P1364CATIONIC CELLULOSE BASED PAD STOPS BLEEDING WITHIN FIVE MINUTES AFTER HEMODIALYSIS
Authors: Shibata Kazuhiko , Morita Hirokazu , Ueda Mitsutaka , Nakai Shigeru 
Published: June 2020

Abstract

Background and Aims
In case of prolonged bleeding at the vascular access site after hemodialysis, a nurse must compress the bleeding site longer than usual. This situation causes the risk of intravascular thrombosis and consumes valuable time of both patients and staff. Therefore, the method that can surely stop bleeding from the puncture site in short time is desired. Nowadays, chitosan is considered as one of the strongest hemostatic substance. Nipro Corporation and Artisan-lab co.,Ltd found the cationic cellulose could clot blood faster than chitosan in the activated clotting time (ACT). After carefully examining its safety and efficacy, it was approved as medicine by the Japanese Ministry of Health, Labor and Welfare. Then, a trial to verify its clinical efficacy as a hemostat was conducted in the Yokohama Minami Clinic.

Method
150 hemodialysis patients treated at the Yokohama Minami Clinic excluding those using catheters or having with good hemostasis were selected as candidates for this study. 127 patients (64 men and 63 women) among them agreed to participate in this study after our explanation. 547 times of 5 minutes’ compression hemostasis were performed to the patients using cationic-cellulose pads for hemostasis from December 29th in 2019 to January 3rd in 2020. We checked the bleeding evidence of the puncture sites at the both timing of immediately after relieving their compression and the start of the following session. At their following session starting, we also checked the existence of adverse effects at their puncture sites, such as contact dermatitis or infection.

Results
Five of 547 cases (0.9%) had bleeding immediately after their compression relieving, and they needed to prolong their compression (the average of prolongation time was 3.0 minutes). But the other 542 cases (99.1%) successfully stopped bleeding within 5 minutes. All cases except two cases with redness at the adhesive tape attached site did not have any adverse effects such as redness, itching or pain of their hemostatic pad attached sites, including one case who forgot to remove his hemostatic pad until 48 hours later. The nurses could reduce their efforts to check the patients’ hemostasis and work smoother than usual, throughout this study period.

Discussion
In most cases of this study, the cationic-cellulose pad could stop bleeding within 5 minutes without any adverse effects. This result suggests that this material has sufficient performance for clinical use. The cationic-cellulose used for the hemostatic pads in this study had already had high enough quality for clinical use and it was produced by Kao Corporation. At present, clinically available strong hemostatic agents are too expensive to be applied for every patient. But the cost to get the cationic-cellulose to make hemostatic pads may be reduced enough low to be distributed to all hemodialysis patients because this material is mass-produced for hairdressing agent.

Conclusion
The cationic cellulose pad can save precious time and efforts of both patients and staff through its quick hemostasis.

Figure
The cationic cellulose pad