I Hate Dialysis Message Board
Dialysis Discussion => Dialysis: Home Dialysis - NxStage Users => Topic started by: fearless on January 05, 2012, 12:48:15 AM
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I'm new to hemo - still in-clinic but hoping to go home and do slow dialysis. My clinic doesn't support that to begin with - only 3x/week or 6x/week, running like in-clinic.
What i want to do, because my arm is so little, is keep using 16G needles, with the slower speed and longer time.
Is anyone here still using 16 G needles, or is 15 G the smallest that's used in an on-going way?
If yes, what lie :) do i tell the clinic so that they'll let me stay with 16G (instead of going up another size) before they find out I'm doing "nocturnal" dialysis?
thanks
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I've just been thinking about this sort of thing for hubby. He runs (at home w/nxStage) with blood flow of 310 generally and just read somewhere (here?) that the 15 g needles are for 400 and above??? Hope we get some input on this :)
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17G is for 200-250
16G is for 250-350
15G is for 350-450
(I think I have that right, don't quote me - you can find it on the web though)
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I'm new to hemo - still in-clinic but hoping to go home and do slow dialysis. My clinic doesn't support that to begin with - only 3x/week or 6x/week, running like in-clinic.
What i want to do, because my arm is so little, is keep using 16G needles, with the slower speed and longer time.
Is anyone here still using 16 G needles, or is 15 G the smallest that's used in an on-going way?
If yes, what lie :) do i tell the clinic so that they'll let me stay with 16G (instead of going up another size) before they find out I'm doing "nocturnal" dialysis?
thanks
Fearless,
-- 17-gauge needle = 200–250 BFR
– 16-gauge needle = 250–350 BFR
– 15-gauge needle = 350–450 BFR
– 14-gauge needle = > 450 BFR
I currently and have been using Medisystems 16g needles for a little over 6 years. My bloodflow is 280 and I dialyze for 5 hours during the morning. I'm not on nocturnal, bur that extended. If your going to running at lower blood flows, then there is no reason why you should have to use a 15g needle unless you are not getting adequate pressure/flow. The lower the blood flow, the better off you will be. As you increase your blood flow, you are stressing not only your vein/artery and increasing the chance for an anuyism, but you are also stressing the heart. Low flow and longer treatments are the way to go.
I would not recommend a blood flow higher than 350. The reason they use 15g needles and a very high blood flow when you are in center is that they are limited on the time a single person can be dialyzing as they have to turn the chair/cycler over to the next patient on the next shift. Normally, when you are in-center you do not run more than 3-4 hours ( I have seen longer in special circumstances (other than nocturnal) This is approx 12 hours of dialysis per week.... No where near the amount of time for adequate dialysis. Your goal as well as the nephrologists goal should be to give you the best treatment possible. Unfortunately, this cannot happen in center.
With nocturnal dialysis, studies show that this is similar to having a transplant in results of labs and how you feel. Studies also show that in-center is the worst possible dialysis you can get. Think about it, the kidneys work 24/7. In center is 3x per week, approx 12 hours per week. Does this sound like you are getting good dialysis at this level?
Home Hemo/nocturnal all the way!!!!!!
///M3Riddler
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I use 15g. At BFR 300-380. Just depends on what I have to remove! And I do not want anything less than 3 hour sessions. I also want time left after UF goal is met to remove toxins.
But I have been very satisfied with 15's.
lmunchkin
:kickstart;
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If you are on Home dialysis don't you use the button hole? It would seem you could use 16ga or whatever you wanted in the blunts.
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Don't do button holes, use sharps with ladder method, so 15ga works fine.
lmunch
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Just another 'take' on this. I was talking to neph at apt yesterday and asked about using 16g needles and what would be wrong with that since we run so slow. His answer was that the 'pressure' that we worry about is that which is squeesing through that needle and that the bigger accomidates and protects the blood with less pressure on it than a smaller needle no matter what the speed. I figure slower, bigger, what ever it takes to protect the blood. Something to think about.. So IF im hearing right, i can see the reason to keep with what we're doing and 15's for us..
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This thread is particularly interesting to me since I just had my graft repositioned. They said they would used 17g and after two weeks (next week!) they use 16g and then 15g after two weeks. I was so apprehensive about cannulation through new skin that I have reverted to using lidocaine. The only problem with that is that I don't feel when they are making a mistake, and on Wednesday I was infiltrated for the first time!
I am not looking forward to 15g at all, and I will try to get them to continue to give me lidocaine.
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Just another 'take' on this. I was talking to neph at apt yesterday and asked about using 16g needles and what would be wrong with that since we run so slow. His answer was that the 'pressure' that we worry about is that which is squeesing through that needle and that the bigger accomidates and protects the blood with less pressure on it than a smaller needle no matter what the speed. I figure slower, bigger, what ever it takes to protect the blood. Something to think about.. So IF im hearing right, i can see the reason to keep with what we're doing and 15's for us..
Howdy,
The reason why a nephrologist was speaking about the pressures is that most nephs prescribe a high bloodflow. If you run at lower pressures, there is nothing wrong with using a smaller needle such as a 16g. I have been using them for over 6 years. Yes, its true you will need a larger guage if you are running at high pressures....but with the evidence out there that that higher bloodflows can cause stenosis and damage the vein walls as well as putting strain on the heart, Not sure why the nephrologists are not educating themselves as well as their patients on longer dialysis with lower blood flows.... ( actually, its all about money and getting people in and out of the center so they can have a larger turnover in centers)
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Why can you not run lower blood flows through larger needles? Surely the bigger the Bore of the needle, the lower will be the pressure and this will be better, isn't that so? Or, are there problems associated with running lower blood flow rate through 15 G?
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thanks everyone for your replies. I've been "out of the loop" for a while.
With my limited understanding of fluid physics :) I think: the bigger the needles and the slower the BFR, the less turbulence and stress on the inside of the vessels. But, depending on the size and condition of your access, the bigger the needle, the greater risk of damage as well.
At this point, I'm at a loss as to what is the best route for me. I hope I can establish buttonholes with 16G, run as slow as possible while still getting adequate dialysis, and then perhaps up to a 15G some time in the future, when I can do it myself and am sure my vein is ready. And stay with the slowest rate that works for me.
Thank you all so much for your input!
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hi noahvale,
hope everything is wrking out for you.
I'm on home hemo w/16g needles, 300bfr. it's working ok, but I sure do spend alot of time doing dialysis. :-(
oh well!
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I'm on incenter hemo, pump speed 350 with the 16 guage needles. They told me with using a 16, there is no need to have a higher pump speed. In fact, they dont' want you running any higher than that. My treatment is 3.5 hrs.
They told me if I were ever to go to the 15's, they would increase the pump speed to 400, but there is no rush to do that right now.
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Cordelia, slower is better!
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I agree, Fearless!
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We had thought of going to the 16 guage as we only run at 300, but, neph suggested to us that though it would be OK, we are better off with the slightly larger as the less 'squeeze' on the blood the better.. At least thats what i remember of what he said... so i wont Quote him :embarassed:
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agreed Noav,, And, bos is a well working buttonhole fistula. Same buttons for a year and a half so far. I wish you a zillion more years with your graft ;)
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We had thought of going to the 16 guage as we only run at 300, but, neph suggested to us that though it would be OK, we are better off with the slightly larger as the less 'squeeze' on the blood the better.. At least thats what i remember of what he said... so i wont Quote him :embarassed:
I have been using 16guage needles for over 7 years now... No reason to go larger as I only run a 280 blood flow. I stay away from high blood flows!!!
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ok, another question then....... if Bo has been using the 15, I had this thought that he may not be able to 'go back' to the 16 w/o leaking?? He would of course love to go smaller, but right now, one battle is all i can gather strength for... But....... for future, the change 'down' in size wouldnt be a problem??
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^
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boswife, the needle gauge is one thing, and the speed is another! If you use a bigger needle, you can use a higher speed. But if you use a slower speed, there's no REASON to use a smaller needle. i use a 16 because I have a small arm and my fistula, although nice and strong, isn't a huge vessel. If I could use a 15 i would because I think it's like your doc said - the bigger the needle, the less "squeezing" the blood cells have to do - so - less traumatic to the individual cells. But I would still use the slowest speed that I could, because that's more about the circulation in the body and the pressure on the vessels/heart. (as I understand it) To go faster, you have to have a bigger needle, but you don't have to have a smaller needle to go slower. :-)
Also, i've been told not to insert the needle all the way up to the hub, as that may cause "hubbing"
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We use 14 gauge and our nurse told us we could run at 550 bfr. I was a little dubious at first, having read a lot of admonitions against the higher blood flow rate. I asked her if it would damage his buttonholes or blood vessels and she said no. Now, I trust this woman and she's shown her intelligence and reliability in so many ways. And she regularly attends NxStage training and is in constant communication with them. We have been doing this for a few weeks now and no issues as far as his access or health that I can detect. We are doing 30 liter treatments and processing around 80-85 liters of blood per treatment.
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My neph has me running 15 g 450, his rule is if it doesn't get up to 450 3 treatments or so in a row time for a fistulagram. I disagree with him on that. Most of the time if it can't do 450 it can do 400 and to me that's fine. I once new an in center patient who had a leg graft and ran 500 with 14 g. Not sure how she did that one.
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thanks everyone for your replies. I've been "out of the loop" for a while.
With my limited understanding of fluid physics :) I think: the bigger the needles and the slower the BFR, the less turbulence and stress on the inside of the vessels. But, depending on the size and condition of your access, the bigger the needle, the greater risk of damage as well.
At this point, I'm at a loss as to what is the best route for me. I hope I can establish buttonholes with 16G, run as slow as possible while still getting adequate dialysis, and then perhaps up to a 15G some time in the future, when I can do it myself and am sure my vein is ready. And stay with the slowest rate that works for me.
Thank you all so much for your input!
Fearless,
You can indeed use 16g needles with buttonholes. I have been doing it for 7 years now. I run at 280 blood flow.
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We've been using JLM 15G needles since the start. Running BFR between 300 to 350. Sometimes I will run it at 370 bfr on the last day before being off, so as to shorten his time on machine. John's weight as of late, has been less than his dry weight for some reason. I don't know if he is not eating while Im at work or just eating & drinking alot less.
I may have to adjust his dry weight, but will wait to see what Neph says when we go to clinic. I have been D'ing him but not taking anything off. His labs have been right on the past few months, so I can't complain. I applaude his efforts immensley!
But back to the needles, all we have ever used is 15G (Sharps). We do not do Buttonholes btw! Have always done the ladder method.
God Bless,
lmunchkin :kickstart;
P.S. Brita puts out a new cup that has a filter iin it, that filters any drink you put in it. To get anything through the filter, you have to squeeze the bottle to get it to squirt. I purchased one for John and it limits the amount of fluid he drinks. He says that it has stopped him from guzzling his drinks. He now just takes swigs. That is huge when it comes to retaining fluids. Sorta like a sippy cup but its a 20 to 24 oz glass with a filter. Its cool, so check it out on line if interested. Google Brita and it should come up. Check out Products!!!!!! He never drinks more than half of that in a day. That is great and I truly believe, it has helped him to maintain his gains!
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Noahvale, needles I served all the way to the hub can give rise to Hibbing. this is where the hub works I to the entry point of the access and can enlarge the hole which can result in leaking. optimal set-up to prevent this is to leave a small amount of metal showing.
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We use 14 gauge and our nurse told us we could run at 550 bfr. I was a little dubious at first, having read a lot of admonitions against the higher blood flow rate. I asked her if it would damage his buttonholes or blood vessels and she said no. Now, I trust this woman and she's shown her intelligence and reliability in so many ways. And she regularly attends NxStage training and is in constant communication with them. We have been doing this for a few weeks now and no issues as far as his access or health that I can detect. We are doing 30 liter treatments and processing around 80-85 liters of blood per treatment.
Chiawana,
Your nurse couldnt have misinformed you more. High blood flow can certainly cause damage to your fistula and heart. I have been on dialysis for over 20 years and if there is one thing I leanred, it would be to educate yourself in all areas including what caused your kidneys to fail, the type of dialysis you are on, the difference between the different modalities and learning about your access and what affects them.
I would not expect an in center nurse to tell their patient that what they are doing could possible harm them, short or long term for obvious reasons.
I could provide you with several studies and articles on this subject. High blood flows can cause damage to your vein walls or epithelial layer by breaking it down over time. It also causes stress on the vessel as well as LVH - Left Ventricular Hypertrophy to the heart. This is very known and I'm sure your nurse knows what this is if you ask.
I will attach two files, Ine about the effects of high blood flows and the other about LVH. I cal also provide any additional info you would want. I encourage you to read them and educate yourself when you can.
File 1 = Blood Pump Spped and your Dialysis Fistula
File 2 = LVH - Heading off a Common Heart Problem
Both Files can be found on Home Dialysis Central's Website. at http://homedialysis.org/
Just because your nurse is in contact with and is properly trained, she certainly should know the effects of high blood flows.
Hope this info helps!!
///M3R
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If you are on Home dialysis don't you use the button hole? It would seem you could use 16ga or whatever you wanted in the blunts.
I highly recommend buttonholes if doing home dialysis, but not necessary. I use 16g by 1 inch.