Thinking of stopping needling myself

[Rain]

I've been putting in my own needles for 3 weeks.  The first 2 weeks were easy, no problem, this last week has been a bloody mess literally.  I have a shallow strong fistula and it keeps spray blood back at me this week.  I've gotten blood all of my shirt, pants and my face from the back splash of my fistula.

I'm thinking of stopping this self needling since I'm just frustrated every time now.  As anyone experienced this?  The nurse mentioned it's because once I get the sharp needle in I pause and so an air gap is present.  Any advice?

[fearless]

I cannot give you any advice because I am behind you in this process.  The nurses are just starting to needle my fistula, but I hope to do it myself one day.
All I can say is, from what I've read, it would be worth it to try to work through it and correct whatever is going wrong, because if you can keep doing it yourself you will likely preserve your fistula longer, and that is healthier and less of a pain in the ass for you in the long run.  And gives you more options about doing dialysis.
I really hope you can make it change, but of course there are others here who would be able to speak from experience.
Good luck to  you friend

[amanda100wilson]

Sounds like what your nurse is saying is correct.  Are you going to do home HD?  If you are planning on using buttonholes you could always get the nurse to develop them for you, has to be the best cannulator in the unit every time

[Rain]

I do plan on doing home hemo but button holes are not the practice here due to high rate of infections.  I'm going to ask the nurse to needle tonight so I could watch her and then try again on monday.

[amanda100wilson]

I would be wondering why they claim that they have high rates of infections with buttonholes.  Could be that they are not using best practice when cleaning/descabbing.  I would feel pretty uneasy about this.  Is there another dialysis unit that you could go to?

[rsudock]

the research I have read does not support your claim about the button holes having high infection rates...yikes!

[Bill Peckham]

The Frequent Hemodialysis Study is one  of a number of recent studies that showed an increase in access problems and infections among the more frequent dialyzers and thus people using the buttonhole technique. There have been a couple others too BUT I think in every instance I've looked into - gotten the paper and read the details - it was either in a situation where it was incenter with staff cannulating or a technique failure was identified e.g sticking the the needle in up to the hosel, picking the scabs with the same needle, not cleaning the area before removing the scabs. The studies I've seen that looked at self cannulators using the buttonhole showed improved outcomes.

Rain I know exactly what you're talking about. I have a strong, shallow fistula. I've been self cannulating since January 1991, sharps first then buttonhole needles but I did buttonhole with sharps before Medisystems came out with their dull needles. I think they came out in 2002 or 2003 and I started buttonholing n 2001 when I switched to more frequent dialysis.

When I have to use sharps to establish new buttonholes I can get sprayed, it's not pleasant. As a practical matter you could use a 4x4 gauze pad as barrier. That's not to say that a barrier is an ideal solution, the spray can and will find the gaps that you leave to see what you're doing but it helps.

A shallow entry angle seems to increase spray. I have a tendency with sharps to make the angle more like 30% instead of 40 to 45%. I visualize  the needle entering the fistula only as far as getting the hole past the skin, keeping the needle at as steep an angle as I can stand and then decrease the needle to thread the rest of the way in.

Visualize putting in the needle at a steeper angle, just the short distance of the tip, pausing, and then decreasing the angle before finishing. You can get through this; it is worth getting to the other side. Meinuk coined the term "a Carrie Moment", we've all had them but it is still better doing it yourself than having someone do it to you.

[Rain]

Just an update.

I've been needling again for 3 weeks with the bevel down and no blood splash.

[MooseMom]

Oh, that's good news!  Everytime I saw your screen name, I thought of blood raining down upon you.  Ack.  Now I don't have to get that particular image anymore.