Effective Management Strategies for Bleeding During Hemodialysis Treatments

Understanding and Addressing Bleeding Complications in Hemodialysis

Bleeding during hemodialysis is a clinically significant concern that requires prompt, evidence-based intervention. While minor oozing may occur occasionally, persistent or excessive bleeding—especially around vascular access sites—can signal underlying technical, procedural, or physiological issues. Early recognition and appropriate management are essential to prevent complications such as hypovolemia, infection, delayed treatment sessions, and patient anxiety.

Managing Bleeding from Temporary Vascular Access Catheters

Temporary central venous catheters—often used as a bridge while permanent access matures—are particularly prone to bleeding at the insertion site. One common cause is suboptimal catheter placement: if the catheter tunnel is too long or the skin entry point is inadequately secured relative to the vessel wall, small gaps can develop, allowing blood to track along the catheter tract. This is especially likely during catheter manipulation, dressing changes, or patient movement.

Additionally, anticoagulation plays a critical role. Patients receiving higher-than-standard heparin doses—or those with heightened sensitivity to anticoagulants due to renal impairment, low platelet counts, or concurrent medications (e.g., NSAIDs or direct oral anticoagulants)—face elevated bleeding risk. In cases of active, non-resolving bleeding, immediate clinical evaluation is necessary. A healthcare provider may apply targeted pressure, adjust anticoagulant protocols, or perform suture repair under sterile conditions to achieve secure hemostasis and reduce recurrence.

Preventing and Controlling Bleeding from Arteriovenous Fistulas (AVFs) and Grafts

For patients using mature arteriovenous fistulas (AVFs) or synthetic grafts, bleeding typically stems from needle insertion technique rather than device failure. Repeated punctures at the exact same location weaken the vessel wall over time, increasing the likelihood of hematoma formation and post-dialysis oozing. Skilled dialysis nurses mitigate this risk through rope-ladder or buttonhole cannulation techniques—systematically rotating puncture sites along the length of the access to promote even tissue healing and structural resilience.

Proper needle stabilization, gentle removal with firm digital pressure applied for 10–15 minutes post-treatment, and patient education on recognizing early signs of bleeding (e.g., persistent dampness under the bandage or unexplained bruising) further support safe, long-term access use.

Optimizing Long-Term Vascular Access: Best Practices for Patients and Clinicians

Clinical guidelines consistently recommend establishing permanent vascular access—such as an AVF—as early as possible in chronic kidney disease progression. Compared to temporary catheters, AVFs offer superior patency rates, lower infection risk, reduced thrombosis incidence, and significantly fewer bleeding-related complications.

Once established, protecting the AVF is paramount. Patients should be counseled to avoid compressing the access arm (e.g., sleeping on it or wearing tight sleeves), lifting heavy objects (>10 lbs) with the access arm, and permitting blood pressure measurements or IV placements in that limb. Maintaining stable blood pressure—particularly avoiding episodes of profound hypotension during or after dialysis—is crucial, as low perfusion pressure increases the risk of clot formation and subsequent turbulent flow upon recanalization, which may damage vessel integrity.

Regular self-monitoring—including daily checks for thrill (vibration) and bruit (audible sound)—empowers patients to detect subtle changes like diminished flow or new swelling, prompting timely specialist referral before serious complications arise.