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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.
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.
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.
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.
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.
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).
Posted Tuesday, November 14, 2017
2) ethilon
3) removed in the outpatient HD unit by the physician
4) HD nurses do not take it out.