problem with needles

[fuzzyL]

started home dialysis in mid Oct so button hole is developed---but wife having problems with needles -she struggles to get the arterial  with a blunt--usually gets it but often very uncomfortable for me while she does it--the worse is the venous as I sit there while she makes several tries to get it--and she occasionally has to use a sharp on the venous--appreciate any helpful aid--its very uncomfortable for us both

[Desert Dancer]

Is there a reason you're unable to cannulate yourself? It's far, FAR easier and much less painful. As mobile as my fistula is I can't imagine letting someone else try to cannulate me. My husband said there's no way he'd even try.

When you do it yourself you can actually FEEL your way in - from the inside - and it's so easy to feel when it's a little off and to know just how to adjust your arm and/or angle to hit the mark.

Of course, if it's not an option for you just disregard the above. If it is, though, I think this is the best solution. Just my 

[M3Riddler]

started home dialysis in mid Oct so button hole is developed---but wife having problems with needles -she struggles to get the arterial  with a blunt--usually gets it but often very uncomfortable for me while she does it--the worse is the venous as I sit there while she makes several tries to get it--and she occasionally has to use a sharp on the venous--appreciate any helpful aid--its very uncomfortable for us both

FuzzyL,

You want to be careful and try not to use sharps on buttonhole tracks.  When you form a buttonhole, it creates a flap in the vein. This is what opens and closes when you insert the buttonhole needles that enables the blood to exit the vein.   Picture or actually, stick a shart needle into a straw. Look iinside the straw and you will see a little flap.
When you use sharps, you have a high risk of cutting this flap off which can cause bleeding and also damage the buttonholes where you will not be able to use them.
Have you ever tried or heard of touch cannulation ?

[Speedy1wrc]

Using a sharp needle in a buttonhole should be avoided as best as possible. I have a couple of spares just in case of emergency, but I wold expect my nurse to do it, not me or my partner.

My fistula has a lot of scar tissue so even with a buttonhole it is tough. Getting the needle angle just right is imperative or it won't go in. Sometimes it takes a lot of effort to break through the flap and for me, that's just the way it is.

There are a couple things which help me, but sometimes even those don't make a difference. If she isn't already, using the thumb and forefinger to hold the skin somewhat taut to keep it from accordioning and distorting the tract is one. Another is slowly augering the needle in which will also help it find it's way down the tract. Sometimes with fluid or weight gain (or loss) the tract moves so you need to manipulate the site to straighten it out and align it where you need ti to be.

[fuzzyL]

I have never tried doing it myself, but i have considered it--my concern is, how would you--(with one hand)take the needles out when you are done, and block the blood flow, by yourself, with one hand?? But I have thought of doing it myself, i might even be more relaxed and confident if I did.

[cattlekid]

So this is how I do it.  I take a 4x4, fold it in quarters and attach it to a piece of pre-cut tape.  I pull all of the tape off of my arm, leaving the needle in.  Then I loosely tape the gauze over the needle, then I pull the needle out using the hand from my fistula arm, let the needle drop to the chair or floor and then immediately put pressure on the 4x4.  After a few minutes (I am quick to stop bleeding), then I use the non-fistula hand to fold a 2x2, attach to pre-cut tape and apply to my buttonhole. I then do the same with the other needle. 

I've never had a blood leak issue yet.  But I do have a couple of things going for me, mostly the fact that my fistula arm is my non-dominant arm and my fistula is on my bicep.  Also, it helps to reach things when you have gorilla arms. My home hemo nurse was amazed at how much I could reach from my chair LOL   

I have never tried doing it myself, but i have considered it--my concern is, how would you--(with one hand)take the needles out when you are done, and block the blood flow, by yourself, with one hand?? But I have thought of doing it myself, i might even be more relaxed and confident if I did.

[bevvy5]

From the care partner's perspective, please be as supportive as you can of your wife.  I cannulate hubby, his buttonholes were established in Feb of 2012, still using the same ones.  It has been a struggle and it has really been in the last three months that we are pretty much getting them in first time, every time.  I cried for two days last summer when we were having major issues and had to get some assistance from our nurse.  So the stress she is feeling is probably equal to your own. 

One thing that really helped was when hubby realized that sitting in the same position, keeping his arm in the same position every single time was important.  He couldn't really understand why it made a difference, but when he agreed to really be conscious of it, it seemed that things started to come together.  Maybe a fluke but I believe that making sure the chair is in the same place, the angle of your arm on the table is the same, all those things do make a difference.  Hubby has his arm in one position for the arterial, then rolls it just slightly in one direction for the venous. 

My husband has nerve damage in his fingers, so cannulation at this point is not something he's willing to attempt.  If you decided to do it yourself, perhaps your wife could assist you in removing the needles or at least be there with an extra hand, especially at the beginning, in case you need an extra pair of fingers on the gauze.  Presumably she removes the needles now and if she's cannulating, being on the removal end is definitely the easier part.

But again, it has taken a long time for both of us not to have a sick dread of cannulating on dialysis days.  It's worth it now though - we were just talking about it last run and even if we did have some issues, we know it's possible to get to a point where it's pretty easy. 

I truly feel for you both.  I will be watching for your posts and hope things start settling down for you

Bev

[fuzzyL]

thank you all for the help !!!!!  "cattlekid"", that is impressive and I will remember that method if I ever do start the needles myself--"bevvy5"-your words are wise--I found the best way to help my wife is to not show I am in pain- I watch Tv to take my mind off while she does it--I have learned that it stresses her to think she is hurting me

[Speedy1wrc]

I'll ditto what everyone else said. My partner would rather do the cannulation and have me set up the machine, so we as a team divided the chores in a way which works for both of us. There are many different ways to cannnuate and take yourself off. Everyone develops a way which works for them. I can cannulate myself and once a week I do it just to stay fresh. Start trying different methods with your wife right there to lend a hand and see what parts you or she can do and what works best for the both of you. She is not just your caregiver but the both of you need to function as a team.

The way I take myself off is to put my thumb on a folded 4x4 over the needle and then using my fore and middle finger pull the tube while timing putting pressure on the gauze. Every method you try takes a few tries to find out if it will work for you or not. I know others who do it diffrently and for them, that's the best technique. You'll find one that works for you.

My fistula went in March of 2005 so there is a tom of scar tissue. When we went to buttonholes it took a very long time for the tracks to be formed. it took even longer still for the flaps to work correclty. Some flaps and tracks are just difficult. You can ask here and look on Youtube for different techniques on how to alleviate some of the common issues. One is the Touch technique which is covered elsewhere on this site.

Keep at it and don't be discouraged.