【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.

1. Keep the wound clean and dry, do not do Ball Squeeze exercise or using excessive force for 4-6 hours after dialysis to prevent wound from bleeding again.
2. In case of hematom, use cold therapy, apply ice pack for 10-15 minutes, resume after 30 minutes rest. Use cold therapy up to 3-4 times a day. Apply heat therapy to bruises and swelling areas on the next day, use heat for 10-15 minutes, 3-4 times a day, do not use temperature above 50 ° C.
3. If the wound still bleeds after returning home, remain calm and with the thumb apply pressure on the clean and sterilized gauze to wound. If the wound still bleeds, ask other to help with compression and go to the hospital immediately; if difficult to stop bleeding, discuss with your nurse and doctor to evaluate the anticoagulant in your next dialysis session.
4.  Examine your vascular access carefully, if possible. if it shows signs of infection such as redness, swelling, warm to touch, persistent pain, pus, or drainage, then inform hospital staff immediately.
5. Be attentive to the sensation of the distal limb of your vascular access, if it shows symptoms such as numbness, pain, or coldness, then notify the healthcare professional immediately.

1. 李怡萱、林莊秋萍、張鳳纓(2018) ･降低血液透析後病人動靜脈廔 管穿剌部位滲血率‧台灣腎臟護理學會雜誌，17(2)，13-24。 https://doi.org/10.3966/172674042018061702002
2. Bizari, D., Khoshmohabat, H., Kordestani, S. S., & Zarepur, R. (2019). Comparison of HemoFoam® and conventional gauze dressing on hemostasis of vascular access site in hemodialysis patients. Galen Medical Journal, 8, e1395. https://doi.org/10.31661/gmj.v8i0.1395
3. Lai, Q., Zhang, H., Chen, B., Gao, X., Chen, L., Tu, B., ... & Wan, Z. (2020). A simple tourniquet technique for bleeding control after percutaneous hemodialysis fistula and graft interventions. BMC nephrology, 21(1), 1-5. https://doi.org/10.1186/s12882-020-01784-y
4. National Kidney Federation.(2020).care of your fistula. https://www.kidney.org.uk/fistula-care