NEW CHITOSANBASED BANDAGE STOPS SEVERE BLEEDING FROM HEMODIALYSIS
NEW CHITOSAN-BASED BANDAGE STOPS SEVERE BLEEDING FROM HEMODIALYSIS PUNCTURE SITE IN 2 MINUTES. Kazuhiko Shibata 1, Tamio Iwamoto 2, Tomoyuki Murakami 2, Syuji Ono 2, Tomoko Kaneda 2, Tadashi Kuji 3, Seiiti Kawata 3, Hidehisa Satta 4, Kouichi Tamura 5, Yoshiyuki Toya 5, Mai Yanagi 5, Satoshi Umemura 5 and Gen Yasuda 5. 1 Yokohama Minami Clinic, Yokohama, Kanagawa, Japan; 2 Saiseikai Yokohama-City Nanbu Hospital; 3 Yokodai Central Clinic and 4 Yokohama Citi University Hospital. Correspondence: k. shibata@houshinkai. or. jp INTRODUCTION RESULTS In Japan, many patients receive We then applied the chitosanhemodialysis treatment that based dressings and started lasts for decades. These pressing the puncture sites for patients have thin and weak two minutes and depressed skin over vascular accesses immediately and looked for because they are repeatedly evidence of bleeding around the punctured. Furthermore, they dressing. At the next dialysis have not only coagulopathies treatment, we checked the area associated with chronic renal where the chitosan-based failure, but also use heparin dressing was applied and made and oral anticoagulants. In sure that there were no adverse cases of prolonged bleeding at side effects such as contact the vascular access after dermatitis or infection. Blood treatment, current compressive sample examination was dressings are convenient but performed. All patients may induce thrombosis. underwent hemodialysis using Nurses therefore must press heparin (625 42 Units/h) without the bleeding sites longer, Figure 1. Shunts stenosis was found in 4 patients among this six cases, and this other anticoagulants. Needles which might also cause may be the reason why bleeding was hard to stop. We performed a PTA for the with a diameter of 1. 7 mm were thrombosis at the vascular internal shunt later. We got possible to stop bleeding afterwards. punctured by expert doctors. access and valuable staff time is consumed. The chitosan. RESULTS based dressing (Hem. Con Strip, Hem. Con Medical Mean blood platelet count was Technologies, Portland, OR 150000 60000 / L and activated USA) is a new hemostatic clotting time during dressing now being used. hemodialysis was 139 13 min. Additionally, recent data have Intravascular pressure was 118 demonstrated that chitosan is 33 mm Hg. Time required to bactericidal. We studied the stop bleeding before the safety and efficacy of the experiment was from 15 to 60 Figure 2. Previous clinical results showed that the chitosan-based dressing works bandage for bleeding at the most effectively if the chitosan surface is in contact with blood. For this reason, we min. By using the new pressed AVF side of the internal shunt to stop blood flow within five seconds in the vascular access after bandage, the time decreased state that showed a little blood from a puncture hole. hemodialysis. to just 2 minutes. There were no adverse effects such as METHODS contact dermatitis or infection or blood clot obstruction of the internal shunt. Out of 150 patients with arteriovenous fistula at the upper extremity, 6 patients (5 men CONCLUSIONS and 1 women, mean age 64 6. 3 Our study suggests that the years old) who sometimes chitosan-based bandage is a Figure 3. Then we put the chitosan-based dressings and started pressing the continued to bleed after 30 puncture sites for two minutes safe and effective hemostatic minutes of pressure at the agent to reduce prolonged post puncture site, were eligible for the study protocol. Exclusion hemodialysis puncture site criteria were: cognitive inability bleeding in severe bleeding. to provide informed consent, allergy to shellfish, shrimp, ACKNOWLEDGEMENTS chitin, or chitosan. We used the We thank you for your warm chitosan-based dressings support of Japanese are consecutive 18 times for these very sorry to pollute the patients in case that bleeding Figure 4. At the next day, the dressing was removed. There was no sign for important sea with radioactive continued after 30 minutes of infection nor bleeding. Wound was clear. material at Fukushima Daiichi pressing. Previous clinical Nuclear Power Plant. results showed that the chitosan-based dressing works Left photograph became the most effectively if the chitosan cover of a magazine. In the surface is in contact with blood. miserable disaster area, a self. For this reason, we pressed defense official who did disaster AVF side of the internal shunt relief with almost no sleep to stop blood flow within five watches the infant and smiles. seconds in the state that Depressed Japanese were showed a little blood from a relieved by this photograph. puncture hole.
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