Needle too big? Painful!

[devon]

Usually my sessions are pretty much the same.  The initial ouch then 4.25 hours of dulldrums.   Other than the throbbing of the machine and sometimes the movement of the tube lying across my arm, I don't feel anything and very little pain or discomfort.

However, the last two sessions, Monday and Wednesday, I was in constant pain for the entire 4.25 hours.  I could feel the needle in my arm for every minute of the session and when it was removed, a searing pain shot through whole body.  When the tech stuck me, I could immediately feel the difference.  She was using a 15 g needle rather than the 16g.   The benefit is that it allows more blood flow as she explained.  Since I am glad to get more flow, I figured that was good.

But this last session was excruciating!  I was in tears when it was over.  I was seriously thinking of discontinuing dialysis if this was what I have to suffer for now on.  Thankfully, an wiser nurse was the one disconnecting me and immediately offered the advice that the needle might be too large for my still maturing fistula.  She suggested going back to the smaller needle for a while.

So, that's my plan of action.  I really can't tolerate much more of that pain!  Geeze! 

Does this make sense to anyone?  Anyone else had this experience?

[twirl]

there is something wrong
you should not be in pain for the entire session
usually, if in pain, I am told that the needle is on the vein
and they readjust the needle
or it hurts for a short time b/c it is a new spot to shot
you should not be in pain like that
do not sit there in pain for that long
that is wrong

[devon]

I agree Twirl!  Usually when there's been any pain, a slight adjustment makes it go away.  This time, no adjustment made a difference.  That's why I suspect the needle size versus other possibilities but I hope someone can help because I can't tolerate this another time.

Thanks for your sentiments tho!  You understand my predicament for sure!

[draven]

My unit also put me in on the "big" needles and i felt a pulse like stinging pain every 30 seconds. had to sit for 4 hours gritting my teeth.
I can now pretty much feel if the needles is not in right. that was a once of thing thankfully.

But my arm did feel very sore after using the big needles afterwards and wanted to go back to the "baby needles" , but after 2 weeks the pain went away and the big needles were not a problem.

[Rerun]

I use 15 gage needles.  Most people use 14.  Sometimes when next to a nerve it will sting the whole time.  Sometimes they go next to a previous hole and the wing of the needle puts pressure on that and it stings.  I have them put a piece of gause under the wing. 

I've heard that if you vote for McCain the pain will stop.     

[monrein]

  Good one Rerun.   I hear from many however that McCain could prolong the Mcpain and that Ms Palin, if you flip out the middle "l" and put it at the front becomes Ms. Lotta Pain.  Either way, in dialysis as in politics there's plainly a lotta pain to go around.


Up here, 15 gauge needles seem to be the biggest we use.  At my unit the thinking seems to be that using bigger needles and consequently higher pump speeds could be detrimental to the fistula in the long run and that there can be more healing complications with a larger needle.

Is it a single needle system using the 14 gauge or is it still two needles?

[circleNthedrain]

I'm really sorry devon.  Did you try reducing pump speed to see if it would ease the pain?  I have had a few sessions where a needle hurts the whole time, hits a nerve I'm told, but never the type of pain you are describing.  Possibly it is too soon for the higher blood flow??  As for the needle size, I really couldn't feel the difference between the big and small needles, they both hurt!  I hope they get this sorted out fast!

[boxman55]

with out knowing where the fistula is located effects my help but, mine is located in the crease of my right elbow and for the longest time I refused the 15GA and stuck with the 16's. I am now on 15GA regularly. What the techs sometime will do is with the Venus they will try and go up higher on the bicep, this area might not be as developed and may cause them to inflitrate or lay next to a nerve. If this is the case make sure you watch where this placement is taking place. The 15GA is a better treatment but until your fistula is more developed have them stay a little lower. Even if they have to pull the needle and start over is better then putting up with the discomfort. A few times I have had 3 needles in my arm till end of treatment with the highest one up the arm disconnected from the machine to stop the pain...Boxman

[devon]

I really couldn't feel the difference between the big and small needles, they both hurt! 

LOL!  Perhaps if they stopped using needles?

I've heard that if you vote for McCain the pain will stop.   

LOL! LOL!  A least it made me laugh and laughing releases endorphins that help control the pain!  Was that your intent?  LOL. Ow.

Box... My fistula is near my right wrist for about the first half of my right arm.  It goes pretty deep quickly.  There are two very pronounced places where they stick and they usually scab over between sessions.  For what it's worth, my arm and the fistula location is fairly sensitive still.  It hurts to press on it.  I don't know if that might be contributing to this.

Tomorrow's session will yield some results, I hope.  

Sounds like we're on the right track with smaller needle.  The proximity to a nerve could also be the case but that pain is usually more pronounced. This is a dull sort of pain.  I can feel the needle at the site and inside the vein... if that makes sense.  It's rather like a nail is inside my arm. The pain comes from the intrusion of an object where it shouldn't be.

At least I know you all understand my predicament and that gives me a great deal of comfort. Thanks.

[Wallyz]

Time to think about buttonholes, Devon.  Ask about it.

[Adam_W]

I started on 16g and moved up to 15 after about a month, and I didn't feel a difference as far as pain goes. However I have a graft instead of a fistula, and that probably has a lot to do with it.

Adam

[Mr.N]

I initially had some soreness with going to a 15g needle, but after a few sessions it went away. A couple months later, after confirmation by my vascular doctor and a sonogram of the fistula, I moved up to the 14g and a 500ml pump speed. After a couple of weeks I  started feeling a real difference. Now, especially the next day after dialysis, I feel pretty darn good.

[monrein]

Think buttonholes and needling yourselves guys, if you possibly can.  It takes a lot of the stress and unpredictability out of the needling.  I know some people can't do it.  I'm not saying anyone must but many who think they can't would never go back once they take charge of their sticking.  I find it hurts a heck of a lot less too.

[Rerun]

I think the single needles are 12 gage.  OUCH!!  They have a double lumen (two holes) at the end and so they push and pull with the blood pump.  It is awful.  I left that back 20 years ago.

[monrein]

I've never used one.  It sounds horrific Rerun.  12 gauge must leave a hole almost like a paper punch.

[circleNthedrain]

Rerun, I remember the single needle from almost 30 years ago....terrible (Ah, the good ole days).   Also, loved the McCain comment!
monrein, I think sticking yourself is great advice, most will not go back to techs after they try it.  Wish I could do it, but I can barely hold a spoon!

devon, your fistula sounds like it's in about the same place as mine.  Perhaps it does need to mature a little longer.  I've had mine for many years, but it was never used much until almost 2 years ago.  Even though it was many years old, I first used 'small' needles  After the fistula got larger they switched to 'big' needles'.  I think it took about 3 months.  Best of luck tomorrow, hope it goes painlessly....er, well, you know what I mean!

[BigSky]

More than likely it was against a nerve. 

The size difference between 15 and 16 isnt that great. 

I believe a 16 gauge needle is 1.2 millimeters, a 15 gauge needle is 1.4 millimeters and a 14 gauge is 1.6 millimeters.   

[kidney4traci]

I agree, it may have not matured enough and be too close to a nerve.  I have had both.  The needle size is not a measurable difference, but I can't even imagine a 12 gauge!!!  OOUCH!!  Keep trying to go back after several weeks, it may get better.  The larger needle and speed does make for better clearance I think. 

[G-Ma]

I use 15 ga and 500 speed and Friday at retraining I stuck my venous higher than I normally do, first time this high and whoa...I felt it, Joe Six Pack and all the hockey moms at one time...it then calmed down as long as I stayed at 300, after about half an hour I was able to go higher..nurse said this pain can happen when using an unused part of a newer fistula...when in center if there was immediate pain, the techs came and pulled out and did another stick.  You should not have to sit in that kind of pain.  As everyone has said..when I stick myself there is no pain during the stick but if someone else sticks me...bring on the big stick.   

 

[kevno]

I use one 17 gauge needle and one tesio line. pump speed just 200. But who cares! Still here! I remember the big single needles of the 70's. Ouch!
Even the 17 gauge needle can be a bit painful sometimes. If the needle is in the wall of the vein. Plus I have a few nerves near the vein and the needle can catch one. All the nurse does is turn the needle or pull the needle out a tiny way. The pain stops quick.

[RichardMEL]

Even after 2+ years when I get stuck in a "new" spot (hard to think there are any left!) it can be painful, but that's just initially and usually settles after 2-3 minutes and isn't an issue for me. When my arterial blew a few weeks back they stuck me above my elbow where the skin is extra soft and had never been touched and that was pretty painful (luckily I requested a local be stuck in before had as I had a feeling it would be painful!).. and the bruising is still around the area ! In general though I don't feel much. I think they use 15 guage on me. Don't think they go to 14 here.

[devon]

Here's the latest, y'all.

Friday went well.  They used the smaller needles and there was relatively no pain.  At least not the continuous pain for 4.25 hours!  So,  I guess that was the problem.  Today will give me more information on which to base that decision.

Thanks again all for the support and encouragement.

-Devon

[Kitsune]

I use 15 gage needles.  Most people use 14.  Sometimes when next to a nerve it will sting the whole time.  Sometimes they go next to a previous hole and the wing of the needle puts pressure on that and it stings.  I have them put a piece of gause under the wing. 

I've heard that if you vote for McCain the pain will stop.     

I've heard that if we vote for McCain, those of us who are eligible for a transplant will lose our Medicare funding for not only our anti-rejection meds (the three measly years we get....When I get my transplant, it's off to Germany for the hubby and I) but also our transplants, which is stupid because monthly maintainance dialysis cost 8 times as much as anti-rejection meds, but when did the USA's policies make any sense anyway.)