Treatment of dialysis access puncture wound bleeding with chitosan dressings

Background. Bleeding from coagulopathic hemodialysis puncture sites can contribute to anemia in dialysis patients, and current compressive dressings may contribute to graft thrombosis. We studied the safety and efficacy of a new chitosan-based bandage with an active clotting surface and compared its time to hemostasis and compression strap usage in dialysis access puncture wounds with that of conventional gauze dressings. Methods. Fifty patients received both the chitosan-based and conventional gauze dressings in random order on 2 successive visits. Time to hemostasis and compression strap usage were compared between the visits. Time to hemostasis was analyzed using the binary response variable at 2 and 4 minutes. A compression strap was used if dressing application was unsuccessful at 4 minutes. Covariates included coagulation state as measured by laboratory analysis and anticoagulation therapy. Results. Hemostasis was achieved by 2 minutes in 30% of the chitosan-based and 38% of the conventional dressings (p = 0.608) and by 4 minutes in 86% of the chitosan-based and 72% of the conventional dressings (p = 0.040). Compression strap usage was reduced by50% in the chitosan-based group compared to the conventional group (7 vs. 14 patients; p = 0.052). No adverse events were reported with either dressing. Conclusions. The chitosan-based bandage from HemCon is a safe and effective hemostatic agent to reduce prolonged posthemodialysis puncture site bleeding and may reduce the use of occlusive compression straps.