Ever miss your graft and start treatment?

[Malibu]

We did this morning.  V pressure was high so MM repositioned the needle and said hit go.  Then he said STOP!  ...laugh...I can laugh now.  His arm is still swollen with blood.  And he said it hurt like the dickens.  We aborted treatment, pulled the V line and called the nurse.  Nurse said hook V line to A access and rinseback.  I could not find in my booklet the procedure to make the thing go into a rinseback so I had to do a manual.  Well, it is all but impossible to do a rinseback to the A line or maybe it was clotted at that point I don't know.  Suffice it to say MM looks a little pale today.  I finally found the Operator End procedure, it was misfiled!  Now I think we both will be really disturbed and scared in the morning when we hit treatment. 

[willowtreewren]

Malibu, did you open up the machine for your rinseback?

It is nearly impossible to push the saline through the machine, but if you open the door you can do it. It isn't very easy, but can be done.

Sorry about hubby's arm, though. It must really hurt.

Aleta

[Malibu]

AHHH! NO!  I didn't open the machine.  That was probably the problem.  We were so freaked out...

His arm sure does hurt and we HAVE to do dialysis tomorrow.  The nurse said to put ice on it to reduce swelling and bruising but he won't do it. 

[willowtreewren]

Do, do, do put ice on it. It is going to take a few weeks for all the blood to be resorbed and the sooner you ice it, the better.

Take care.

Aleta

[Malibu]

Spoken like someone who has first hand knowledge of that....

We were so fucused on finding the rinseback info and then the manual rinseback that we didn't even look in the book for directions on doing the manueal rinseback!!!  I just looked in my book and found it....  Oh my, were you guys like this when you first started? 

[willowtreewren]

Yep! Used to panic and get butterflies with each alarm. Now it's more like, oh cr*p.

And we made two big boo-boos this week, after a long, long stretch with nothing going on. Got too confident.

Had to abort a treatment Saturday night because hubby opened the clamps on the saline T and it drained into him in a mater of moments while I'm going, I guess I'm getting a zero on the arterial pressure because the pressure pod is defective - NOT. When we saw the air racing toward him, it was a big STOP! Couldn't get the air cleared from the machine and had to quit. Couldn't do the rinseback, not even manual because of all the air in the line. Oh, well. Then tonight forgot to unhook the drain line from the saline bag. Caught it before it exploded, LOL!

Didn't panic either time. Used to. It gets easier. Best wishes.

Aleta

[rocker]

Spoken like someone who has first hand knowledge of that....

We were so fucused on finding the rinseback info and then the manual rinseback that we didn't even look in the book for directions on doing the manueal rinseback!!!  I just looked in my book and found it....  Oh my, were you guys like this when you first started?

Ooooooohhhhh...definitely.

I still worry about everything, but we haven't had a major scare in a while.  Well, yesterday we started with an absurdly high arterial, but that just turned out to be the way the tubes were taped.

Couple months ago, first treatment home again after a hospital visit, I got a 38.  Aaaaah, 38, didn't unclamp the dialysate line.  Checked it....no.  Grabbed the book. "37,38 - HIGH BALANCE CHAMBER PRESSURE".  Well, that's useful. Scanned through the troubleshooting while getting more nervous - nothing. (Brain is screaming "timetimetimeclottingtimetimetime!") Gave up and called the on-call....who was at lunch in a noisy place and the conversation went "I've got a 38."  "28??"  "THIRTY eight!"  "Thirty what?"  "THIRTY EIGHT.  TREINTA OCHO."  "veinta ocho?"  "TREINTA!  THIRTY!"  "Ooooh, 38.  Haha.  Is your waste line clamped?"  ....oh.  I had been worried during setup.  The waste line was still attached to the saline.  "Um, oh, yeah, waste line clamped.  Thanks!"
 

Took the book and wrote "WASTE LINE" beneath the page header.

The page does say "waste line occluded" somewhere in the list, but I missed it on my quick scan.

I also had to do a manual rinseback once because I couldn't figure out how to get the machine into rinseback mode quick enough.

I'd say the most fun so far was a fluid leak in the Pureflow about a half hour in.  The cycler is pinging 14, and the Pureflow is pinging "FLUID LEAK", and the whole thing is making a racket.  But once I figured out that the cycler was still running, and I had time to deal with it, I was fine.  Ran downstairs and got a box of bags and a warmer bag, ran back upstairs, turned the warmer on, slapped in a warmer bag, hung a dialysate, primed the bag, then switched out the dialysate line after steri-gelling my hands.  Then I realized that the warmer overloads the UPS, so I had to find a different electric cord and plug the warmer into a different outlet.  Unclamped the dialysate line, did a quick stop-go on the machine, and whew!  Now the treatment is continuing, and I'm free to sit down, relax, and......BAIL OUT THE D*MN PUREFLOW.   

I'd say the whole thing took about three minutes.

So, just stay calm.  It only takes a few seconds to look it up in the book, and you have those seconds.  Beware of "bullet time" - it can seem like minutes have passed, when it's only seconds.  Take the extra few seconds to organize your thoughts, or to read the page fully.  You've been trained, you can handle it.

Before you know it, your sessions will be boring. 

[Malibu]

rocker, than you for your account of what goes on in our home when we have these problems!!!  :O)  This is exactly what I am thinking and doing and you are right:  it seems like a very long time when it only has been 2 minutes!  .....laugh.......

Well we had to abort treatment again this morning.  MM insisted on sticking where the infiltrate was, I dont' know if that was the problem or not but...  We stuck the Aterial line, couldnt' get a flashback unless the needle was hanging halfway out, so after messing with it a couple minutes we said OK, you want to hang halfway out so be it and we taped it inplace with lots of tape.   We stuck the Venous access line, got a nice flashback, tested it, everything smooth.  Started treatment and his arm started ballooning up even more than it already was!  He hollared STOP!!!!!!!  Pain, anger, freaking out...we aborted treatment again.

I really wanted to go to the training facility because he is getting so angry at himself for these snafu's even though he should not be, and so I feel like he will continue to mess it up just because he is freaked out.  I wish I knew how to cannulate and what it should feel like with my finger on his skin...I cannot tell if it is in, out, or what.  I told him this am that I need to knwo what I am doing so I can fix a problem if/when he gets freaked.  We will work on that when bubble-boy deflates.  Until then I think we are going to stick A and V in the A side (where it is not so swollen and bulbous).  I believe they did this when we first started, like for the first 3-4 days.  Do any of you do that?  I'll call the nurse but just curious. 

How long will this blood (and now saline) take to reabsorb?  And is there any way to get it out?  I just want to poke and squeeze it!

[willowtreewren]

Malibu,
Since you have gone two days now without a treatment - CALL YOUR UNIT! Don't wait.

Let them help you through this. Just because you are at home doesn't mean that you cannot get any help. Your husband's helath is the most important consideration.

Call now and let them know what has happened.

[tyefly]

   OMG.....  this sounds so confusing........   I am sure I will have all these problems and more......   why cant life be easy......          

[rocker]

Malibu,
Since you have gone two days now without a treatment - CALL YOUR UNIT! Don't wait.

Let them help you through this. Just because you are at home doesn't mean that you cannot get any help. Your husband's helath is the most important consideration.

Call now and let them know what has happened.

Seconded.  Call now.

In my unit, if you are having trouble with treatments, they WILL WORK YOU IN even if they have a cramped schedule.

There is help available.  Use it.  They would much, much, much rather have you ask for help than to give up and go back in-center.

  - rocker

[Malibu]

We called them yesterday and they helped us through the disconnect.  They said to do treatment today.  We are going to try running again later today.

I suggested to MM that we head down there to the Davita at Home clinic and have them help us, he poo-poo'd the idea.  I wish I could make him but I can't. 

We never did in-center...the first day of at home training was his first day of dialysis ever.  We are truly newbies!

[Malibu]

OK I sent them an email detailing what happened, told them of our plan of action, asked a couple questions (Do we give heparin again?) and asked for advice.  I think they will probably call in a minute. 
Thanks guys for the support.

[Trikkechickk]

  I made a B00 Boo:

To abort a treatment:  Press Stop  Machine stops
                                Press Stop again - the numbers on face w/zero out; then ....
                                Press Stop again and hold

You should come up w/my favorite number 273 for rinseback.  Proceed w/Add Fluid.

If you have to abort on the venus line, first attach the arterial line to saline.  Then move venous line to the arterial needle connection, then proceed w/the stop procedure above.

[Malibu]

Thanks trikkechickk.  I did find the procedure misfiled in my flip chart.     Tee he he. 

Also we've instituted a monthly training, the 2nd or 3rd Sat of the month we are going to read a chapter out of our training book.  Perhaps this will help us keep info in the at the front of our minds.  Or at a bare minimum we will remember where to look for the procedure!

Guess what>>>>>>>>?  He is on right now!!!     We actually successfully attached the Venous line!!!  And ran with it! :O)  He will be done in 22 min.  COOL HUH??  I think he thought we would never be able to do it again.  Poor guy, ya gotta love him.  He has been down all day about this.

Thank you Thank you all of you for your support.  I really sincerely appreciate it.   

[willowtreewren]

So glad things are looking up, Malibu. 

[rocker]

 

[Malibu]

We have stayed away from the area that we were having trouble with and we have not had any further trouble.  I found out the surgeon who cleared the stenosis said to stay away from that area!  It is really deep and just not friendly. That is a real shame that about 1.5 inches of the 4 inches available is not usable.