What do I do for a dialysis catheter that won't stop bleeding?

Management of Dialysis Catheter Bleeding

For a dialysis catheter that won't stop bleeding, apply direct pressure with sterile gauze dressing until hemostasis is achieved, and if bleeding persists, replace the dressing while ensuring it's not damp, loosened, or visibly soiled. 1

Initial Assessment and Management

When confronted with a bleeding dialysis catheter, follow this algorithm:

1. Apply direct pressure:

   • Use sterile gauze dressing at the catheter exit site
   • Apply firm, continuous pressure for 5-10 minutes
   • Avoid excessive pressure that might dislodge the catheter

2. Assess the dressing:

   • If the current dressing is soaked with blood, replace it with fresh sterile gauze 1
   • For persistent bleeding or oozing, gauze dressing is preferred over transparent dressing 1
   • Ensure the dressing is secure but not restricting catheter function

3. Evaluate catheter position and integrity:

   • Check for catheter displacement or partial dislodgement
   • Inspect for cracks or damage to the catheter that might cause leakage
   • Consider angiographic evaluation if unexplained bleeding persists, as tunneled catheter leaks can occur 2

Advanced Interventions for Persistent Bleeding

If bleeding continues despite initial measures:

• Replace the catheter dressing:

  • For short-term CVC sites, replace gauze dressings every 2 days 1
  • For tunneled or implanted CVC sites, replace transparent dressings no more than once per week unless soiled or loose 1

• Assess for systemic factors:

  • Check recent anticoagulation status (heparin during dialysis)
  • Review medications that affect coagulation (warfarin, clopidogrel, aspirin)
  • Consider uremic bleeding tendency common in dialysis patients 3

• Consider hemostatic interventions:

  • Apply topical hemostatic agents if available
  • For tunneled catheters with persistent bleeding, consider if catheter replacement is necessary

Important Considerations and Pitfalls

• Do not submerge the catheter or catheter site in water, as this increases infection risk 1

• Do not use topical antibiotic ointment or creams on insertion sites, except for dialysis catheters, due to potential for fungal infections and antimicrobial resistance 1

• Avoid excessive manipulation of the catheter which may worsen bleeding or cause dislodgement

• Monitor for signs of catheter dysfunction (blood flow rates <300 mL/min, arterial pressure <–250 mm Hg, venous pressure >250 mm Hg) as these may indicate underlying issues 1

• Be aware that while bleeding from dialysis vascular access is uncommon, fatal hemorrhage can occur in rare cases (fewer than 1 episode per 1,000 patient-years) 4

When to Seek Additional Help

Escalate care if:

• Bleeding continues despite appropriate dressing changes and pressure
• Patient develops hemodynamic instability
• There are signs of catheter dysfunction or infection
• The bleeding is associated with a new catheter placement (may indicate tunnel or vessel trauma)

While bleeding from dialysis catheters is typically manageable with proper dressing techniques and pressure, persistent bleeding should prompt evaluation for underlying causes to prevent serious complications.