Redefining Post-Hemodialysis Bleeding Control with SURGISPON® DIAL

 

Chronic kidney disease (CKD) is a significant global health issue, affecting over 750 million people worldwide. For more than two million patients with end-stage renal disease (ESRD), hemodialysis serves as a vital lifeline, enabling survival despite the loss of kidney function [1, 2]. As the need for hemodialysis in patients with end-stage renal disease (ESRD) continues to rise, the creation of hemodialysis access points—such as arteriovenous fistulas (AVFs) and arteriovenous grafts (AVGs)—has become a routine yet essential vascular surgery procedure, crucial for ensuring long-term dialysis success [3, 4].

Fig. 1: AVF surgery [Kidney Care UK]

Maintaining the patency of these dialysis access points is a significant challenge, as less than half of all AVFs and AVGs remain functional beyond three years due to frequent complications such as narrowing or thrombosis [4]. To address these issues, catheter-based interventions like percutaneous transluminal angioplasty are commonly used to restore blood flow. However, achieving hemostasis after these procedures remains a time-consuming challenge, underscoring the need for better bleeding control methods.

The presence of uremic toxins in ESRD patients complicates bleeding control, underscoring the need for improved hemostatic solutions. This is where haemostats for dialysis like SURGISPON® DIAL can revolutionize patient care.

Understanding the Need for Dialysis

Dialysis becomes necessary when kidney function declines to a point where 85-90% of it is lost, marked by a glomerular filtration rate (GFR) of less than 15. In this stage, without dialysis, toxins accumulate in the body, leading to serious health risks. Despite its life-saving properties, dialysis presents challenges, among the most pressing being the management of post-procedure bleeding.

The Challenge of Post-Hemodialysis Bleeding

After each hemodialysis session, controlling bleeding at the puncture site is a critical concern. Although this may seem straightforward, several factors complicate the process—most notably the use of anticoagulants, such as heparin, which are essential for preventing blood clotting during dialysis. However, these same medications significantly increase the risk of post-dialysis bleeding [5]. This complication, known as Post-Hemodialysis Site Hemorrhage (PHSH), becomes even more complex in patients with other conditions like hypertension, diabetes, or low platelet counts. These factors prolong the bleeding and make the hemostasis process time-consuming and difficult.

Methods for Controlling Post-Dialysis Bleeding

Today, healthcare professionals use two primary techniques to control post-hemodialysis bleeding:

1. Direct Pressure: This is the most commonly used method. It involves applying firm pressure to the puncture site with gauze or a cotton roll until the bleeding stops. The time required can vary greatly, from 20-30 minutes to over an hour, depending on the patient’s health status, comorbidities, and the extent of the bleeding.
2. Tourniquet Application: a sterile elastic tourniquet is applied along with direct pressure to control bleeding. While effective, applying excessive pressure can reduce the lifespan of the fistula, the vascular access point used for dialysis. This renders it a suboptimal solution for long-term use, particularly in patients requiring frequent dialysis. 

The Need for Advanced Haemostats for dialysis

The current methods, while standard, have limitations. They take time, are labour-intensive, and may damage the vascular access, potentially compromising future dialysis sessions [6]. This highlights the need for advanced hemostats for dialysis, like SURGISPON® DIAL, that can offer rapid, reliable bleeding control without compromising the integrity of the fistula or graft. These advanced solutions would not only reduce the time required for post-dialysis care but also decrease the burden on healthcare staff, allowing them to focus on other critical aspects of patient care. Discover more about our hemostatic solutions here.

We at Aegis Lifesciences introduce “SURGISPON®DIAL”, an optimal haemostatic dialysis bandage to control bleeding post-renal dialysis.

The Role of SURGISPON® DIAL in Post-Hemodialysis Bleeding Control 

As the need for hemodialysis continues to grow, the challenge of maintaining the functionality of dialysis access points persists, with frequent complications such as narrowing and thrombosis[3]. Despite advancements like catheter-based interventions, post-procedure bleeding remains a significant and unresolved issue, highlighting the need for improved hemostatic solutions like SURGISPON® DIAL.

SURGISPON® DIAL offers a revolutionary approach to managing post-dialysis bleeding, addressing the unique challenges posed by anticoagulants and other complicating factors, thus redefining post-hemodialysis bleeding control and enhancing patient care.

SURGISPON® DIAL

SURGISPON® DIAL is an absorbable hemostatic gelatin sponge specifically designed to meet the unique challenges of post-renal dialysis patients. By addressing the limitations of traditional hemostatic methods, SURGISPON® DIAL offers a faster, more efficient solution.

a) Key benefits

1. Highly Porous Structure: SURGISPON® DIAL is capable of absorbing fluids 40–50 times its own weight, ensuring rapid and effective bleeding control.
2. Function: SURGISPON® DIAL provides a matrix that promotes platelet aggregation and coagulation and prevents the loss of natural clotting factors.
3. Indication: It is specifically designed for use in post-hemodialysis patients to stop bleeding at the puncture site.
4. Mode of Action: SURGISPON® DIAL’s porous structure activates the thrombocytes at the moment blood comes in contact with the matrix of the sponge. This initiates the release of substances that promote thrombocyte aggregation while their surfaces undergo change, facilitating fibrin formation and arresting the bleeding.

  Fig. 2: Effective hemostasis in action—SURGISPON® DIAL at the bleeding site.

5. Size available: offered in a convenient 30cm x 30cm x 10cm size, it is specifically designed to cover dialysis puncture sites.
6. Reduced Recovery Time: SURGISPON® DIAL is designed to minimize post-operative time and promote a faster return to normal activities, enhancing recovery outcomes for patients. 

b) Clinical highlight 

Cristóbal et al. (2021) aimed to evaluate the pressure generated by an adjustable hemostasis clamp on arteriovenous fistulas (AVFs) during the hemostasis process and compare it with the direct two-finger pressure applied by the patient. The study analyzed data from 51 hemodialysis procedures involving 15 patients. SURGISPON® DIAL, an absorbable gelatin dressing, was utilized as an adjunct hemostatic agent during the study to apply pressure to the puncture site, enhancing the effectiveness of both the adjustable clamp and manual compression techniques. The combination of SURGISPON® DIAL with these pressure methods contributed to improved hemostasis, ensuring adequate pressure while minimizing the risk of complications, such as external bleeding or hematomas [7]. Read the full case study here.

Conclusion

Managing post-dialysis bleeding is a vital but often underemphasized part of patient care. With the increasing number of patients requiring dialysis, the need for more effective and efficient hemostatic solutions is clear. SURGISPON® DIAL addresses this challenge by providing a fast, reliable method to control bleeding while preserving vascular access for future treatments. Its innovative design reduces recovery time, enhances patient outcomes, and lightens the workload for healthcare professionals. By integrating SURGISPON® DIAL into their practices, healthcare providers can significantly improve the quality of post-dialysis care. Discover our full range of hemostasis solutions here.