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Alternative to the finger in the dike: use of the vascular closure button to control postdialysis bleeding in a haemodialysis access conduit
  1. Alfred Sacchetti,
  2. Adam Hennessey,
  3. Brian Shannon
  1. Emergency Medicine, Our Lady of Lourdes Medical Center, Camden, New Jersey, USA
  1. Correspondence to Dr Alfred Sacchetti, Our Lady of Lourdes Medical Center, Camden, NJ 08103, USA; sacchetti1011{at}gmail.com

Abstract

Objective The purpose of this case series is to describe the application of a vascular closure button (VCB) for the repair of haemodialysis access bleeding. The VCB’s main function is not to assist in bleeding control, but instead to provide easy access for removal of tightly placed sutures in the repair.

Methods A retrospective review of patients undergoing ED repair of persistent bleeding from puncture sites in haemodialysis access conduits (HACs) using a VCB was conducted. Study patients were collected from ED visits to Our Lady of Lourdes Medical Center in Camden, New Jersey, USA, between May 2013 and August 2017. Patients were followed until the time of definitive repair of the underlying pathology or until the end of the study period.

Results Seventeen VCBs were used to control persistent bleeding from HACs in the ED. Sixteen bleeds were the result of recent haemodialysis punctures, while one was from a bleeding site ulcer. All repairs were successful at controlling the bleeding with preserved HAC function in the ED and no delayed thrombosis. Follow-up time ranged from 1 day to 778 days.

Conclusion Vascular control buttons provide an effective means to control HAC postdialysis bleeding and allow for ease of suture removal without disruption of a repair with no long-term complications.

  • renal
  • vascular-arterial
  • Invasive
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Footnotes

  • Contributors AS and AH: conceived the study, identified patients on the electronic health record. BS: performed follow-up chart reviews to identify delayed complications in patients. AS and AH: wrote the manuscript. BS: editorial comments on the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the hospital's institutional review board (LHS IRB #19–009, IRBNet #1435836–1).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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