Most subjects had prompt, uncomplicated cannulation but a few had wound necrosis, large hematomas and prolonged time until cannulation. Liposuction is effective in enabling cannulation of deep vein fistulas but because of the substantial risk of serious surgical site complications, it may not be the ideal method.

PurposeWe report the first use of a sterile elastic exsanguination tourniquet (SET) in performing hemodialysis vascular access procedures in 27 patients. The main advantages of this tourniquet are the reduction of blood loss and need for possible transfusions. Additional benefits are the near-perfect exsanguination and excellent exposure of the operative field.MethodsThis SET is a sterile elastic stockinet device that rolls up the arm starting from the hand by pulling on two handles. The elastic silicone ring provides sufficient pressure (220 ± 30 mmHg) to block arterial flow into the limb. The stockinet can be cut to provide access to the incision area while providing an additional sterile cover over the rest of the limb.ResultsNo transfusions were required in any patients. Minor adverse effects occurred in four patients, including a twisted vessel, a bleeding vascular branch, a tear in atrophic arm skin, and pain, all of which had resolved on subsequent follow-up. Operational recommendations to avoid these adverse effects are outlined.ConclusionsWe conclude that this sterile elastic exsanguination tourniquet is effective and safe in preventing bleeding during upper extremity hemodialysis vascular access procedures.