Treatment of dialysis access puncture wound bleeding with chitosan dressings

Abstract

Background. Bleeding from coagulopathic hemodialysis puncture sites can contribute to anemia in dialysis patients, and current compressive dressings may contribute to graft thrombosis. We studied the safety and efficacy of a new chitosan-based bandage with an active clotting surface and compared its time to hemostasis and compression strap usage in dialysis access puncture wounds with that of conventional gauze dressings. Methods. Fifty patients received both the chitosan-based and conventional gauze dressings in random order on 2 successive visits. Time to hemostasis and compression strap usage were compared between the visits. Time to hemostasis was analyzed using the binary response variable at 2 and 4 minutes. A compression strap was used if dressing application was unsuccessful at 4 minutes. Covariates included coagulation state as measured by laboratory analysis and anticoagulation therapy. Results. Hemostasis was achieved by 2 minutes in 30% of the chitosan-based and 38% of the conventional dressings (p ¼ 0.608) and by 4 minutes in 86% of the chitosan-based and 72% of the conventional dressings (p ¼ 0.040). Compression strap usage was reduced by 50% in the chitosan-based group compared to the conventional group (7 vs. 14 patients; p ¼ 0.052). No adverse events were reported with either dressing. Conclusions. The chitosan-based bandage from HemCon is a safe and effective hemostatic agent to reduce prolonged posthemodialysis puncture site bleeding and may reduce the use of occlusive compression straps.

Vascular access hemorrhages contribute to deaths among hemodialysis patients

“…Over half of FVAH cases reviewed hemorrhaged from an AV graft, and AV graft use at last dialysis was significantly associated with FVAH in the case-control study, even after controlling for confounding factors. These results support previous studies that have documented an association between AV graft use and vascular access complications such as infection and stenosis [7][8][9] and may reinforce the importance of quality improvement initiatives such as the CMS Fistula First Breakthrough Initiative (FFBI), which recommends AV fistula use over the more complication-prone AV grafts and central venous catheters. 23 Although AV fistula placement is generally encouraged for maximal patient safety and access patency, some hemodialysis patients cannot sustain fistula placement because of poor vasculature.…”

“…In the past 35 years, single case reports of FVAH have been published describing FVAH by suicide, needle or catheter separations occurring during dialysis, or spontaneous rupture. [5][6][7][8][9] Current prevention measures focus on solutions to needle or catheter separation during dialysis (e.g., constant visualization of access during dialysis or alarms to detect blood-soaked bandages and safety clips and clamps). 10 However, needle or catheter separations only account for a portion of FVAH.…”

Crab vs. Mushroom: A Review of Crustacean and Fungal Chitin in Wound Treatment

“…Human clinical trials utilizing commercially available and custom-made chitin and chitosan wound treatments, resulting in significant improvements in the healing of ear, nasal, oral, and skin wounds, in addition to treatment of ulcers and serious hemorrhages. Data from [162][163][164][165][166][167][168][169][170][171][172][173][174][175][176][177]. Chitosan, unknown [177] These wound treatments have experienced significant success in oral clinical trials where they have been used to treat aphthous stomatitis (mouth ulcers), postoperative and tooth extraction wounds.…”

Long‐term outcomes of a chitosan hemostatic dressing in laparoscopic partial nephrectomy

“…Increased levels of interleukin‐8, interleukin‐1, gamma–interferon, and C3 have been associated with chitosan enhancing wound healing responses 13. Different forms of the chitosan dressing have been developed to enhance hemostasis involving bleeding from varying external wounds,1 oral wounds,14 and vessel puncture sites 15. In our previous studies, a new platform of the chitosan dressing was investigated to arrest life threatening hemorrhaging in inferior vena cava injury and renal parenchymal resection with laparoscopic technique 2, 3.…”