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Suture Survey

Posted By Ramesh Soundararajan, Tuesday, November 14, 2017

Please complete the following quick online survey - click here

 

I will share summary report on blog.

 

Here is a preview of the survey questions below:

 

1) Do you routinely suture the entry site of access after intervention. Yes no

2) if so what is the material used a)proline b ethilon

3) when do you take it out a) waiting room b) next day

4) do dialysis units take them out for you. Yes  no 

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Comments on this post...

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Adrian Sequeira says...
Posted Tuesday, November 14, 2017
1) yes
2) ethilon
3) removed in the outpatient HD unit by the physician
4) HD nurses do not take it out.
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Mihran V. Naljayan says...
Posted Tuesday, November 14, 2017
1. yes after declots; usually not for fistulogram unless using a larger sheath (7F)
2. ethilon
3. 1 week later with ultrasound and exam
4. No
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Jeffrey Packer says...
Posted Tuesday, November 14, 2017
Almost never (answered survey) unless large sheath for stent or significant anticoagulant for thrombo. But, when we do, it is 3-0 Vicryl or Monocryl
Permalink to this Comment }

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David Fox says...
Posted Tuesday, November 14, 2017
I answered Prolene, but I use plain gut suture. I sometimes remove same day sometimes next day.

Not all options are given
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Administration says...
Posted Tuesday, November 14, 2017
Survey amended to allow for "other" responses and comments.

Real-time results are available at: https://www.surveymonkey.com/results/SM-FYY6VRFC8/
Permalink to this Comment }

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Bharat S. Sachdeva says...
Posted Tuesday, November 14, 2017
Yes for sectors only, use nylon, removed outpatient dialysis
For fistulograms no suture, unless using >8 sheath
Permalink to this Comment }

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Bharat S. Sachdeva says...
Posted Tuesday, November 14, 2017
autocorrect issue!

Yes for declots only, use nylon, removed outpatient dialysis
For fistulograms no suture, unless using >8 sheath
Permalink to this Comment }

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Ramesh Soundararajan says...
Posted Tuesday, November 14, 2017
Thanks again for your input and keep it coming. There is so much difference in this simple question. There should be a standard. Every one quoted the rare pt who bled at home and so sutures every one. It has its own issues including stitch related infections scabs and inconvenience of having to come back as well as the added time and expense of sutures scissors etc. may be this needs a discussion in next meeting.
Permalink to this Comment }

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Antoine Samaha says...
Posted Tuesday, November 14, 2017
I avoid sutures at all cost even when I use a 9fr sheath in fistula Thrombectomies. We only use tip-stops (+/- Chito dot) or Kytostat. I have seen enough problems with forgotten sutures that I gave up this practice of placing them (only) in thrombectomies ~15 yrs ago.
If for any unforeseen reason (extremely rare) we have to put one for persistent bleeding, I usually use a 4-0Ethilon.
Our dialysis units refuse to take them out, so either our rounding NP does that or the patient is advised to come back in 1-3 days to remove them.
Permalink to this Comment }

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Nnaemeka Chikwendu says...
Posted Tuesday, November 14, 2017
I use only Ethilon 3-0 after thrombectomies or use of sheaths larger than 8Fr.
If I get called back in room when hemostasis not achieved I place suture to facilitate room turnover.
Sutures are removed by most of our dialysis units on 2nd or 3rd day.
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Maria Mendez says...
Posted Wednesday, November 15, 2017
I do not use sutures routinely except after a thrombectomy, larger than 8 Fr sheath or if the patient is on Coumadin. Use gut so they do not have to come back. Our units do not take the sutures out.
Sometimes use a 'slip' stitch of 3-0 Ethilon and it is removed by the nurses prior to discharge.
Permalink to this Comment }

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Suresh Appasamy says...
Posted Wednesday, November 15, 2017
I typically place sutures for all access entry independent of the size of sheath used. We typically take them out in about an hour in the post op area before pt gets discharged - except when they are on anticoagulation with warfarin, plavix, eliquis etc or have received heparin during procedure; or the arm is swollen from venous hypertension or access was near or over an aneurysm.
We use 4-0 prolene sutures.
For pts who go home with sutures, many dialysis units (DCI) typically are able to take them out - 24 - 48 hrs. Some Davita units do not - and we have those pts come in a few days to remove them.
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Kevin C. Harned says...
Posted Wednesday, November 15, 2017
I suture everything 6Fr or higher in a fashion of using a cut piece of clear tubing (about 3cm long) in a double-loop fashion with Ethilon. Dialysis nurses take them out the next day (except DaVita, which we keep the pt for an hour then remove prior to d/c home).
Permalink to this Comment }

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