Hello from Spokane, Washington

[JeanieSpokane]

My name is Jeanie and I have been on dialysis for 18 months using a catheter.  I had my fistula done in December and modified in March and am trying to establish buttonholes.  The center talked me into doing the needles myself - I started last week.  It has been very, very overwhelming.  I am successful in the first needle, but the second (the Venous) is literally hit or miss.  It's frustrating.  I used the catheter for half on Friday, fully on Monday because the nurse was gone, and half today.  Very frustrating.  But I found your site and am hoping I can get support and encouragement here.

[galvo]

G'day, Jeanie, and  . 

[chook]

I think you are so brave! I know that putting the needles in yourself is the best option but hope I never have to do it. The thought of it is overwhelming! Wish there was a medal icon so I could put one here for you. Hope the nurse is there full time from now on and that it gets easier.  instead of a medal

[Poppylicious]

  Jeanie.  Lovely to 'meet' you.

[willowtreewren]

   Jeanie!

Well, this is the right place for support and encouragement! Plus you'll find lots of good information!

 

Aleta

[peleroja]

Welcome to the group, Jeanie.  You're very brave to stick yourself.  Hope you resolve your problem soon.  Glad you found us!

[ihernandez]

welcome im new to this site too i leave in vancouver just started NxStage 

[Rerun]

Hi Jeanie, I live in the Spokane Valley.  I go to DSI on Mirabeau.  You must go to one of the FMC Clinics?  Dr. Obermiller doesn't push button hole so I don't do it.  Plus I still can't watch when they put in my needles.  You Go Girl!!

This is a great site.  You will find lots of support.  Maybe we can meet for lunch sometime.  We can be BAD and go to Taco Time!

So glad you found us.

Rerun, Moderator       

[Ang]

 

i was hassled in to needling myself,did it once,felt a sense of achievement
told the nurse"can cross that off my bucket list"
your job again,
never do that again
kicker was"she is scared of needles herself"

[jazzin11]

  Welcome to the group Jeanie! I have been dializing in Bellingham.  But, tomorrow am getting a transplant at the UW in Seattle! My donor is from the Spokane Valley! Best wishes for you as you go through this journey. There is light at the end of the tunnel!  Ang...I had to laugh at your post because I did that too! only once, but that was enough!

[Hemodoc]

Hi Jeanie, I live in the Spokane Valley.  I go to DSI on Mirabeau.  You must go to one of the FMC Clinics?  Dr. Obermiller doesn't push button hole so I don't do it.  Plus I still can't watch when they put in my needles.  You Go Girl!!

This is a great site.  You will find lots of support.  Maybe we can meet for lunch sometime.  We can be BAD and go to Taco Time!

So glad you found us.

Rerun, Moderator       

Dear Rerun, what a small world, Dr. Obermiller is my doc as well at DSI N. Spokane past the mall on Division.

As far as self cannulation, if you can do the lower arterial, it will only be a matter of time before you master the upper venous as well.  The hardest part is getting over the fear of sticking yourself and just doing it. If you are having difficulty with the top, learning the location and direction of the needle stick helps immensely.  I use landmarks on my arm to know the right location and direction to insert the needle. If you are already using a buttonhole that is established, I now place the needle just above the hole and gentle bring it down until I feel it go into the buttohole and then just insert once I feel it go into the right place.  Works like a charm but you must, MUST, disinfect the skin very well to use that to find the buttonhole.  Once you have found the exact insertion site, make sure you have your skin secured so it won't move.  I use my 3rd and 4th fingers about an inch or so below the hole to anchor the skin by pulling down on it and use my thumb and index finger to hold the needle for insertion.  Then  knowing the right angle to insert and it goes in almost effortlessly the majority of the time. 

Every once in a while, I need to use a sharp one or two sessions to get it working right again, but thankfully that is not that often.  Using those three elements of finding the exact location, right angle of insertion at about 30 degrees and securing the skin by anchoring it with my other fingers pulling the skin in the same exact direction each time, it all works.

If you haven't anchored your skin previously, you may need to do so using a sharp for several days to establish the buttonhole with that kind of traction on the skin.  If you notice most nurses when they insert the needles pull the skin taught between two fingers of one hand and insert the needle with the other hand.  With a little practice, you can do both with one hand using different fingers as noted above.

Lastly, I always, ALWAYS use a tourniquet to get the maximal diameter of the fistula for cannulation.  Many people avoid the tourniquet but that places the vein at higher risk of damage according many cannulation experts.  You can get similar engorgement of the vein by doing a valsalva maneuver, but people have passed out doing that as well.  Valsalva is when you hold your breath and bear down, it backs up the blood coming into the lungs, but once again, you might pass out if you are not careful doing that. 

In any case, that is how I do my buttonholes and it works well.  I hope this helps when discussing your problems with your medical team.

God bless,

Peter

[JeanieSpokane]

Thank you everyone - and Peter especially for techniques.  I go to the Fresenius center on Pines and the home patient nurse is coaching me.  17 days now - I'm on the buttonhole needle for the bottom site - still having trouble with the venous site - it's deeper.  As for "landmarks" - what a fantastic idea, and guess what?  I have a million freckles!!!!  (I think it is hilarious that the nurse thinks that a freckle is my bottom hole - good thing I've got that one down)

[Bruno]

Jeanie, the venous access is always the hardest because it's the deepest...I notice that the needle is much deeper in before I get flashback. I always (I know I'm not supposed to) put a pen mark on my arm in the direction I want to go because that then lets me concentrate on the angle, because they are the two "musts" for a successful cannulation: Angle and direction.
On the venous needle, I find it useful not to rush it, and (I don't know why) to breathe out and say relax,relax, relax.
I reckon it took me 2 months to get reasonably proficient at needling my self, so be brave, it's far, far better to do it yourself than have others do it for you.
If you can manage to do it yourself, you have a chance at doing dialysis in your own home and getting your life back.
So happy to meet you and good luck.
 

[JeanieSpokane]

I wanted you all to know that I had a change in plans last Friday.  I couldn't get the buttonhole in either site.  Then the nurse coaching me tried and couldn't get either needle placed.  THEN the tech tried and also failed.  The nurse was coming out of her way to my clinic on her way to her clinic on Sherman Ave. (Spokane).  She had decided to discontinue stopping by starting Monday.  So - Friday, what would have been my 17th day turned out to be a "do over" and I started Day 1 again - only the tech is doing it with sharps in new sites and we are hoping that once the buttonhole is established, I can start doing the buttonhole needles myself.  She is determined to make this work and has planned to come in even on her off days.

I was so emotionally involved in this, and so stressed over it, that I completely fell apart on Friday, sobbed all day - told my significant other that I flunked Needling 101.  He laughed, I cried, he felt terrible, and after a good night's sleep, I'm all better now.  But it bugs me anyway.  You'd think I could do a simple thing like poke myself.

[Hemodoc]

I wanted you all to know that I had a change in plans last Friday.  I couldn't get the buttonhole in either site.  Then the nurse coaching me tried and couldn't get either needle placed.  THEN the tech tried and also failed.  The nurse was coming out of her way to my clinic on her way to her clinic on Sherman Ave. (Spokane).  She had decided to discontinue stopping by starting Monday.  So - Friday, what would have been my 17th day turned out to be a "do over" and I started Day 1 again - only the tech is doing it with sharps in new sites and we are hoping that once the buttonhole is established, I can start doing the buttonhole needles myself.  She is determined to make this work and has planned to come in even on her off days.

I was so emotionally involved in this, and so stressed over it, that I completely fell apart on Friday, sobbed all day - told my significant other that I flunked Needling 101.  He laughed, I cried, he felt terrible, and after a good night's sleep, I'm all better now.  But it bugs me anyway.  You'd think I could do a simple thing like poke myself.

It is NOT an easy task to learn how to self cannulate. Even though I was quite proficient at placing large needles into other people's veins, when it came to doing my own sticks, it literally took me a few months to become completely at ease with the entire process. My question is did you try to use a sharp after the dull needles failed to cannulate? That is something that all of us that self cannulate must do from time to time to keep the buttonhole open.

The buttonhole is a very finicky process that you MUST access in the same exact fashion each time or it will not work. Just being off by only a millimeter is enough to stop it cold. If you feel well doing the stick, the best way to get a working buttonhole is to have you establish the site with sharps yourself and then when it feels like it easily threads with very little resistance, that is when I switch over to the dull needles. i have been working on a new site for a couple of months and yesterday was the first time that the resistance just melted away. I am finally ready to switch to the dulls. It is something you just learn to feel with experience.

You may wish to talk to your medical team to see if your fistula is large enough for you to start accessing it with sharps so that you won't have to go back in-center if your access quits on you which does happen from time to time. I have established all of my own buttonholes with sharps myself for nearly 2.5 years now.

I use landmarks to make sure I am in the same exact hole, using the same exact traction on the skin and the same exact angle. When you hit the sweet spot each time, cannulation is quite easy, but I do every once in a while create a false track and then you just will not enter the vein no matter how hard you try. You can only cannulate in that situation with a sharp. In the long run, you should learn how to do both sharps and dulls to maintain your own independence. Using sharps  long term can lead to weakening of the vessel wall causing aneurysms. But there are times where only the sharp will work. If you have a large well developed fistula, the wall may be quite tough and hard to get through. In that case, it will take longer to get the access working with the buttonhole. It took me over 2 years to get my venous site working with dulls alone. I had what is called the trampoline effect where you can get the dull needle through the skin but it bounces off of the vein.

I am not sure why your access failed but try to watch very closely how the needle is inserted by the tech while you are reestablishing the buttonhole so you can duplicate this when you take over. Talk it over with your medical team but remember that even with my MD, it took me months to become completely self proficient doing my own sticks. It is not at all an easy skill to acquire but well worth the effort and I firmly believe it it the best way to protect your fistula in the long run. So don't get too let down with this minor setback. You have at least over come the fear to even try the needle stick yourself.  That is actually the hardest step.  The rest comes with practice.

Remember also that the way the tech holds the skin tight may not be easy to duplicate with only one hand. That is why I do everything myself without any assistance so that the manner in which I stretch the skin tight with only one had is something I can duplicate each time. Using someone else to start the hole who has two hands to hold the skin and hold the needle means you will have a a different angle when you use only one hand to stick and hold the skin tight at the same time. Thus, it is very difficult to duplicate exactly the tech or nurse that starts your buttonhole. I know some folks who have jumped right into the self stick business with sharps right off the get go, but that is a rare bird. I was not one of those myself. I didn't sleep at all the night before my first attempt.  It is not at all easy to do what you are attempting to do but I am sure like the rest of us that you will try and learn step by step. Ask questions of those that know how to cannulate and learn as much as you can. I suspect one day it will all just fit together and then you will have gained one of the greatest survival skills a dialysis patient can develop. Many believe rightfully in my opinion that it is a key survival skill.

Good luck and don't get discouraged.

God bless,

Peter

[Bajanne]

Welcome to our community, Jeanie! I am so  glad that you found us and decided to join us.  This is just the place for information, support and encouragement, as you have seen already.  You are now part of the IHD family - a wonderful group of sharing and caring people!  Just keep reading and keep on posting.  Let us know how you are doing.





Bajanne, Moderator

[Annig83]