Single Needle Dialysis

[Rerun]

I am having surgery on my fistula tomorrow morning and he is going to fix a pseudo aneurysm.  The problem may be that there is not room for two needle dialysis for a few weeks until the incision heals.

20 years ago we did dialysis with one needle and it had two holes in the end.  Anybody remember those?

W&W I called your center and they said they don't do single needle sticks.

I'm afraid they (Doctor, clinic, etc.) won't want to take the time and effort to look into this.  They will just want to stick a catheter in me somewhere.

Tell me what you know about single needle dialysis.     

[cherpep]

Never heard of single needle dialysis.  I want to know more!!

[Adam_W]

I've heard that single needle dialysis is less efficient. I'm not sure exactly why because I know nothing about it, that's just what I heard somewhere.

Adam

[David13]

Rerun, I found this information from RenalWeb:

"The single-needle system, as the name suggests, requires only one needle to perform hemodialysis. The blood-flow through the needle is continuously reversed. This method is not popular in hemodialysis units because it can’t deliver high blood flow and therefore results in poor dialysis. In the case of Nocturnal Dialysis, with its long duration and high frequency, high blood flow is not necessary. Therefore, single-needle dialysis is excellent for Nocturnal Dialysis."

[Rerun]

David you are an angel!

               

[Bill Peckham]

One other thing to consider - along the lines of a single needle - would be to drop the needle gauge down to 17 or even 18. This would require lower blood flows, like single needle meaning less efficient treatments but I agree that efficiency is less of a concern if you're doing nocturnal.

I think your instincts to avoid a catheter is smart. What do you think about smaller needles? Would that make using the fistula an option? - when I had my fistula revised I switched to 17s for a while but I had unrevised space to stick - virgin fistula territory. Do you go any unused space that could accommodate smaller diameter needles? What size needles do you use now? If you're using 15s then the 17 or 18 would look tiny by comparison.

FYI cherpep: The reason we might see home nocturnal hemodialysis machines that use single needle in the future is that it gets around the concern about venous line disconnect - if the needle comes out/is disconnected the arterial is disconnected too which would make the machine alarm/stop immediately.

[Rerun]

Thanks Bill.  I went over to the dialysis center because the staff is there setting up for Nocturnal.  They only have 17ga not 18.  But 17 is better than 16.  They said I had more room than I thought because my fistula turns a corner which I guess I thought was where it was "the hook-up".   So we will see tonight.

I just can't be the only person who could benefit from single needle dialysis in a pinch while a fistula revision is healing.  I've seen the needles online to be ordered, I've seen the directions for the Fresenius Machine for set-up for single needle.  But, no one wants to go there. 

[Wattle]

Hi Rerun,

I am not sure if this helps but Jay72 does Nocturnal with a single needle.

http://ihatedialysis.com/forum/index.php?topic=11002.0

I hope the surgery goes well.   

[Rerun]

Hi Rerun,

I am not sure if this helps but Jay72 does Nocturnal with a single needle.

http://ihatedialysis.com/forum/index.php?topic=11002.0

I hope the surgery goes well.   

Thanks you so much Wattle!!  Jay is in Canada, but just the same I can prove to my doctor that it can be done!!   

[draven]

i had single needle dialysis once, when the nurse accidentally stuck me wrong and the head nurse decided to use 1 needle instead. i was on the machine for 4 hours but they did not take enough fluid off and i felt under dialyzed. so unfortunately 2 needle dialysis is needed for a proper session.

[Rerun]

i had single needle dialysis once, when the nurse accidentally stuck me wrong and the head nurse decided to use 1 needle instead. i was on the machine for 4 hours but they did not take enough fluid off and i felt under dialyzed. so unfortunately 2 needle dialysis is needed for a proper session.

Are you sure it was only single needle dialysis, or did she hook the other end to your catheter with one needle left in your arm.

You are correct that single needle is not as efficient.... except with Nocturnal where you are there 8 hours.  AND I would think single needle would be a better option than a catheter.

[pelagia]

I found this link to a first hand account of someone using single-needle for nocturnal.

http://stanford.wellsphere.com/kidney-failure-article/single-needle-dialysis/163443

[Rerun]

Well, people here are just blowing me off.  I can't understand why they can't see the possible benefits for people with healing fistulas.  No.... they can easily generate work for the hospital and surgeons by shoving a catheter in someone's chest or in my case my "leg". 

I'm standing my ground.  They can set up a machine for a single needle stick.

Thanks, I appreciate all the information you can find for me.

[Bill Peckham]

Well, people here are just blowing me off.  I can't understand why they can't see the possible benefits for people with healing fistulas.  No.... they can easily generate work for the hospital and surgeons by shoving a catheter in someone's chest or in my case my "leg". 

I'm standing my ground.  They can set up a machine for a single needle stick.

Thanks, I appreciate all the information you can find for me.

I agree. Go get them Rerun.

Especially considering they offer nocturnal incenter hemodialysis, single needle is a good option for people in your situation or anyone who in consultation with their doctor thinks single needle is the right choice.  I'd be interested to know what exactly is involved ... checking a box on an order requisition and swapping out the blood pump? After the first one it'll get easier.

[willieandwinnie]

W&W I called your center and they said they don't do single needle sticks.

rerun, I am so sorry. I haven't been on all week. That clinic in Leonardtown did do single needle dialysis in 2002. I was there. The were 2 patients that I know of that they used just one needle. Have things changed that much in 7 years? I hope you get things figured out and again I'm sorry I didn't get a hold of you sooner. 

[Rerun]

Last night they did get two 17ga needles in my "small" area for 8 hours of dialysis.  The Arterial was alarming all night because my arm practically lays right on the needle.

My Nephrologist came in and he said he is interested in pursuing this.  He has asked me to contact the company and have them send us 4 or 5 samples of the needles. I have emailed Baxter and Gambro.

I'm more interested in finding a clinic that does single needle dialysis and find out the pump that would be needed and the protocol that would be in place at there clinic. 

I did email Jay72 but he has not been online for a few days. 

Come on Jay.....               

[thegrammalady]

very interesting. would shorter needles be of use? they really do exist, i've seen them and used them. worked well for me.

[Rerun]

Jay finally PM'd me back with his center's phone number.  I called them in Canada and the lady was very nice.  She is a nurse and has been in the dialysis field for 30 years. 

She told me that ALL her home nocturnal patients were on single needle dialysis.  She told me that the Fresenius K and the Fresenius @homeK were all capable of single needle dialysis if you buy the right component.  Once you get the correct component then the machine will do either single needle or double needle with the push of a button.

She told me I would have to get single needles and the correct tubing.  She told me when I order the component it comes with a step-by-step book on procedure.

Today I will try to find a Fresenius Representative willing to talk to me and give me some samples and information to present to my Nephrologist.

It is funny how Canada (Socialized Medicine) has this procedure already in place and we (USA) don't.  I thought Socialized Medicine was bad???  It all boils down to $$$$ and we will see if the docs around here are willing to put down the bucks for better treatment for healing fistulas.  They may not want to give up the income generated to the surgeons and hospitals for catheater insertion.

[cherpep]

Great work, Rerun!!!   This is extremely interesting.  Thanks for sharing the information. 

[David13]

Rerun, I am sad that it is requiring so much time and effort by you to simply get the care you deserve, but I admire your persistence. 

Go get 'em!   

[Rerun]

When I finally got the name and phone number of the Fresenius representative in this area, he asked me what doctor I have.... I told him ... and he said "oh, Leo".

Hmmm sounds like my doctor sent me on a wild goose chase.  If my doctor really was interested in single needle dialysis wouldn't you think he would give me a place to start?  "here is the name of my Fresenius rep., give him a call and see what he says".

I emailed this guy all the information that I have found.  So we'll see.  I can see the chips are stacked against me.

I also realize that the people that use single needle are on extended nocturnal.  So they dialyze six nights a week.  I only dialyze 3 nights a week, so the recirculation that the single needle provides may bring down my labs.

But, if your fistula is trying to heal over 3 weeks single needle is still a better option than a catheter which provides recirculation also.

[David13]

I also realize that the people that use single needle are on extended nocturnal.  So they dialyze six nights a week.  I only dialyze 3 nights a week, so the recirculation that the single needle provides may bring down my labs.

But, if your fistula is trying to heal over 3 weeks single needle is still a better option than a catheter which provides recirculation also.

I agree!    

Don't give up, Rerun! 

[Savemeimdtba]

I don't know much... but I really think almost anything is better than those catheters.  All the Dr's and nurses do is complain about how bad the catheters are and how inadequare the dialysis is.. so, why put you through that if you don't have to?  From my perspective, the results you get from the single needle would probably be better than the catheter...

and btw, if they're so horrible - why haven't they come up with something new?  Seems to me they figure if you're not dead, it's working.. and that's not good enough for me. 

[Rerun]

The Fresenius Rep has not answered my emails or my phone calls.  So.... I called to get the name of the Idaho Rep.  He could tell I was pissed off and is going to call the guy for me.

Damnit, just at least email me and say "i'm working on it".  What is wrong with these people!

They just plain don't want to look into it or do anything.       

I wonder.... if I posted this guys phone number and about 500 of us called him and left a message that we are interested in single-needle dialysis if that would light a fire under his ass?

                           

[Rerun]

This is the information from Fresenius if anyone else is interested:
Good morning Darla,

The information that you are looking for in regards to Double Blood Pump and Single needle option I've attached below:

Double Blood Pump w/single needle/single nob - $1,650.00 ea

Single Needles #820-3500 15G Fixed Back-eye - $59.69 per box/ 50 needles per box

Single Needle Blood Tubing - #03-2696-7 $104.40 per case / 20 bloodlines per case

Note: The instructions for use of single needle/double blood pump, should be in the 2008K operators manual (that the units already have with each machine purchase)

Best Regards -

P.S. As I get more information I will pass it on to you.