【Learning Key Points】

1. Vascular access is the lifeline of dialysis patients. It is necessary to correctly pressurize and stop bleeding of the puncture wound and maintain good vascular access function.
2. To stop bleeding after puncture, use either hand pressure to stop bleeding or tourniquet pressure. Excessive pressure should be avoided to cause fistula blood flow obstruction.
3. When applying pressure to stop bleeding, pay attention to whether the skin temperature of the extremities of the vascular access is cold, numb, or tingling.
4. When hematoma occurs in the puncture wound, ice compress can be given, and hot compress can be applied after 24 hours on the bruised and swollen area.

Arteriovenous fistula is the main vascular access for hemodialysis patients. When hemorrhage does not stop correctly after dialysis, blood can leak into surrounding tissue, causing bruises and hematomas, which will increase the chance of obstruction of the arteriovenous fistula. In severe cases, it may decrease hemoglobin, increase mortality.

1. If blood seeps out, using your thumb to apply pressure and inform the healthcare professional.
2. The best way to achieve hemostasis is compress wound by hands. Choose the hand method or tourniquet method, do not use both methods together, as it may block the blood flow of the arteriovenous vessel.
   
3. 1. Keep the wound clean and dry. Avoid squeezing a ball or applying excessive force for 4–6 hours after dialysis to prevent re-bleeding.
4. If a hematoma develops at the puncture site, apply a cold compress for 10–15 minutes, then rest for 30 minutes before repeating. This may be done 3–4 times per day.On the following day, apply warm compresses to bruised or swollen areas for 10–15 minutes, 3–4 times per day. The temperature should not exceed 50°C.
5. If bleeding occurs after returning home, remain calm and apply firm pressure directly over the puncture site using clean or sterile gauze.If bleeding persists, ask someone to assist with compression and seek medical attention immediately.
   If bleeding is difficult to control, inform your nurse during your next dialysis session to evaluate the anticoagulant dosage.
6.  Carefully inspect your vascular access site. If there are signs of infection such as redness, swelling, warmth, pain, or discharge, notify healthcare staff immediately.
7.  For arteriovenous fistula (AVF), receiving far-infrared therapy for 40 minutes, three times per week during dialysis may help increase vessel diameter and reduce needle insertion pain.
8. Pay attention to the temperature and sensation of the affected limb. If you experience coldness, numbness, or tingling, inform your nurse or physician immediately for evaluation.
   

1. 陳範宇、林志慶（2023）·遠紅外線治療改善血液透析血管通路功能及預後·臨床學月刊91(6)396-399 。 https://doi.org/10.6666/ClinMed.202306_91(6).0065
2. National Kidney Federation.(2020).care of your fistula.https://www.kidney.org.uk/fistula-care
3. Bulbul, E., Yildiz Ayvaz, M., Yeni, T., Turen, S., & Efil, S. (2023). Arteriovenous fistula self-care behaviors in patients receiving hemodialysis treatment: Association with health literacy and self-care agency. The journal of vascular access, 24(6), 1358–1364. https://doi.org/10.1177/11297298221086180