vascular people, I think.
Once you have taken the bandage off after an appropriate period of time, just accidentally losing the scab as happens sometimes with shirt sleeves pulling some of it off should not cause bleeding. One possibility is being too agressive with taking the scab off before dialysis. If you dig or pick at it too much, you might draw blood from tiny blood vessels right near the hole. That could be what is bleeding later on. If you have to dig for the scab, just leave it. When that happens to me, I just make sure I’ve “opened” the hole in the middle with the syringe needle, so the buttonhole needle has a way in.
Personally, I would definitely call my nurse if I was bleeding as you describe.
Pierre
Does he access his fistula using the buttonhole or the ladder technique?