Graft problems

[Adam_W]

The last week or so, I've been having really high arterial pressures when I dialyze. My usual blood flow rate is 450, but I'm usually able to run only 350 to 400. Then yesterday I checked my thrill and bruit like I always do, and the bruit had that weird whistling sound. I talked to my doctor and he thinks that it might be stenosis. He's setting me up to have a fistulagram (or I guess in my case, a "graft gram"). I've heard these hurt a lot so I'm not really looking forward to it, but I'll do what needs to be done to get my graft working right.

Adam

[jbeany]

The fistulagram is kind of a pain - but not horrible.  They give you some of that "twilight sleep" stuff that just makes you sort of groggy.  If you feel any real discomfort while they are ballooning the stenosis, they should give you more pain meds while they are doing it.  It's all done outpatient, so you'll be home that night.  They will warn you that if they mess up horribly, they will put a cath in before you leave so you can still dialyze, but that's pretty rare.  I've had 3 of them done since I started in Dec.  The worst part is actually the day after when your arm is so sore it hurts to cough or sneeze, so be sure you have a good supply of Tylenol for the next few days.  Cannulating the next day has never been a problem for me.

[angellady07]

Adam, I hope everything goes well for you. Take care.

[Adam_W]

I've just switched from 16G needles up to 15G monsters, and that has improved my bloodflow significantly, but the pressure is still higher than it should be. I can actually feel a spot at the bottom of my graft where it has narrowed. I have the fistulagram tomorrow (Aug. 10). My main concern  is dialyzing tomorrow afternoon. I've already taken my day off this week, but I may ask my nurse if I can take tomorrow off and dialyze all seven days next week when my arm is (hopefully) feeling better. I'll let you all know what happens.

Adam

[KT0930]

Thinking about you Adam, hope all goes well today.

[Adam_W]

I just got back from the procedure, and everything went well. There was a little bit of narrowing where the graft attaches to the artery, and they ballooned it open. There wasn't really any pain at all, and my arm is only very slightly sore right now. It seems to be flowing better now, so I'll see how my next treatment goes.

Adam

[KT0930]

Glad to hear it went well, Adam. Take care!

[goofynina]

So how have your treatments been since the procedure Adam?  I hope everything is running smoothly for you 

[Adam_W]

My treatments are going a heck of a lot better. I can go right up to my normal BFR, and my arterial pressures rarely go above 200, and before the fistulagram, they would run in the 250s with a BFR of only 350 to 400. I won't be switching back to the 16g needles, but I don't mind the 15g. Even though the needles are bigger, they still don't really hurt (and I've even stopped using anesthetic), and I haven't really had any more issues with bleeding, even though the needle holes are now bigger. I do hope I can go a while now without another "tuneup".

Adam

[jbeany]

The NxStage Rep told me that I'd have fewer fistulagrams with a Nxstage, since I would be using the graft more.  I have no idea if that's true, but I hope so.  I've only been on for a month, and I've been averaging a fistulagram every 3 months, so we'll see. . .