New Fistula

[Annette]

i just started using my fistula Wednesday with two needles!  After 3 failed surgeries it was finally ready to use. I can't really say I am loving it, but i will be glad to get the cather out of my chest in two weeks, providing the fistula works OK.  I kinda miss just whipping out the cather and letting them unscrew it and watching the blood flow.  Now I have to get stuck two times well actually three cause I get the numbing shot first! Yes i take the chicken juice!  It is my friend.  Do you ever get used to the stick?  I also have a problem holding it after they pull out the needles  . The buzzing makes me sick to my stomach. Hope to get used to it soon!

[Zach]

Congrats on the fistula!

Are you continuing to exercise it?  The longer you do, the stronger (blood flow) it becomes.

And you'll get use to the buzzing.     

[Annette]

I haven't been as faithful to the exercise as I probably should!  When you say exercise are you talking about squeezing the ball?

[Zach]

I haven't been as faithful to the exercise as I probably should!  When you say exercise are you talking about squeezing the ball?

Yes, the ball.  It really is important. Maybe a little later on you could use a can of soup and do some bicep curls.  But you need to discuss that with your Nephrologist.

I've had my fistula for many years ... and still going strong (me and the fistula).     

[Joe Paul]

I haven't been as faithful to the exercise as I probably should!  When you say exercise are you talking about squeezing the ball?

You'd be surprised how the ball makes things bigger and better. So far as the holding goes, do they have clamps there? The buzzing don't bother me, but my left hand cramps often waiting for the bleeding to stop, so I have them use clamps.

[susie q]

Today was supposed to be my first try with 2 needles also... well, nursie poo put the venous needle in first and blew it.. .. back to one and one.. 

[meadowlandsnj]

I'll be ready to use my fistula in about 3-4 weeks they say.  I'm not looking forward to it but it'll be better than than the catheter which is getting old.  I keep getting them replaced and they don't work right.  I was just in Wednesday to get one replaced and they gave me a much longer one so hopefully it'll work better and I won't be going in for TPA every treatment like I have been doing. 

[charee]

I am booked in to hospital 9th October to get my fistula , its going to be in the upper arm, everyone here mentions squeezing a rubber ball, no docs have mentioned that yet, does it still help with a upper arm one ? and  how long after the surgery should you start to do it ?

[Epoman]

I am booked in to hospital 9th October to get my fistula , its going to be in the upper arm, everyone here mentions squeezing a rubber ball, no docs have mentioned that yet, does it still help with a upper arm one ? and  how long after the surgery should you start to do it ?

Upper arm or lower arm exercising the arm WILL help develop your fistula. I think for an upper arm fistula "arm curls" would be best. It is funny you mention that the docs didn't mention anything about exercising to develop the fistula, I am finding out from members that some docs don't mention it at all. 

[charee]

Thanks Epoman I will mention it at my next appointment curious to see what his view is, keep you posted .

[Rerun]

Zach and Epoman......after all these years do you "still" exercise with the ball to keep your fistula big?    

[Epoman]

Zach and Epoman......after all these years do you "still" exercise with the ball to keep your fistula big?    

Not me, I don't want it to get bigger. Mines huge.

[Zach]

Zach and Epoman......after all these years do you "still" exercise with the ball to keep your fistula big?    

I do bicep curls with light weights.  I do it as part of my exercise routine ... but it has also helped lower my venous pressure.   

BTW my fistula in down around my wrist.     

There is a small study (5 patients) that has recommended exercising the fistula arm three months before the surgery.  Has anyone heard of that before?  Sounds like a good idea.

I had my fistula for almost a year before I started dialysis.

[angieskidney]

I just started having 2 and 2 (the 15 gauge ones) just last month. My first fistula failed after 10 days. So I know what you mean. And my 2nd fistula kept blowing. I have already had 2 fistulograms because of all the problems. Infact I have had so much trouble that I still have my catheter! I was hoping to be able to swim this summer 

You and I could swap stories at this rate  

Upper arm or lower arm exercising the arm WILL help develop your fistula. I think for an upper arm fistula "arm curls" would be best. It is funny you mention that the docs didn't mention anything about exercising to develop the fistula, I am finding out from members that some docs don't mention it at all.

My Surgeon didn't tell me to exercise neither. He was saying that I wouldn't need to. Turns out I DID need to! He was wrong about my fistula being easy and big .. when he operated trying to make it the first time he came around saying it was too small and that was why it failed after only 10 days. I have learned that it does make a difference if you get the surgery before or after dialysis (before is best).

[Zach]

And my 2nd fistula kept blowing. I have already had 2 fistulograms because of all the problems.

From the K/DOQI Guidelines of the National Kidney Foundation (U.S.A.):

Technique for AV Fistula/AV Graft Cannulation
 ... After skin preparation, pull skin taut in opposite direction of needle insertion.
 ... Use approximately 45 degree angle of insertion for AV graft and approximately 25 degree angle for AV fistula
 ... Once the vessel has been penetrated, there are basically three methods employed in extant practice:

1. Advance the needle slowly with cutting edge facing top of vessel and do not rotate axis

2. Immediately rotate the axis of the needle 180 degrees and advance slowly with cutting edge facing bottom of the vessel

3. Advance the needle to desired position, then rotate the axis 180 degrees

 ... Tape the needle at the same angle or one similar to the angle of insertion
 ... Remove needle at same or angle similar to angle of insertion, and NEVER APPLY PRESSURE BEFORE NEEDLE IS COMPLETELY OUT

For more information, including explanations please read:
http://www.kidney.org/professionals/kdoqi/guidelines_updates/doqiupva_iii.html#14

[AlasdairUK]

Zach,

With exercise and lifting weights, what are safe limits for a fistula? Mine is in my upper arm and it is six months old with a high blood flow.

I have had conflicting advice: My fistula access nurse is happy for me to lift weights and all the other dialysis nurses tell me not to lift anything. Exercise can only be a good thing.

I was given a ball to squeeze even though my fistula is in my upper arm and it seemed to help strengthen it, I no longer squeeze a ball as mine has matured enough to use 14g needles.

Thanks
Alasdair

[Zach]

I use relatively light weights (10-15 lbs.) on the bicep curl for the left arm.  Sometimes even lower weights with higher reps.

Since your fistula is on the upper arm and mine is near the wrist, I can't say what's good or not in your situation.  The upper arm fistulas I've seen are usually large enough without additional weight training exercise.

But definitely continue doing weight training exercises for other parts of the body.  It can only help in the long run, despite what some people here say.     

[angieskidney]

And my 2nd fistula kept blowing. I have already had 2 fistulograms because of all the problems.

From the K/DOQI Guidelines of the National Kidney Foundation (U.S.A.):

Technique for AV Fistula/AV Graft Cannulation
 ... After skin preparation, pull skin taut in opposite direction of needle insertion.
 ... Use approximately 45 degree angle of insertion for AV graft and approximately 25 degree angle for AV fistula
 ... Once the vessel has been penetrated, there are basically three methods employed in extant practice:

1. Advance the needle slowly with cutting edge facing top of vessel and do not rotate axis

2. Immediately rotate the axis of the needle 180 degrees and advance slowly with cutting edge facing bottom of the vessel

3. Advance the needle to desired position, then rotate the axis 180 degrees

 ... Tape the needle at the same angle or one similar to the angle of insertion
 ... Remove needle at same or angle similar to angle of insertion, and NEVER APPLY PRESSURE BEFORE NEEDLE IS COMPLETELY OUT

For more information. please read:
http://www.kidney.org/professionals/kdoqi/guidelines_updates/doqiupva_iii.html#14

Why do you rotate the axis?

Also I have had them apply pressure when the needle is not completely out because the 2 needles are placed so close to each other at most times

[sandman]

Why do you rotate the axis?

I believe I may know why but I think I will leave that answer to someone who is more qualified. 

[BigSky]

Why do you rotate the axis?

Also I have had them apply pressure when the needle is not completely out because the 2 needles are placed so close to each other at most times

Some people find it easier to stick themselves edge up or down but once needle is in they rotate it to achieve a better pressure.

My arterial I stick edge up and leave it.

My venous I stick either edge up and rotate it or stick myself edge down and leave it as when cut edge is down on my venous I get a better venous pressure.

[redheadedangel]

Both of my fistulas and grafts in my arms failed. So I went straight to my leg.Graftwas successful, however the nurses never are. Always it takes atleast three sticks. Geez..I need a group hug. thanks. and a beer oh hell and some pop corn ...Now I feel better. Yes I know that's not on my diet but Epoman allows it on here.LOL. I would gladly take an extra shot to bypass the pain of (2) 15 guage needles!But it is not offered where I am. I have a hard time stopping the bleeding afterwards. Sure Sassy of course you do! damn big hples in your legs girl! So, I carry with me an ice bag and apply it afterwards. Works for me.  Good luck Sweetie..Oh yea, if ya smile when you look at your nurse it makes them wonder what you're up to.  .Sassy

[angieskidney]

Both of my fistulas and grafts in my arms failed. So I went straight to my leg.Graftwas successful, however the nurses never are. Always it takes at least three sticks. Geez..I need a group hug. thanks. and a beer oh hell and some pop corn ...Now I feel better. Yes I know that's not on my diet but Epoman allows it on here.LOL. I would gladly take an extra shot to bypass the pain of (2) 15 guage needles!But it is not offered where I am. I have a hard time stopping the bleeding afterwards. Sure Sassy of course you do! damn big hples in your legs girl! So, I carry with me an ice bag and apply it afterwards. Works for me.  Good luck Sweetie..Oh yea, if ya smile when you look at your nurse it makes them wonder what you're up to.  .Sassy

Have you ever heard of Emla cream? The don't offer the shot in my unit neither so I went to the drug store and asked the pharmacist for Emla cream (they keep it only behind the counter) and paid for it out of pocket but it is worth it. You put it on ONE hour before your get sticked and you wrap the area with Saran wrap to keep it from evaporating (some Pharmacists will say you don't need to do that but trust me from experience,  you DO and it works!).
(sorry about the run on sentense lol)

@ Bigsky:
Thanks BigSky! That helped a lot!

@Sandman:
I know Sandman that you could "figure it out" but so can I. I wanted someone who knows for sure to answer. Thank you for holding back. It is much appreciated.

[geoffcamp]

I have had my share of problems with fistulas and grafts too!  When I first went back on dialysis after my transplant failed a doctor told me I could not get a fistula because my veins were too small.  So he told me about this state of the art amazing graft that would be perfect... so I took the bait and said do it.  Well it lasted less then a week and clotted!  So I went to the translant center and they took a look and said my veins were small but they could do one!!!  So they cut me all the way from my inner elbow to under my are and got one working.  It worked great for over 5 years then after a big problem with high blood pressure my docs put me on a bunch of meds that lowered it all right and clotted my fistula!  After 4 or 5 attempts to unblock it it only worked for a few days after surgery.  So the ended up fixing up a graft using bovine vein (some bio-engineered thingy!)  that acts more like a fistula then a graft and we got the blood pressure back up and everything has been good for about a year now!  But my access is all the way up almost to my armpit and is inside my arm.. it is not an easy stick but my center has some good techs and they got the hang of it and now everything is going well!  I know what you mean about swimming, I had that stupid cath in for a few months and I hated it.  I swim almost everyday living in Florida and could not stand it!  I also work out but I have not restricted my weights.  My doctors told me it would be fine to work out with no restrictions so I don't put any on myself.. i usually curl around 50lbs and do pull down triceps at 70lbs and i have never had a problem.

[angieskidney]

My first one failed and the Surgeon told me that it was because MINE was too small as well Don't you hate that?

My 2nd one worked however!!