Fistula Stent techniques

[Hootie]

Per my earlier posting, my wife's broken leg is healing after her mishap in hospital on August 13th. We are back home after 12 days in hospital with surgery on her leg and 12 days in a rehab facility. Her mobility is much better but she is still using a walker and attending off site PT two days a week. Before we left the hospital, we had the fistula  looked at via a fistula gram. The cardiac surgeon did ballooning of three places and inserted at stent in the venous side. He said there would be no problem punching through the stent. The in center and hospital guys have had no problems using the stent.  Yesterday she was able to go upstairs to do our first in home hemodialysis on the nxStage system. That session went fine.

Today we had major  issues with high venous pressures. We adjusted the needle several times and flipped the needle. We dropped speeds down to 300 from 350 but could never get pressures at an acceptable  level for any appreciable time. We stopped treatment 35 minutes in treatment. Could not even do a rinse back due to pressures. Ended up doing a manual rinse back. No infiltration during any of treatment. I am thinking I did not push needle all the way in stent. I just do not have a good feel for the stent cannualization yet.

Question, thoughts any tips for a using a stent within the fistula?

[Rerun]

Try again tomorrow.  If the same thing call the home care nurse.

[Simon Dog]

Question, thoughts any tips for a using a stent within the fistula?

If I had that situation, I'd go in-center for a few treatments and do it myself there with people around to help until I was confident of puncturing solo.    My home care RN never has a problem getting me some in-center time (yuk!) if I am having problems.

[Hootie]

We took Rerun's advice and did treatment again the next day. No issues with fistula and good pressures. We did have a problem in last ten minutes with nxstage red code 36 which means lack of dialysate in pure flow system. We used some for aborted treatment on treatment and the day before.  We had some left. I kept turning off and own with NxStage technical support but machine kept cutting off. Ended up doing a manual rinse back which worked fine. We use 60 l bags but only 25 each treatment so we should have had plenty after aborted treatment on Sunday. Nxstage seemed to think it was kinked tubes inside bag.

I have another question....when my wife was evaluated for transplant her bone density test show she was fine and no issues. She broke her leg on a simple fall.  Her nephrologist said the ckd patients have issues with the mesh in the bone structure. She says bone density can be fine and a person can still have breaks. Through all the hospital evaluations with the various doctors, her endocrinologist pops up and stated she wants my wife to go on Prolia. The nephrologist appears to not be in support of that shot due  to side effects.

I have done some research and read lots of reviews. Some say it works but the majority feels it's an awful drug with many side effects. Many are calling for the drug to be pulled from the market place. Any thoughts here?

Joe