Targeted Temporary Tunnel Compression Suture: A Precision Method for Localizing and Controlling Postimplantation Bleeding in Tunneled Dialysis Catheter.

BACKGROUND: Tunneled dialysis catheters (TDCs) remain the mainstay of unplanned and urgent start hemodialysis. TDCs are implanted by interventional radiologists, surgeons, or nephrologists, and these clinicians must be familiar with the management of TDC-related complications. Postimplantation bleeding at the exit site of a TDC poses diagnostic and therapeutic challenges.

METHODS: In this case report, we describe a simple bedside method for precise localization of the bleeding spot and targeted placement of a compression suture to arrest exit site bleeding from a TDC.

DISCUSSION: Bleeding at the exit site may be the result of bleeding from a venotomy wound or the tunnel tract or the exit wound itself. Precise localisation of the bleeding spot is an essential first step in achieving secure hemostasis. Currently recommended measures like application of manual compression, compressive dressing, local infiltration of hemostatic agents, and suturing of the exit site are limited by their empirical nature and failure to specifically target the bleeding vessel.