INTRODUCTION RESULTS METHODS METHODS RESULTS In Japan, many patients receive hemodialysis treatment that lasts for decades. These patients have thin and weak skin over vascular accesses because they are repeatedly punctured. Furthermore, they have not only coagulopathies associated with chronic renal failure, but also use heparin and oral anticoagulants. In cases of prolonged bleeding at the vascular access after treatment, current compressive dressings are convenient but may induce thrombosis. Nurses therefore must press the bleeding sites longer, which might also cause thrombosis at the vascular access and valuable staff time is consumed. The chitosan- based dressing (HemCon Strip, HemCon Medical Technologies, Portland, OR USA) is a new hemostatic dressing now being used. Additionally, recent data have demonstrated that chitosan is bactericidal. We studied the safety and efficacy of the bandage for bleeding at the vascular access after hemodialysis. Out of 150 patients with arterio- venous fistula at the upper extremity, 6 patients (5 men and 1 women, mean age years old) who sometimes continued to bleed after 30 minutes of pressure at the puncture site, were eligible for the study protocol. Exclusion criteria were: cognitive inability to provide informed consent, allergy to shellfish, shrimp, chitin, or chitosan. We used the chitosan-based dressings consecutive18 times for these patients in case that bleeding continued after 30 minutes of pressing. Previous clinical results showed that the chitosan-based dressing works most effectively if the chitosan surface is in contact with blood. For this reason, we pressed AVF side of the internal shunt to stop blood flow within five seconds in the state that showed a little blood from a puncture hole. CONCLUSIONS Our study suggests that the chitosan-based bandage is a safe and effective hemostatic agent to reduce prolonged post hemodialysis puncture site bleeding in severe bleeding. ACKNOWLEDGEMENTS We thank you for your warm support of Japan. Japanese are very sorry to pollute the important sea with radioactive material at Fukushima Daiichi Nuclear Power Plant. Left photograph became the cover of a magazine. In the miserable disaster area, a self- defense official who did disaster relief with almost no sleep watches the infant and smiles. Depressed Japanese were relieved by this photograph. NEW CHITOSAN-BASED BANDAGE STOPS SEVERE BLEEDING FROM HEMODIALYSIS PUNCTURE SITE IN 2 MINUTES. Kazuhiko Shibata1, Tamio Iwamoto2, Tomoyuki Murakami2, Syuji Ono2, Tomoko Kaneda2, Tadashi Kuji3, Seiiti Kawata3, Hidehisa Satta4, Kouichi Tamura5, Yoshiyuki Toya5, Mai Yanagi5, Satoshi Umemura5 and Gen Yasuda5. 1Yokohama Minami Clinic, Yokohama, Kanagawa, Japan; 2Saiseikai Yokohama-City Nanbu Hospital; 3Yokodai Central Clinic and 4Yokohama Citi University Hospital. Correspondence: Mean blood platelet count was / L and activated clotting time during hemodialysis was min. Intravascular pressure was mm Hg. Time required to stop bleeding before the experiment was from 15 to 60 min. By using the new bandage, the time decreased to just 2 minutes. There were no adverse effects such as contact dermatitis or infection or blood clot obstruction of the internal shunt. We then applied the chitosan- based dressings and started pressing the puncture sites for two minutes and depressed immediately and looked for evidence of bleeding around the dressing. At the next dialysis treatment, we checked the area where the chitosan-based dressing was applied and made sure that there were no adverse side effects such as contact dermatitis or infection. Blood sample examination was performed. All patients underwent hemodialysis using heparin ( Units/h) without other anticoagulants. Needles with a diameter of 1.7 mm were punctured by expert doctors. Figure 1. Shunts stenosis was found in 4 patients among this six cases, and this may be the reason why bleeding was hard to stop. We performed a PTA for the internal shunt later. We got possible to stop bleeding afterwards. Figure2 ． Previous clinical results showed that the chitosan-based dressing works most effectively if the chitosan surface is in contact with blood. For this reason, we pressed AVF side of the internal shunt to stop blood flow within five seconds in the state that showed a little blood from a puncture hole. Figure3 ． Then we put the chitosan-based dressings and started pressing the puncture sites for two minutes Figure4 ． At the next day, the dressing was removed. There was no sign for infection nor bleeding. Wound was clear.