INTRODUCTIONINTRODUCTION

RESULTSRESULTS

　　　　　　 METHODSMETHODS

RESULTSRESULTS In Japan, many patients receive

hemodialysis treatment that lasts for decades. These

patients have thin and weak skin over vascular accesses because they are repeatedly

punctured. Furthermore, they have not only coagulopathies associated with chronic renal failure, but also use heparin and oral anticoagulants. In

cases of prolonged bleeding at the vascular access after

treatment, current compressive dressings are convenient but

may induce thrombosis. Nurses therefore must press

the bleeding sites longer, which might also cause

thrombosis at the vascular access and valuable staff time

is consumed. The chitosan-based dressing (HemCon Strip,

HemCon Medical Technologies, Portland, OR

USA) is a new hemostatic dressing now being used.

Additionally, recent data have demonstrated that chitosan is bactericidal. We studied the

safety and efficacy of the bandage for bleeding at the

vascular access after hemodialysis.

Out of 150 patients with arterio-venous fistula at the upper extremity, 6 patients (5 men

and 1 women, mean age 64 6.3 years old) who sometimes continued to bleed after 30 minutes of pressure at the

puncture site, were eligible for the study protocol. Exclusion

criteria were: cognitive inability to provide informed consent, allergy to shellfish, shrimp,

chitin, or chitosan. We used the chitosan-based dressings

consecutive18 times for these patients in case that bleeding continued after 30 minutes of

pressing. Previous clinical results showed that the

chitosan-based dressing works most effectively if the chitosan

surface is in contact with blood. For this reason, we pressed AVF side of the

internal shunt to stop blood flow within five seconds in the state that showed a little blood

from a puncture hole.

CONCLUSIONSCONCLUSIONSOur study suggests that the chitosan-based bandage is a safe and effective hemostatic

agent to reduce prolonged post hemodialysis puncture site bleeding in severe bleeding.

ACKNOWLEDGEMENTSACKNOWLEDGEMENTSWe thank you for your warm

support of Japan. Japanese are very sorry to pollute the

important sea with radioactive material at Fukushima Daiichi

Nuclear Power Plant.  

Left photograph became the cover of a magazine. In the

miserable disaster area, a self-defense official who did disaster

relief with almost no sleep watches the infant and smiles.

Depressed Japanese were relieved by this photograph.

NEW CHITOSAN-BASED BANDAGE STOPS SEVERE BLEEDING NEW CHITOSAN-BASED BANDAGE STOPS SEVERE BLEEDING FROM HEMODIALYSIS PUNCTURE SITE IN 2 MINUTES.FROM HEMODIALYSIS PUNCTURE SITE IN 2 MINUTES.

Kazuhiko Shibata1, Tamio Iwamoto2, Tomoyuki Murakami2, Syuji Ono2, Tomoko Kaneda2, Tadashi Kuji3, Seiiti Kawata3, Hidehisa Satta4, Kouichi Tamura5, Yoshiyuki Toya5, Mai Yanagi5, Satoshi Umemura5 and Gen Yasuda5. 1Yokohama Minami Clinic, Yokohama, Kanagawa, Japan; 2Saiseikai Yokohama-City

Nanbu Hospital; 3Yokodai Central Clinic and 4Yokohama Citi University Hospital.

Correspondence: k.shibata@houshinkai.or.jpCorrespondence: k.shibata@houshinkai.or.jp

Mean blood platelet count was 150000 60000 / L and activated

clotting time during hemodialysis was 139 13 min.

Intravascular pressure was 118 33 mm Hg. Time required to

stop bleeding before the experiment was from 15 to 60

min. By using the new bandage, the time decreased to just 2 minutes. There were no adverse effects such as

contact dermatitis or infection or blood clot obstruction of the

internal shunt.

We then applied the chitosan-based dressings and started

pressing the puncture sites for two minutes and depressed immediately and looked for

evidence of bleeding around the dressing. At the next dialysis

treatment, we checked the area where the chitosan-based

dressing was applied and made sure that there were no adverse

side effects such as contact dermatitis or infection. Blood

sample examination was performed. All patients

underwent hemodialysis using heparin (625 42 Units/h) without

other anticoagulants. Needles with a diameter of 1.7 mm were punctured by expert doctors.

Figure 1. Shunts stenosis was found in 4 patients among this six cases, and this may be the reason why bleeding was hard to stop. We performed a PTA for the

internal shunt later. We got possible to stop bleeding afterwards.

Figure2 ． Previous clinical results showed that the chitosan-based dressing works most effectively if the chitosan surface is in contact with blood. For this reason, we pressed AVF side of the internal shunt to stop blood flow within five

seconds in the state that showed a little blood from a puncture hole.

Figure3 ． Then we put the chitosan-based dressings and started pressing the puncture sites for two minutes

Figure4 ． At the next day, the dressing was removed. There was no sign for infection nor bleeding. Wound was clear.