button hole problems with low blood pressure at end of treatment

[WD]

Recently, after 10 months on NXstage using button holes, I am experiencing an aching and buring pain at my access sites and my blood pressure begins to lower rapidly causing me to quite my dialysis treatment anywhere from an hour to 15 minutes early.  Has anyone experience this and is so, what can be done about it.  Do you know the cause.  It makes me nauseous, and feel as if I'm going to pass out.   My center says they've never heard of this but I can't believe it's never happened to anyone else.  They want to start new button holes but I only want to do that as a last result.  My needles have always hurt going in but it only lasts a few seconds.  Help if you can.  Thanks.  WD

[boswife]

I know this is probably not it, but the other day at the NxStage unit, i had asked about running the machine slower and they said slow is good but you have to watch that because too slow can cause your blood to clot.  same as if your blood pressure drops to much it is not going through the tubes fast enough and may clot.  I wonder if your just before clotting (if thats even possible) and thats causeing a strain through the tubes???  Heck, i dont know but something you might ask.

[looneytunes]

WD, based on our recent past experiences, I might suggest you contact NxStage Tech Support to see if they want to check out your cycler.  They replaced ours just this past weekend because there were some discrepancies between the UF that we set the machine to pull off and hubbys weight when he was done.  We don't really know if there was a problem with the machine or not (we have had it since April) but if they were willing to fly another one in and deliver it on a Sunday, I suspect they saw something in the logs and our run sheets that they wanted to look closer at.   They are always very helpful and if the machine checks out ok, then at least you've ruled it out. 

Best to you.

[M3Riddler]

Recently, after 10 months on NXstage using button holes, I am experiencing an aching and buring pain at my access sites and my blood pressure begins to lower rapidly causing me to quite my dialysis treatment anywhere from an hour to 15 minutes early.  Has anyone experience this and is so, what can be done about it.  Do you know the cause.  It makes me nauseous, and feel as if I'm going to pass out.   My center says they've never heard of this but I can't believe it's never happened to anyone else.  They want to start new button holes but I only want to do that as a last result.  My needles have always hurt going in but it only lasts a few seconds.  Help if you can.  Thanks.  WD

WD,

I very much doubt it is a machine issue.  What is your blood flow rate?  When you run at higher blood flow rates, this can stress your fistula/veins from the turbulance of the high pressure. It is common for those running at high flows >400 to experience this. 
Longer and slower dialysis is much gentlier on the body.
Slower flows are also gentlier on the fistula.  Yes, slower flows may require more heparin but many are on extended treatments or nocturnal with blood flows between 200 and 300. It can be done.

There is a vascular access/cannualtion nurse who may be able to help you. You can find him here: 
Cannulation Issues
If you choose to ask him a question, please be as detailed as possible when describing the problem....blood flow rate, size of needles, treatment length etc...

Hope this helps...

///M3R

[JohnJ]

Recently, after 10 months on NXstage using button holes, I am experiencing an aching and buring pain at my access sites and my blood pressure begins to lower rapidly causing me to quite my dialysis treatment anywhere from an hour to 15 minutes early.  Has anyone experience this and is so, what can be done about it.  Do you know the cause.  It makes me nauseous, and feel as if I'm going to pass out.   My center says they've never heard of this but I can't believe it's never happened to anyone else.  They want to start new button holes but I only want to do that as a last result.  My needles have always hurt going in but it only lasts a few seconds.  Help if you can.  Thanks.  WD

No idea why you have the low B/P. Your doctor should be on this immediately.

As far as the pain it happens to me occasionally. I simply start two new accesses and use those for a couple of days. Then I go back to the original ones. I realize that my background in medicine helps because using a needle is no big deal but trust me..it's easy. You might want to ask a nurse to be there when you do it the first time but trust me..YOU know where your fistula is. It's not hard at all to hit it....just don't be scared.

[sbrown2459]

I have hemodialysis 3 times a week. I used to take medicine for high blood pressure, but my pressure dropped so much during my treatments my doctor told me stop taking the medication. Every time I  have a treatment, my blood pressure gets very low and the techs always ask if I feel okay. Usually about  60 to 30 minutes before the end of my 3 1/2 hour treatment, they turn off the rate and quit removing fluid and instead give me saline. Without the saline, I feel nausea and my vision is blurred. At the end of each the treatment they will not release me until by blood pressure gets up to at least 92. My doctor said that some people's pressure increases during their treatment. More people are likely to have a lower pressure.

[M3Riddler]

sbrown,

This is very common for in-center dialysis.  What is more than likely happening is that they are removing too much fluid too fast. This not only causes blood pressures problems, but is very stressful on the heart. The in-center approach to this is to give you more fluid.... Now, you have just been sitting there for a 3 hour treatment to remove fluid ( and toxins) and they give you more fluid at the end of treatment.... What sense does this make... It is like a roller coaster ride....
When you remove too much fluid or remove fluid too fast, the bodys response is for the blood pressure to drop. You may also feel nauseated and have a sick feeling for several hours. You may also experience head ache.
There are three compartments in which fluid resides and must pass in order for it to be removed in dialysis. It goes from the tissues of the body - to cells - to bloodstream. When it reaches the bloodstream, this is what is being removed by dialysis.
Problem:  The body is only capable of removing a certain amount of fluid per hour since the bloodstream can only hold a certain amount... This amount is approx .400cc's (.4L) give or take a few hundred cc's per each individual depending on weight/height etc.  So lets say it is 600cc's or .6L.  If they are taking more than that off per hour, or lets say 1800cc's ( 1.8Liters) per treatment, then you may get the washed out horrible feeling. You are stressing not only the heart, but also your fistula/veins.  It takes approx 1 hour for the fluid to move from one compartment to another in the body.

I have been in-center and most people after their day off, are removing much more than the 1.8 Liters per treatment. They can remove as much as 5 liters or more in a 3 or 4 hour treatment. This is stressing the heart entirely too much.

For all of those in-center -
Also, with in-center, they are running people at entirely too high of blood flows. Sometimes 5-600 pump speed. This also can cause issues with your fistula/heart.  The reason they do this is that they are required by CMS for you to reach a certain KT/v each month.  Since you are only there for 3 or 4 hours every other day, they must crank up the blood flow to each this goal.
The fact is that more dialysis and slower dialysis is much better for you. It is gentler on the body, and removes more of the toxins from the body. No head aches, no washed out feeling, no bp drops.
The aggrevating thing is, the nephrologists know this. So why do they not offer it to in-center patients...The answer is, they must get you out in order for them to get the next patient in. Most in-center patients are not receiving opticmal dialysis, but rather adequate and sometimes not even that. 
Nost in-center patients will not question their nephrologist but rather take their word as what goes.... So for your own health, ask your nephrologists - ask them if the nausea, bp drops and washed out feeling is related to the high blood flows and pulling too much fluid off too quickly.....
Research dialysis and how the settings affect you..... Do you want adequate just getting you by or do you want optimal?
Is home dialysis possible for you?