Current status of subcutaneous hematoma management following arteriovenous fistula puncture: a cross-sectional survey

doi:10.3760/cma.j.cn441417-20250217-13005

Abstract

Abstract:

Objective　To conduct a cross-sectional survey on the current management methods for subcutaneous hematoma after arteriovenous fistula (AVF) puncture, providing references for nursing care of hematoma following AVF puncture. Methods　A convenience sampling method was used to conduct a questionnaire survey on 75 dialysis centers across 9 provinces in China in September 2024. The survey aimed to understand the management methods for subcutaneous hematoma or ecchymosis after AVF puncture in maintenance hemodialysis (MHD) patients and the preferred methods recommended by medical staff to patients. Results　A total of 81 questionnaires were collected in this study, with 75 valid questionnaires (excluding 6 questionnaires from the same hospital), resulting in an effective rate of 92.59%. In the participants of the survey, 70.67% (53/75) were from tertiary hospitals, 14.67% (11/75) from secondary hospitals, and 14.67% (11/75) from private hospitals; 66.67% (50/75) were from Guangdong province, and 33.33% (25/75) from other provinces. There were mainly six management methods for subcutaneous hematoma or ecchymosis after AVF puncture in MHD patients: external application of fresh potato slices [88.00% (66/75)], external application of Hirudoid [86.67% (65/75)], hot compress 24 h after hematoma [66.67% (50/75)], wet compress with 50% magnesium sulfate [54.67% (41/75)], papaya wine application [41.33% (31/75)], and application of Ma Yinglong hemorrhoid ointment [4.00% (3/75)]. There were mainly five preferred methods recommended by medical staff to patients with subcutaneous hematoma after AVF puncture: external application of Hirudoid [28.00% (21/75)], wet compress with 50% magnesium sulfate [26.67% (20/75)], external application of fresh potato slices [24.00% (18/75)], hot compress 24 h after hematoma [9.33% (7/75)], and papaya wine application [6.67% (5/75)]. Conclusions　The most commonly used methods for managing subcutaneous hematoma after AVF puncture in MHD patients are external application of fresh potato slices and Hirudoid. The preferred interventions recommended by medical staff are external application of Hirudoid and wet compress with 50% magnesium sulfate.

Key words: Arteriovenous fistula, , Subcutaneous hematoma, , Ecchymosis, , Nursing

摘要：

目的　调查自体动静脉内瘘（arteriovenous fistula，AVF）穿刺后皮下血肿处理方法的现状，为AVF穿刺后血肿的护理提供参考。方法　采用便利抽样法在2024年9月对全国9个省份75家透析中心进行问卷调查，了解维持性血液透析（maintenance hemodialysis，MHD）患者AVF穿刺后皮下血肿或瘀斑的处理方法和医护人员优先为患者推荐的方法。结果　本研究共收集问卷81份，有效问卷75份（排除来自同一家医院的问卷6份），有效率92.59%。参与调查的人员70.67%（53/75）来自三级医院，14.67%（11/75）来自二级医院，14.67%（11/75）来自民营医院；66.67%（50/75）来自广东省，33.33%（25/75）来自其他省份。MHD患者AVF穿刺后皮下血肿或瘀斑的处理方法主要有6种：鲜马铃薯片外敷［88.00%（66/75）］、喜疗妥外涂［86.67%（65/75）］、血肿后24 h热敷［66.67%（50/75）］、50%硫酸镁湿敷［54.67%（41/75）］、敷木瓜酒［41.33%（31/75）］、涂马应龙痔疮膏［4.00%（3/75）］。医护人员为AVF穿刺后皮下血肿患者优先推荐的方法主要有5种：喜疗妥外涂［28.00%（21/75）］，50%硫酸镁湿敷［26.67%（20/75）］，鲜马铃薯片外敷［24.00%（18/75）］，血肿后24 h热敷［9.33%（7/75）］，敷木瓜酒［6.67%（5/75）］。结论　MHD患者AVF穿刺后皮下血肿处理选择较多的方法是鲜马铃薯片外敷和喜疗妥外涂，医护人员优先推荐的干预方法是喜疗妥外涂和50%硫酸镁湿敷。

关键词: 自体动静脉内瘘, 皮下血肿, 瘀斑, 护理

Wen Biyi, Song Li, Yin Yan, Wu Guofeng, Zhao Liyan, Cui Dongmei.

Current status of subcutaneous hematoma management following arteriovenous fistula puncture: a cross-sectional survey [J]. International Medicine and Health Guidance News, 2025, 31(13): 2132-2135.

文碧艺宋利尹燕吴国锋赵立艳崔冬梅.

自体动静脉内瘘穿刺后皮下血肿处理方法的现状调查 [J]. 国际医药卫生导报, 2025, 31(13): 2132-2135.

References

[1]中国医院协会血液净化中心分会血管通路工作组.中国血液透析用血管通路专家共识(第2版)[J].中国血液净化,2019,18(6):365-381. DOI:10.3969/j.issn.1671-4091.2019.06.001.

[2]Kukita K, Ohira S, Amano I, et al. 2011 update Japanese Society for Dialysis Therapy Guidelines of vascular access construction and repair for chronic hemodialysis[J]. Ther Apher Dial, 2015, 19 Suppl 1:1-39. DOI: 10.1111/1744-9987.12296.

[3]KDOQI, National Kidney Foundation. KDOQI clinical practice guidelines and clinical practice recommendations for anemia in chronic kidney disease[J]. Am J Kidney Dis, 2006, 47(5 Suppl 3):S11-S145. DOI: 10.1053/j.ajkd.2006.03.010.

[4]Association UKR. Clinical Practice Guideline on vascular access for haemodialysis (6th Edition, Final Version) [EB/OL]. https://renal.org/wp-content/uploads/2017/06/vascular-access.pdf,2015.

[5]Polkinghorne KR, Chin GK, MacGinley RJ, et al. KHA-CARI Guideline: vascular access - central venous catheters, arteriovenous fistulae and arteriovenous grafts[J]. Nephrology (Carlton), 2013, 18(11):701-705. DOI: 10.1111/nep.12132.

[6]Foley RN, Guo H, Snyder JJ, et al. Septicemia in the United States dialysis population, 1991 to 1999[J]. J Am Soc Nephrol, 2004, 15(4):1038-1045. DOI: 10.1097/01.asn.0000119144.95922.c4.

[7]Navuluri R, Regalado S. The KDOQI 2006 vascular access update and fistula first program synopsis[J]. Semin Intervent Radiol, 2009, 26(2):122-124. DOI: 10.1055/s-0029-1222455.

[8]Ozpak B, Yilmaz Y. Arteriovenous fistulas ipsilateral to internal jugular catheters for hemodialysis have decreased patency rates[J]. Vascular, 2019, 27(3):270-276. DOI: 10.1177/1708538118811483.

[9]蒋丽琼,罗畅,吴传芳,等.1例连续性血液净化患者动静脉内瘘血肿的根因分析[J].中国当代医药,2023,30(3):185-188. DOI:10.3969/j.issn.1674-4721.2023.03.048.

[10]Lok CE, Huber TS, Lee T, et al. KDOQI clinical practice guideline for vascular access: 2019 update[J]. Am J Kidney Dis, 2020, 75(4 Suppl 2):S1-S164. DOI: 10.1053/j.ajkd.2019.12.001.

[11]刘胜利,李文秀,温玉,等.两种湿敷方法在血透患者动静脉内瘘应用的体会[J].医学信息,2013(20):412-413. DOI:10.3969/j.issn.1006-1959.2013.20.563.

[12]朱朝军,韩炜,吕佳康,等.中医外科外用药剂型特点及剂型创新的思考[J].中国临床药理学杂志,2018,34(14):1728-1731. DOI:10.13699/j.cnki.1001-6821.2018.14.040.

[13]朱鸿丽.硫酸镁液在尿毒症患者内瘘和静脉肿胀后的应用[J].吉林医学,2011,32(32):6816-6817. DOI:10.3969/j.issn.1004-0412.2011.32.041.

[14]张镜.自制银丹膏外敷治疗输液性静脉炎[J].护理学杂志,2009,24(19):23-24. DOI:10.3870/hlxzz.2009.19.023.

[15]蔡素因,谢春艳,叶琳旬,等.冷敷加新鲜马铃薯片外敷治疗血液透析自体动静脉内瘘血肿疗效观察[J].白求恩军医学院学报,2013,11(6):516-517. DOI:10.16485/j.issn.2095-7858.2013.06.011.

[16]刘丽,矫健梅,安丽伟.马铃薯切片外敷治疗动静脉内瘘并发症效果观察[J].护理学杂志,2009,24(15):14-15. DOI:10.3870/hlxzz.2009.15.014.

[17]叶锡兰,邱碧辉,夏运风,等.木瓜酒保护动静脉内瘘效果观察[J].护理学杂志,2010,25(9):12-14. DOI:10.3870/hlxzz.2010.09.012.

[18]杨淑莹,吴国锋.木瓜酶促进大鼠血管内皮细胞成血管的功能研究[J].国际医药卫生导报,2022,28(16):2276-2278. DOI:10.3760/cma.j.issn.1007-1245.2022.16.013.

[19]尔梦娜,张美丽,丁帆.在血液透析患者动静脉内瘘护理中联合应用喜疗妥的效果分析[J].中外医疗,2024,43(18):169-172. DOI:10.16662/j.cnki.1674-0742.2024.18.169.

[20]胡春燕,李雅婧,耿同会,等.HITH-4远红外线治疗仪联合多磺酸粘多糖乳膏对糖尿病血液透析患者动静脉内瘘功能的保护效果研究[J].中国全科医学,2023,26(8):951-954. DOI:10.12114/j.issn.1007-9572.2022.0550.