Treatment of dialysis access puncture wound bleeding with chitosan dressings

Abstract

Drs.Bachtell,Grunkemeier,andJinarewithProvidenceHealthSystem;T.GoodelliswithOregonHealthS and Dr. Gregory is with Oregon Medical Laser Center, Portland, Oregon. Background.Bleedingfromcoagulopathichemodialysispuncturesitescancontributetoanemiaindialysispatients,andcurrent compressive dressings may contribute to graft thrombosis. We studied the safety and efficacy of a new chitosan-based bandage with an active clotting surface and compared its time to hemostasis and compression strap usage in dialysis access puncture wounds with that of conventional gauze dressings. Methods. Fifty patients received both the chitosan-based and conventional gauze dressings in random order on 2 successive visits. Time to hemostasis and compression strap usage were compared between the visits. Time to hemostasis was analyzed using the binary response variable at 2 and 4 minutes. A compression strap wasused if dressing application was unsuccessful at 4 minutes. Covariates included coagulation state as measured by laboratory analysis and anticoagulation therapy. Results.Hemostasiswasachievedby2minutesin30%ofthechitosan-basedand38%oftheconventionaldressings(p ¼0.608) andby4minutesin86%ofthechitosan-basedand72%oftheconventionaldressings(p ¼0.040).Compressionstrapusagewas reducedby50%inthechitosan-basedgroupcomparedtotheconventionalgroup(7vs.14patients;p ¼0.052).Noadverseevents were reported with either dressing. Conclusions. The chitosan-based bandage from HemCon is a safe and effective hemostatic agent to reduce prolonged posthemodialysis puncture site bleeding and may reduce the use of occlusive compression straps.