Authors (including presenting author) :
HO HS, WO SY, WONG H, LAM WC, WONG KW, CHOW CCV, MO KLS
Affiliation :
Department of Medicine, Pamela Youde Nethersole Eastern Hospital
Introduction :
Hemostasis after needle extraction at the end of hemodialysis (HD) session cannot be overemphasized. The time required to achieve hemostasis significantly affects patients’ quality of life and workload of nursing staff. The current practice is to use an absorbable hemostatic gelatin sponge with gauze, applying on two needle puncture sites of the arterio-venous fistula (AVF) or arterio-venous graft (AVG) after hemodialysis. After achieving hemostasis, the sponge is replaced by a small piece of curaplast, covering the needle puncture sites. On removal sponge, the clot may be dislodged and bleeding recurs, requiring extra time of the patient and nursing staff to achieve hemostasis again. To improve the hemostasis, a new hemostatic material which was a hemostatic Injection Pad with adhesive bandage was introduced.
Objectives :
To improve hemostasis of access site in patients receiving HD therapy by applying new Injection Pads.
Methodology :
From January 2021, a new Injection Pad was applied to needle puncture sites after HD for haemostasis. These include:
1) Design pre and post questionnaire and monitoring chart
2) Conduct staff training in a small group or an individual format
3) Set up a workgroup to assist data collection
4) A pre-questionnaire of using existing method was distributed in January 2021 to
collect data of hemostatsis time and post-hemostasis bleeding frequency
5) A monitoring chart for patient using new method of Injection Pad was used to
record hemostasis time and bleeding frequency
6) A post-questionnaire of using Injection Pad was distributed in March 2021 to
collect data of hemostasis time and post-hemostasis bleeding frequency
7) Monitor patients’ response towards the new method by post-questionnaire and
continuous monitoring
Result & Outcome :
A total of 59 HD patients with AVF / AVG were recruited. Results showed a positive feedback on using Injection Pad by post-questionnaire. Patients and nursing staff found it easy to apply and accepted the new practice. No adverse effect on patients was noted. The Injection Pad is effective in achieving hemostasis and significantly reduces the frequency of post-hemostasis bleeding by 57% compared to current practice. Moreover, the cost of using new Injection Pad was 7 times lower compared to current product.
Thus, the Hemostatic Injection Pad is a cost-effective management to achieve hemostasis. It enhances patient quality of care and safety. Workload of nursing staff is also mitigated.
