anybody using 16 gauge on-going?

[sullidog]

My neph has me running 15 g 450, his rule is if it doesn't get up to 450 3 treatments or so in a row time for a fistulagram. I disagree with him on that. Most of the time if it can't do 450 it can do 400 and to me that's fine. I once new an in center patient who had a leg graft and ran 500 with 14 g. Not sure how she did that one.

[M3Riddler]

thanks everyone for your replies.  I've been "out of the loop" for a while.
With my limited understanding of fluid physics  I think: the bigger the needles and the slower the BFR, the less turbulence and stress on the inside of the vessels.  But, depending on the size and condition of your access, the bigger the needle, the greater risk of damage as well.

At this point, I'm at a loss as to what is the best route for me.  I hope I can establish buttonholes with 16G, run as slow as possible while still getting adequate dialysis, and then perhaps up to a 15G some time in the future, when I can do it myself and am sure my vein is ready.  And stay with the slowest rate that works for me.

Thank you all so much for your input!

Fearless,

You can indeed use 16g needles with buttonholes. I have been doing it for 7 years now.   I run at 280 blood flow.

[lmunchkin]

We've been using JLM 15G needles since the start.  Running BFR between 300 to 350.  Sometimes I will run it at 370 bfr on the last day before being off, so as to shorten his time on machine.  John's weight as of late, has been less than his dry weight for some reason.  I don't know if he is not eating while Im at work or just eating & drinking alot less. 

I may have to adjust his dry weight, but will wait to see what Neph says when we go to clinic.  I have been D'ing him but not taking anything off.  His labs have been right on the past few months, so I can't complain.  I applaude his efforts immensley!

But back to the needles, all we have ever used is 15G (Sharps).  We do not do Buttonholes btw!  Have always done the ladder method.

God Bless,
lmunchkin

P.S.  Brita puts out a new cup that has a filter iin it, that filters any drink you put in it.  To get anything through the filter, you have to squeeze the bottle to get it to squirt.  I purchased one for John and it limits the amount of fluid he drinks.  He says that it has stopped him from guzzling his drinks.  He now just takes swigs.  That is huge when it comes to retaining fluids. Sorta like a sippy cup but its a 20 to 24 oz glass with a filter.  Its cool, so check it out on line if interested.  Google Brita and it should come up.  Check out Products!!!!!!  He never drinks more than half of that in a day.  That is great and I truly believe, it has helped him to maintain his gains!

[amanda100wilson]

Noahvale,  needles I served all the way to the hub can give rise to Hibbing.  this is where the hub works I to the entry point of the access and can enlarge the hole which can result in leaking.  optimal set-up to prevent this is to leave a small amount of metal showing.

[noahvale]

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[M3Riddler]

We use 14 gauge and our nurse told us we could run at 550 bfr. I was a little dubious at first, having read a lot of admonitions against the higher blood flow rate. I asked her if it would damage his buttonholes or blood vessels and she said no. Now, I trust this woman and she's shown her intelligence and reliability in so many ways. And she regularly attends NxStage training and is in constant communication with them. We have been doing this for a few weeks now and no issues as far as his access or health that I can detect. We are doing 30 liter treatments and processing around 80-85 liters of blood per treatment.

Chiawana,

Your nurse couldnt have misinformed you more.  High blood flow can certainly cause damage to your fistula and heart.  I have been on dialysis for over 20 years and if there is one thing I leanred, it would be to educate yourself in all areas including what caused your kidneys to fail, the type of dialysis you are on, the difference between the different modalities and learning about your access and what affects them.
I would not expect an in center nurse to tell their patient that what they are doing could possible harm them, short or long term for obvious reasons. 
I could provide you with several studies and articles on this subject. High blood flows can cause damage to your vein walls or epithelial layer by breaking it down over time. It also causes stress on the vessel as well as LVH - Left Ventricular Hypertrophy to the heart. This is very known and I'm sure your nurse knows what this is if you ask. 
I will attach two files, Ine about the effects of high blood flows and the other about LVH.  I cal also provide any additional info you would want. I encourage you to read them and educate yourself when you can. 

File 1 = Blood Pump Spped and your Dialysis Fistula
File 2 = LVH - Heading off a Common Heart Problem

Both Files can be found on Home Dialysis Central's Website. at  http://homedialysis.org/

Just because your nurse is in contact with and is properly trained, she certainly should know the effects of high blood flows. 

Hope this info helps!!

///M3R

[M3Riddler]

If you are on Home dialysis don't you use the button hole?  It would seem you could use 16ga or whatever you wanted in the blunts.

I highly recommend buttonholes if doing home dialysis, but not necessary.  I use 16g by 1 inch.