Using bottle lids to control fistula bleeding

  • Stop the Bleed patient and Pip
    Stop the Bleed patient and Pip
  • Stop the Bleed lids
    Stop the Bleed lids
Natalie Peck
Southern NSW Local Health District

Over 26,000 Australians received dialysis or a kidney transplant in 2021, according to Kidney Health Australia. Southern NSW local Health District partnered with Canberra Health Services to launch the Stop the Bleed project, supporting those undergoing dialysis to look after their fistula.

Dialysis filters or cleans the blood of patients with kidney disease. To work efficiently, doctors create a fistula by surgically connecting an artery and vein in the patient's arm, increasing blood flow to the dialysis machine. An average adult has five litres of blood. Blood can flow from a fistula at 500ml to a whopping 2L per minute.

"You can imagine if someone's fistula has a flow of 2L per minute, within two and a half minutes, that person has lost all their blood," says Southern NSW Local Health District Renal Clinical Nurse Consultant Pip O'Reilly.

Bleeding from a fistula is rare but catastrophic. It's likely to occur in the home, while shopping or visiting friends. In regional NSW, it could happen far from medical treatment.

"It's very traumatic for anyone involved," says Pip.

The new initiative came about after a Southern NSW Local Health District patient bled at home and died. His family were unaware the fistula could bleed or what to do if it bled.

One of the vascular surgeons in Canberra heard about a successful initiative in the UK. They were saving an average of 10 patients a year using plastic bottle tops to stop fistula bleeding. The British were placing the hollow part of a bottle top over the bleeding point, the hole in the fistula, and holding or taping it in place. The rim of the cap reduced blood flow to the area as the cap filled with blood and clotted. The downward pressure of the blood in the cap further reduced the bleeding without damaging the fistula.

After consultation with NSW Ambulance Service, health care providers and patients, the STOP the Bleed – Use a Lid initiative was born. Posters, brochures, fridge magnets and a wallet sized alert card were created in conjunction with the ACT and Canberra Health Services, where most Southern NSW patients are treated.

"They're encouraged to have bottle tops everywhere, all over their house, in their bags in the car, wherever," says Pip.

Patients are informed to call 000 if they have a bleed and cover the area with the bottle top, pressing down firmly. The ambulance takes them directly to Canberra Hospital. The lids are ideal for the large regional area, as they can stay in place for up to 18 hours.

"No one takes the lid off until the patient is actually in the operating room with the vascular team, with all scrub ready to go and blood on tap. They've got cannulas in the patient, so they can do a massive transfusion if required. It's a real game changer, especially for regional patients."

When designing the brochure, healthcare professionals initially wanted to focus on how to use the bottle top rather than the fistulas. However, the patients had other ideas.

"The patients were saying, we want information about what to look for with the fistula. We don't want to have to use a bottle top; we want to stop it here," says Pip.

So, a simple plastic bottle top became a symbol of empowerment for dialysis patients.

"They feel they know what to do. They like the fact that they've been given more information about what an at-risk fistula looks like and what to do about it. If it does happen to bleed, they feel more confident (in treating it)."

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