How do I take care of my fistula?

[Lilu323]

When I was a child they said to me to put really hot compresses on my arm and do exercise with a ball. Now my dialysis clinic states that after dialysis I should put a cold compresses on for 15min. Then the next day I should put on warm not hot compresses for no longer then 20min and do exercise with a ball or dumbell. (my fistula is on my upper arm) What do you guys do or how do they tell you to take care of your fistula? Also I dont want to get those bumps (aneurysm) No disrespect to anyone. How do I prevent from getting them?? Thanks

[monrein]

I have never used warm compresses on my fistula because it was never suggested.  I use an ice compress only when I infiltrate and the reason is to minimize the swelling and bruising.  I do light weights at the gym for general exercise and I did the squeeze ball exercises for my first fistula which was on my forearm.  I now have an upper arm fistula like you and my surgeon said I didn't have to bother with the arm squeezes as upper arm fistulas tend to develop more easily without help from the ball.  However I have really good flow so that might be an individual thing.  The squeeze exercises won't hurt anyway and if they help to develop the fistula then that's good.

As for the aneurysms, the best way to avoid them is to make sure that the nurses don't get lazy and needle you always in the easiest place.  They need to ladder the sticks slowly up the arm so the vein develops evenly instead of weakening in certain spots and bulging out.
The other option is to develop buttonholes.  You use EXACTLY the same hole and same angle with the needle each time until you create more permanent channels and then a blunt needle that slips in quite easily (or is supposed to anyway).  There are threads on here about buttonholes and members who use them too.  Do a search and you'll find more info.  I'm laddering right now to develop and strengthen my fistula but eventually will try to establish buttonholes also.

Hope this helps.         

[Lilu323]

Thank you so much for your insight. Its so frustrating to hear other ways people take care of things. I wish I could know which one was the best for me. If I read correctly you canulate by yourself? How long did it take you to do that?I thought putting the needle in the same place over and over again (button hole method) causes the weakening of the vessel wall and causes an aneurysm ?

[Krisna]

I had a lower arm fistula that lasted for 21 yrs.  The last 15 yrs. I had an aneurysm near my wrist.  It developed because in my case it was the HMO I belonged to which shall remain nameless.  The surgeon there didn't tie off the branches further up my arm so the part that should've been the venous part never developed.  It also needed to be brought closer to the surface.  This made the area they could get in with the needles very small.  When I turned 23 I got kicked off my dads' insurance and switched to a different doctor.  A few months later it clotted and while the new surgeon was fixing it she also tied the branch off and brought the vein closer to the surface.  I had told her abt all that in pre-op consult.  Abt 10 yrs. ago they had to go in for another clot and replace the weakened area with artificial tubing.

Now, I have to say one thing and that is that I didn't do my ball exercises when I was 15 so I thought that was why it was so hard to get into it later on.  Until it clotted after I was at the new doctor.  The new surgeon told me that since it was in my dominant arm it wouldn't have mattered.  And I tend to believe her.

I know a lot more people who have upper arm fistulas that lower arm fistulas and I've never known any of them to put heat on them.  But I suppose it depends on where in world you are.  I was always told even now that my new one is in my upper arm, to not lift anything with it weighing more than 10lbs., never ever let anything cut off the blood flow, and now blood pressures or blood draws/IV's.  Check for the "thrill" several times a day and if you notice diminished flow call doctor right away. 

I pretty much guarded it with my life even during the years that I had a working transplant because I knew I would eventually need it again!  Other than that I'd say research it online.  I've found a bunch of info online.

Hope this is somewhat helpful.  lol

[Krisna]

Thank you so much for your insight. Its so frustrating to hear other ways people take care of things. I wish I could know which one was the best for me. If I read correctly you canulate by yourself? How long did it take you to do that?I thought putting the needle in the same place over and over again (button hole method) causes the weakening of the vessel wall and causes an aneurysm ?

I'm not an expert on the Button Hole technique but I do know several people who use and am considering it with my new fistula.  The weakening of the wall is caused by going in the same general area but not the same hole.  Button Hole is where you pick the scab off each time and go in the same exact holes each time and eventually you are able to just pick the scab off and use blunt needles.  This is because it creates a tunnel which takes away the need for local anesthetic and reduces scar tissue! 

[Lilu323]

Thank you so much for your detailed response. I am going to see my vascualar surgeon next week and ask him what he thinks I should do. Thank you again for your story