Unable to cannulate and getting very fustrated.

[vcarmody]

We stated training for home hemo on Nov 16.  I know this sounds like a long time but with the holidays and some prior obligations and a 1 week hospital stay we are still training.  Our nurse is pushing for us to go home, but I am still unable to cannulate my husband.  I am getting very frustrated and am thinking it will probably be best for my husband to stay in center.  We had one button hole established and I was having no problems cannulating it, but when he went in the hospital they did not have blunts and his doctor told the nurse there not to used the button hole with a sharp, so she went all around the button hole and now we can not find the established buttonhole (wish I would have had enough sense to mark it).  I seem to be doing OK with the arterial now but still can not do the venous.  Does anyone out there have any pointers? Do you think I should have him stay in center sense I can not cannulate him?  Maybe I should have him  go back in center until button holes are established?  I want him to be at home and be comfortable but if I can not stick him what good is bringing the Nxstage home?

[petey]

I'm hoping that the sharp sticks in the hospital didn't damage the "track" that had started for your husband's buttonhole.  So very few dialysis professionals are familiar with buttonholes -- I know that sounds crazy, but it's true.  Aside from the obvious sign on the outside (the buttonhole), you also establish a track inside that runs from the buttonhole on the skin straight into the fistula.  If a stick with a sharp is made that pierces through the track, you may have to establish a new track, a new buttonhole -- in a different part on his fistula.

My husband and I have been on NxStage for 2 and a half years.  My advice (amateur that it is) would be to try, try again.  Home hemo (for us) is a million, trillion times better than in-center.  We're fortunate that we're still using the same buttonholes that we established during our training (knock on wood), but I do know how to start new buttonholes if the need ever arises.  I would say talk to the nurse who trained you about starting a brand new buttonhole.  (Another piece of advice for further down the road --  NO ONE -- repeat NO ONE cannulates your husband's fistula ever again except you!)  When my husband has to be hospitalized (and even once when he had to return to in-center for IV antibiotics two years ago), I carry blunt needles with me and I cannulate.  The hospital or the clinic may buck you on this, but STAND YOUR GROUND.  Get your husband's neph involved, and say, "This buttonhole access is his lifeline.  I'm going to do all the cannulation.  Help me help my husband and keep his fistula and buttonhole!!!"

Good luck and let me know if I can help.

[del]

Petey is 100% right!!!  Never, never let anyone cannulate only you.  I have been doing my husbands needles (he uses buttonholes) for over 3 years now.  It is his lifeline!!  Make sure every one understands that!!!


Petey - I LOVE the pic of you and Marvin!!

[Malibu]

I agree with petey...go back to the training nurse and ask her to help you start a new buttonhole.  Try not to give up....home will be much better.  Hopefully he is not getting upset with you when you fail to cannulate.  If he is sit down and have a stern talk with him that you need his support.  IF it is ony you...sit down and have a stern talk with yourself.  Put your big girl pants on and stand up to the challenge.  You Can Do It!

[Hanify]

And don't rush yourselves!  Over here the usual traning period is three months!  Do they usually do it quicker where you are?

[Trikkechickk]

I had a bad button hole in my vein, so I established another buttonhole myself.  It is working perfectly.  I could have gone to the clinic to have It done for me, but I decided I didn't want to put all the time on top of D by driving back and forth. 

Sharps don't hurt if you go slow and easy!

[vcarmody]

Thankfully my husband never gets upset, it is usually me that gets upset and on edge cause I know trying to find the vein hurts him.  He tells me all the time either way it hurts, me doing it or a nurse.  I'm very determined to get it right I want him home, but I feel like I am being rushed.  I want buttonholes established before we go home but I don't think they want us to stay that long.  It sounds like everyone doing Nxstage has buttonholes or a catheter.  I want to thank all of you for the good advise I would have never insisted on sticking him when he was in the hospital, but now that I see it is an option I will now push for it in the future. 

[petey]

vcarmody --
the longer you do this, the more you will understand that your options are not always presented to you/your husband as options (like you cannulating when he's in clinic or in hospital).  It's unusual for a spouse to do this in a hospital setting, but it IS an option -- they just don't tell you that.  And, be prepared for this answer if you insist that you do the cannulating -- "But nobody else's spouse has ever cannulated when the patient was in hospital."  Make your answer what mine has been -- "Well, then, there's a first time for everything, and we're going to be your hospital's first."

And I know what you mean about your getting upset and being on edge during cannulation.  That's the only part of home hemo that I hate -- absolutely hate!!  I know it hurts Marvin when I put the needles in (even with his lidacaine cream), and it hurts me to hurt him.  He's so brave about it and never complains, but still...I hate that part of it.  But, that's the part that we have to do in order to do treatments at home.  I suck it up, take a big breath, and say to myself, "I can do this.  I can do this.  I can do this."  Relax...a lot of your nervousness about it is in your head (it's in mine six days a week when I do it!!!).  Convince yourself that you can do -- nothing to it -- and then go for it!!

[willowtreewren]

Vcarmody,
My husband does NOT have button holes. I ladder up his fistula and stick a new spot every day.

I thought I would pass out the first time I stuck him. Now I only get "upset" when the d#%$*d needles won't go in. A little cussing helps at those times. Like your husband, mine never gets upset.

He is doing the snap and tap right now so it is just a matter of minutes before the stick! 

Aleta

[cookie2008]

It took Dave from July to I say October to get my buttonholes, after doing the six to eight sharps to start the track if he couldnt get the blunt in he would use a sharp then the next day use a blunt.  Dont give up it takes time to get the feel and hang of it ask donna if you could take a needle home to practice with using a rubber tube something flexable or so you can practice there while training.

[Jean]

If " the caregiver" doing the cannulation gets sick, or God Forbid, dies, or is gone for a week or two, what happens then? Does the " caregiver" also have to stay in the house every minute while the dialysis is going on? I mean, cant run to the store for ice cream or a pizza or something, not leaving for the whole evening?

[petey]

Jean,
I have often thought about what would happen if I get sick, hurt, etc. and am unable to cannulate for Marvin's treatments.  We have a "back up" plan -- his very first dialysis nurse from 15 years ago has remained a good friend, and she has agreed to "fill in" for me if we ever need it.  (She's now a regional supervisor over all the clinics in a five-county area -- and she lives about 10 minutes from us!)  Thank goodness, we haven't had to call on her -- but it's reassuring knowing that the offer is there.  I had surgery on my left arm in October, and I had everything in place just in case I couldn't cannulate Marvin for a day or two (it was my left arm, thank goodness, and I'm right-handed, but you still need two hands to do it -- or least, I do).  We took off the day of my surgery so Marvin didn't need a treatment, and the next day, I was able to cannulate as usual (lucky, I guess).

I do not leave the house during Marvin's treatments.  Now, I don't stay in the same room with him every single minute, but I'm close enough to hear the machine if it alarms or hear Marvin call me if he needs me.  I usually "check in" every 15-20 minutes, and sometimes, I do sit in his "clinic" and talk to him during the whole treatment, sometimes we play cards, sometimes we watch a movie, etc.  It just depends.  But, I couldn't leave the house -- I just wouldn't feel comfortable.

[cookie2008]

how is everything going, 

[willowtreewren]

Jean, I stay with Carl. too.
The only time I have EVER left Carl was because there was a false fire alarm at school one evening and if I had not gone over there to unlock, the fire department would have broken down the door. LOL!

I do go outside to swim as long as I have a walkie talkie to allow me to know if there is an alarm.

Aleta

[willowtreewren]

Oh, and our back-up plan involves Carl's going back into the clinic with his NxStage machine. When I have to travel, that's what he does.

[stanbiker]

has your husband considered cannulating himself?

It is so much better for me. I can feel if its not right, and now I won't allow anyone near my fistula. Even in the hospital the day after I had my kidney removed I self cannulated. I am convinced that is the key to successful buttonholes and access health