Snakey Fistula help (new fistula)

[angieskidney]

I worry because my fistula keeps bursting. I am worried that it is because they are not following the ladder pattern and instead are grouping the cannulation (is that such a word??). I have heard that makes the fistula weaker. But that is what the nurses are doing to me. Plus so many of the nurses do NOT know how to stick someone with a "snakey" fistula.. 

This is what my arm looks like right now 

[Panda_9]

Oh dear you poor thing that doesnt look good!! Why are they grouping the sites together? Cant they do buttonholes? Perhaps you could look at self cannulation if its allowed there, it is soooo much better!

[Joe Paul]

Looks painfull, sorry Angie, hope it gets better for you!

[Sara]

I'm sorry Angie.  Joe's arm looked like that, and worse at times, more in the beginning.  It's been getting better now, but I'm sure they are still infiltrating it.  I wish I had some advice for you.   

[BigSky]

You mean thats not normal?  Just kidding


IMO with new fistulas it is important to get the blood flowing at higher rates to toughen up the fistula.  If they stick new spots in a ladder system they are continually sticking fragile spots and thus have to keep blood pump speed down each time.  Grouping allows the spot to toughen up and let them increase speed to toughen up the rest of the fistula.  A second reason IMO is on new fistulas it is also easier on the nurse to stick a familiar spot instead of constantly moving around and missing on new fistulas. 

As to making it weaker, That depends on each person differently and how their veins are.

[angieskidney]

Why are they grouping the sites together? Cant they do buttonholes? Perhaps you could look at self cannulation if its allowed there, it is soooo much better!

I will be learning Buttonhole when I am switched to mornings. Then I can Self cannulate. But right now my fistula is still new and I don't even have my catheter out yet.

IMO with new fistulas it is important to get the blood flowing at higher rates to toughen up the fistula. If they stick new spots in a ladder system they are continually sticking fragile spots and thus have to keep blood pump speed down each time. Grouping allows the spot to toughen up and let them increase speed to toughen up the rest of the fistula. A second reason IMO is on new fistulas it is also easier on the nurse to stick a familiar spot instead of constantly moving around and missing on new fistulas.

As to making it weaker, That depends on each person differently and how their veins are.

Thank you. I just had a test done on Sat (do they do this at every time they do the labs? I don't know) to test the fastest flow I can get and mine was up to 700ml/min. So I was told I have excellent flow. Maybe that is why it blows so easily though? They run me at 400.

[Epoman]

Why are they grouping the sites together? Cant they do buttonholes? Perhaps you could look at self cannulation if its allowed there, it is soooo much better!

I will be learning Buttonhole when I am switched to mornings. Then I can Self cannulate. But right now my fistula is still new and I don't even have my catheter out yet.

IMO with new fistulas it is important to get the blood flowing at higher rates to toughen up the fistula. If they stick new spots in a ladder system they are continually sticking fragile spots and thus have to keep blood pump speed down each time. Grouping allows the spot to toughen up and let them increase speed to toughen up the rest of the fistula. A second reason IMO is on new fistulas it is also easier on the nurse to stick a familiar spot instead of constantly moving around and missing on new fistulas.

As to making it weaker, That depends on each person differently and how their veins are.

Thank you. I just had a test done on Sat (do they do this at every time they do the labs? I don't know) to test the fastest flow I can get and mine was up to 700ml/min. So I was told I have excellent flow. Maybe that is why it blows so easily though? They run me at 400.

That's a NEW fistula? looks nice and big to me, I could stick that from HERE! How old is it?

[Panda_9]

It does look like a good fistula doesn't it. Id like to know how old it is too. Mine has got very tough over time, it took a while though. Once its toughened up you should be fine. I think everyone is bound to have an infiltration in their dialysis lifetime. Good luck with the buttonholes, it should be so much better when you are in control.

[Epoman]

It does look like a good fistula doesn't it. Id like to know how old it is too. Mine has got very tough over time, it took a while though. Once its toughened up you should be fine. I think everyone is bound to have an infiltration in their dialysis lifetime. Good luck with the buttonholes, it should be so much better when you are in control.

Yeah if the nurses are infiltrating that fistula, then they must REALLY suck at their job or they really dislike Angie. From the looks of that fistula it should be a VERY easy stick. 

[angieskidney]

My fistula has been since May 31st 2006. The first attempt failed and this one had problems as well but at least it works.

Here is a pic explaining what I think you guys are counting as part of the fistula. Ever since the surgeon had to go back in and clear out blockage I have had that bigger part which is at the beginning of the fistula but is not part that they stick. The rest of it is not that big at all. But it is slowly getting stronger and is very snakey. Today they gave my arm a break and used my catheter.

Look where they stick me .. the fistula is not the big yet. Does everyone who has had the surgeon go back in to get rid of blockage end up with a big part like that? That is where he went in and jabbed real hard over and over again while it was numbed. I couldn't see what he did but I was told he did something with a balloon??

[Panda_9]

Well that explains things then!!! Only being a few months old explains the cannulating problems. I would probly continue with the catheter for a little while longer so it can develop a bit more. I have a massive bulge at the start of my fistula, think that part is called the astenosis (where the join is). You dont stick there.

[angieskidney]

I have a massive bulge at the start of my fistula, think that part is called the astenosis (where the join is). You don't stick there.

Ah ok. Thanks that does answer a lot. I will look up 'astenosis' for more info.

Anyway, turns out when I just got the 2nd Fistulogram on Monday Aug 21st that I had a huge spot that was narrowed and that is why it kept blowing. Ever since the surgeon went in with a balloon and fixed it .. I had dialysis Monday, Wed, and tonight and no blows!!!! I am soooo ecstatic about it that I can't contain myself

I am hoping that I will not have problems again for a long time and that they can finally take out the catheter that is in my chest and that I can finally go swimming. Too bad it is looking like it will be AFTER the summer is over however. 

One thing I have noticed, since the fistula has been fixed it is not so dramatically snaky and the nurses can actually cannulate it successfully! I guess Epoman was  right about saying that my fistula IS  big enough. I should not have doubted him .. but I just didn't think my pic was good enough. 

[BigSky]

I think this is the word she was looking for anastomosis.

[angieskidney]

I think this is the word she was looking for anastomosis.

This is what I have found about that but all sites on this are so medical.

[Panda_9]

Whoops sorry got my words mixed up. Anastomosis is where the artery is joined to the vein. This aterialises the vein, which is why you get the bulge. 

[angieskidney]

Ah okay! Thanks! I didn't know what to call it when people thought the bulge was my fistula and were saying it is big