Fistulas and tourniquets

[pdpatty]

How many that have a fistula have a tourniquet used when it is to be accessed


I was told today by a tech that did a test on my fistula ,they should never use a tourniquet because it could cause a blockage and destroy my fistula.

About a week and half back I was stuck 7 times before they got the veinus . Yesterday it was 2 times. Surgeon says my fistula is BIG,straight and should be easily stuck. Yet there are only two techs who have stuck me with very little problem.

Surgeon also said if they keep doing what they are doing they will destroy my fistula.

This is the only center in our small town.

[LightLizard]

can you request the techs that got it right administer to you exclusively, or at least, as much as possible?

[monrein]

I would encourage you to think long and hard about trying to do your own needles.  I know that you may well recoil in horror and think...OK she's nuts, but it would be the best thing you could do to save your fistula, not simply to keep it functional but also to ladder up and down properly, consistently or better yet, eventually to establish buttonholes.  If you can get to the point where you do, it will take away a huge part of the anxiety that goes with D.  No more wondering if you're getting the "good" tech or the one whose fine motor skills have always been sketchy.  You could use Emla cream for numbing although I personally needed to feel what the needle was doing as I cannulated.   I have had both a forearm and an upper arm fistula, at separate times and neither was damaged or stopped working while I was using it.
I know that many people say and truly believe they could not do this and yet I've personally known people who started off with that view but now would not accept that anyone else do their sticks.

I did use a touniquet, one designed with velcro for easier one-handed use but I never put it as tight as the nurses liked to because there was no need for it to be that tight.
If I've encouraged you in this direction before and you already told me to back off with the crazy ideas, I apologize, but for me, if anyone is going to shove those needles in me I want it to be my job.  No one else will ever care for my fistula as I do.

[del]

So true Gail!!!  We do not use a tourniquet when needling.  One of us will just put our hand gently around the upper arm while the other needles. If you can possibly do your own needles it would be best.  Personally I think all that sticking is probably worse than using a tourniquet.  Take care

[pdpatty]

can't do it myself,fistula is in right arm and I am very right-handed. I also have sight problems.

[monrein]

Ok, fair enough pdpatty...so on to my next best unasked for advice.  Ask to speak to the charge nurse in order to discuss the situation.  I would ask my surgeon for a letter stating what he told you about the possibility of destroying the fistula and to include the recommendation that no novice needler come near your arm.  You should firmly ask/insist, that you get a very experienced person to do your sticks.  Also don't let anyone use a tourniquet.  You can apply pressure to your arm while the tech sticks.  You must also be firm in telling them to ladder the needles.  Do not let them go in the same spots over and over again.  This kind of assertiveness isn't easy because it often feels that we are at the mercy of the centre but it is too crucial not to be be done.  You can be nice but firm, however,  if you have to step on some feelings for your fistula to live its longest life possible then tough rocks for the bad techs' self-esteem. 

[BigSky]

Surgeons are always going to claim its big and straight and should be easy to stick.  That is their nature.  

A tourniquet can be used and if used properly its the same as someone clamping down on your arm to restrict blood flow some to make the vein swell up.  They shouldnt be using it in the manner that is used for drawing blood nor be left on for any extended period of time.

In the beginning there were a number of times a tourniquet was used on mine and I never had any problems associated with its use.

In the beginning fistulas like to spasm and roll alot when being stuck. 

[Zach]

I use a tourniquet for my venous cannulation, due to the fact that the vein is deep.
And the tourniquet use was recommended by the vascular surgeon.

[nursewratchet]

A tourniquet is considered protocol for a fistula.  Some need it, and some don't.  Up to your fistula.  Best to stick yourself, but some can't.  Either alternate the sites, or use the buttonhole tequnique.  Ask for the best cannulator.  It's ok ot do that. 

[Hemodoc]

I use a tourniquet for all my sticks without difficulty.  I got several velcro tourniquets and my wife sets it.  I know others that self cannulate alone that use a BP cuff set just above venous level.  Infiltrating the fistula poses great dangers to a fistula.  My personal take was to avoid infiltration at all costs.  Talk it over with your team,  but for myself, no cannulation without a tourniquet.

[dwcrawford]

I've been infiltrated once and almost twice.  Is my fistula doomed now?  Supposedly I have the best cannula (oh heck, I'll never spell it)  STICKER but when she takes the needles out she is so rough and it almost always bleeds.  Others are more gentle with removal.

How long do I have to wait for buttonholes?  Surgeon OK use of fistula weeks ago but they kept messing up and  its only been working all the time for a week now?  Who says when they start it?  Surgeon, Neph or nurse?

Ok yea, they tie one of their rubber gloves for a tourniquet.  Is that ok?

[Hemodoc]

You can look up velcro tourniquet on the internet and find the best price.  One can last for months, so having two or three on hand will give you all you need.

I started my buttonhole as soon as my fistula could tolerate a 15ga needle.

I found the only way to not have pain with removing my needles was to do it myself.  My tech taught me her technique of placing the bandaide over the buttonhole, then taping the bandage firmly but not tightly over that and then remove the needle.

What I do now, is my wife places the bandaid and the bandage with the it taped down, I pull the needle myself at the same exact angle and direction it went in, then my wife tamponades the bandage.  I then take over for her and she tapes it up.  It works very well and with good bandages, we have very little blood loss with none most of the time.

As in all things, discuss this with your team, but pulling needles out should NEVER hurt if done properly.  They are either pushing down before the needle is all the way out which is cutting your fistula on the inside to the outside which could cause aneurysm.  Or they are not paying attention to the angle and direction that the needle went in.

My only cure was to stick myself and to pull it out myself, same exact angle and direction everytime.  Only occassionally do I feel any pain.

That is my experience with buttonholes and self cannulation.

Buttonholes likewise do much better when the patient cannulates themselves since you can never have only one person every single day.  People miss due to illness or schedule changes.  Having more than one person stick you makes a buttonhole not work  in the majority of cases.

So, talk over these issues with your medical team and see what they have to say.

Good luck.

[tyefly]

    Peter      Hey how about a  video showing us your self cannulation techniques...... and finishing techniques........  Hey Bill P.   has one ...     we would love to see one from you ......   
               Pictures are like a 1000 words......   

[Bill Peckham]

can't do it myself,fistula is in right arm and I am very right-handed. I also have sight problems.

I can't brush my teeth or write left handed but I can put my needles in - with a fistula you can use the buttonhole technique and feel the needle into position see these two presentations:
# Precannulation training: Tandem-hand cannulation & clinical observations
(presented by Stuart Mott, July 30, 2009)

# Cushion Cannulation
(presented by Stuart Mott, April 23, 2009)

Staff could help you to guide the needle in but with you in control you could feel how it is going and adjust accordingly.

I do not believe you could do worse than the people sticking you and I would be willing to bet you could do way, way better.

[Bill Peckham]

               Pictures are like a 1000 words......

Which means videos are like a book

[Hemodoc]

Thanks Tyefly, but Dialysis From the Sharp End of the Needle only has room for one movie start at a time.  Bill's video is great.  Taking charge of your dialysis care takes time to practice all of the skills under good medical supervision, but once you have it right, you are in control.

Like I said above, I still worry about inflitration and am quite careful everytime I cannulate and I am thankful to the Lord everytime it works.  Learning the landmarks on your arm and what angle and direction to place the needle takes time.  However, learning how to take the needle out takes less time, but you need to know exactly what angle and direction it was placed.

So, one movie star at a time at DSEN is the way it should be. 

[tyefly]

    Well    Peter         You are still  our shinning star........... Thx for all of your information and keep up the great postings on DSEN.   We love reading all of them.....


       Kathy