Use of a Simple Compression Dressing to Obtain Hemostasis after Pharmacologic Thrombolysis of Dialysis Grafts

Abstract

0 SCVIR, 1999 THERE are several methods for obtaining hemostasis after percutaneous treatment of a thrombosed dialysis graft. Manual compression is effective but can be very time-consuming in anticoagulated patients. Reversal of anticoagulation with protamine is effective, but carries the not infrequent risk of severe reaction (1). Recently, use of a purse-string suture has been described and it can be both safe and effective (2-4). Use of a purse-string suture has several disadvantages. Supplemental compression is often required, there is a concern that pseudoaneurysms may occur because the puncture site is not directly compressed, and one must assume the graft is well incorporated because its use in an unincorporated graft is contraindicated (4). There is an added concern that an exposed skin suture provides a portal of entry for bacteria, with the potential for graft infection. To deal with these concerns, we had been fashioning a sterile compression dressing made of gauze and Bioclusive (Johnson & Johnson, Arlington, TX) after placement of the suture, and had achieved immediate hemostasis without supplemental compression. It became readily apparent that the suture might not be necessary at all. This study describes our experience with a simple compression dressing used as the sole form of hemostasis.