MO781THE CATIONIC CELLULOSE BASED PAD REDUCE THE HEMOSTATIC TIME AFTER HEMODIALYSIS
Authors: Shibata Kazuhiko , Nakai Shigeru , Kobayashi Yusuke , Ozawa Kiyoshi , Tamura Koichi 
Published: May 2021

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, effective hemostatic agents are 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 (Figure). 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 Toshin Clinic. In our clinic, the timer is set on the hemodialysis machine after the needles are removed and pressure is started after hemodialysis. We examined how long the timer should be set to be able to sufficiently stop bleeding in case cationic-cellulose pads are used.

Method
Of the 150 hemodialysis patients treated at the Toshin clinic; patients who agreed to this trial were enrolled. We set a timer for 5 minutes initially using cationic-cellulose pads for hemostasis, and was shortened in the next trial by 1 minute if the bleeding had been stopped. If the patient did not consent, the timer was not shortened further. from April 15th to December 31st in 2020. We checked the bleeding evidence of the puncture sites at the timing of immediately after relieving their compression. At their following hemodialysis session, we also checked the existence of adverse effects at their puncture sites, such as contact dermatitis or infection.

Results
Ten patients (9 men and 1 woman, Age 58.5y ±13.1) agreed to participate in this study. In the case of stable hemostasis, we continued to shorten the time by 1 minute each time, and added 1 minute in case of bleeding. After searching for the shortest time to achieve stable hemostasis, we confirmed hemostasis an average of 14.2 times in all cases. The average time to set for the timer was 3.0 ± 0.94 minutes (2-5 minutes). Two patients refused to shorten the time set for the timer, the hemostasis time were 5 and 4minutes respectively. The hemostasis time in all the other cases was equal or less than 3 minutes. In one case, the hemostasis time was reduced to 3 minutes with a cationic cellulose pad, compared to 30 minutes with The Neoplaster hemostatic pad (Nipro Corporation) which is made with the carboxymethyl cellulose. Of the 142 case compressions performed, 1 case resulted in bleeding and required 2 minutes of additional compressions. All cases did not have any adverse effects such as redness, itching or pain of their hemostatic pad attached sites.

Discussion
This study showed that the average time to set for the timer, when using cationic cellulose pad was 3 minutes on average, without any adverse effects. Cationic cellulose pads can stop bleeding safely, quickly and stably. At present, clinically available strong hemostatic agents are too expensive to be applied for many patients. But the cost to get the cationic-cellulose to make hemostatic pads may be reduced enough to be distributed to many hemodialysis patients because this material is mass-produced for hair conditioner, shampoo, and toothpaste.

Conclusion
The average time set for the timer was estimated around 3 minutes using the cationic cellulose pad. The cationic cellulose pad can save precious time and efforts of both patients and staff through its quick hemostasis.