What do I do if my dialysis catheter is oozing blood?

Managing a Dialysis Catheter That Is Oozing Blood

For a dialysis catheter that is oozing blood, you should immediately apply a sterile gauze dressing rather than a transparent dressing until the bleeding resolves. 1

Immediate Management Steps

1. Assess the catheter site:

   • Observe the amount of bleeding
   • Check if the catheter is properly secured
   • Look for signs of infection (redness, swelling, warmth)

2. Apply appropriate dressing:

   • Replace current dressing with sterile gauze dressing 1
   • Ensure the gauze completely covers the oozing area
   • Secure the dressing with medical tape

3. Monitor the site:

   • Check the dressing frequently for saturation
   • Replace the gauze dressing if it becomes damp, loosened, or visibly soiled 1
   • Continue using gauze dressing until bleeding/oozing resolves

Evidence-Based Rationale

The Clinical Infectious Diseases guidelines clearly state that "if the patient is diaphoretic or if the site is bleeding or oozing, use gauze dressing until this is resolved" (Category II recommendation) 1. Similarly, the ESPGHAN/ESPEN/ESPR guidelines recommend that "sterile gauze dressing is preferable if the catheter site is bleeding or oozing" 1.

Gauze dressings are preferred over transparent dressings in this situation because:

• They absorb blood and exudate better
• They can be changed more frequently (every 2 days vs. 7 days for transparent dressings) 1
• They reduce the risk of infection when the site is not dry

Additional Management Considerations

Infection Prevention

• Always use proper hand hygiene before and after touching the catheter or dressing 1
• Wear clean gloves when handling the catheter site 1
• If the gown becomes soiled with blood during dressing change, replace both gloves and gown immediately 1
• Use masks when the catheter lumens or exit site are exposed to prevent airborne contamination 1

Dressing Change Protocol

1. Perform hand hygiene
2. Apply clean gloves
3. Remove old dressing
4. Inspect the site
5. Clean the site with appropriate antiseptic (preferably chlorhexidine-based) 1
6. Allow antiseptic to dry completely
7. Apply new sterile gauze dressing
8. Secure dressing properly

When to Seek Additional Help

• If bleeding persists or worsens despite proper dressing
• If signs of infection develop (fever, increased pain, purulent drainage)
• If the catheter appears dislodged or the cuff is exposed 1

Follow-up Care

Once the bleeding/oozing resolves:

• You may switch to a transparent semi-permeable dressing 1
• For short-term catheters, replace gauze dressings every 2 days and transparent dressings every 7 days 1
• For tunneled catheters, transparent dressings can be replaced once weekly unless soiled or loose 1

Important Cautions

• Do not apply topical antibiotic ointments to the insertion site (except for dialysis catheters in specific circumstances) as they may promote fungal infections and antimicrobial resistance 1
• Do not submerge the catheter or catheter site in water 1
• Avoid excessive manipulation of the catheter to prevent dislodgement
• Never use scissors or sharp objects near the catheter

By following these evidence-based guidelines, you can effectively manage a dialysis catheter that is oozing blood while minimizing the risk of infection and other complications.