start out flow speeds w/new fistula

[tyefly]

   Well I thought I would start a topic on flow speeds and a new fistula on the nxstage system...... I don't have a clue and I know its comming soon......  I will start training on the nxstage system write from the beginning of my dialysis as I have never done dialysis before.... new fistula and all......  Since I am going to be learning alot.... I was wondering if others can give me some insight to blood flow speeds , need gauges.... and that type of thing....  I am sure that the center has protocol.... well I hope so... they have only trained 7 people so far on the nxstage system ... and when visiting the center... well  I hope everyone was just tired that day cause I did see alot of confidence in their opinion of the nxstage system.... They did however tell me that they  would do buttonholes right from the get go.....
   So  when I first start....   I will do something like a 17 ga needles and how long do you think I should stay with that size before moving to a bigger size..... what kind of flow speeds should I start out and for how long..... something like 200  and what about distillate speeds.....  This is a new fistula and My plan in the try to go as slow as they will let me and to dialysis as long at they will let me .... I keep hearing that from them   they like to run at least 450 to 500..... isn't that fast for a new person........   I wish I knew someone who was close to my house doing the nxstage system and I could talk to them.....  Its not like I don't trust what they have to say  it just that they dont sound like they are very confident is what they are saying....They seem confused and unsure..... This is the only training center for nxstage in my area under my insurance plan.....

[willowtreewren]

When my husband started dialysis last summer he spent a week at each needle size before moving to the next. Once he had dialyzed for a week on the 15 gauge needles we started our NxStage training. They kept us in training for 5 weeks, but I hear from many others that the training is shorter. The up side of our extended training is that we rarely make mistakes (until THIS week). 

We run at 400 blood flow, but his sister who is also on NxStage in another state runs at 500. Before I knew better I wanted to increase his blood flow in order to decrease his time on the machine, but now I want him to go slow and easy.

Your nephrologist will be making the calls regarding the amount of dialysate per treatment, the blood flow, dialysate speed, etc. Keep asking questions. The more you know, the better able you will be to monitor your treatments.

Aleta

[petey]

When Marvin started home hemo two years ago, they used the gauge needles (15) that he had been using for years on in-center.  The only difference was that after the first eight days, they switched from 15-gauge sharps to 15-gauge buttonholes.

Also, the first day of home hemo, Marvin started at a 450 BFR (well, you know, the first few minutes, it's 200 BFR and then we work up to 450 within about 5 minutes).  When Marvin was in-center, his BFR was 500 (most days).

[Hemodoc]

Dear Tyefly.  the manner in which to know how your fistula is doing while starting dialysis is fairly simple.  Follow the arterial and venous pressures.  Right now on NxStage,  I run at 350-370 blood flow, my arterial is 130-140, my venous usually runs 150-160 after the tubing warms up.

I always tried to keep my incenter pressures less than 200.  Talk to your tech when you are starting and consider setting parameters as a guide to when you will be ready to go to the next level and the bigger needles.

I had an incredible tech who was actually my patient before I became her patient who monitored my pressures very closely as I started dialysis.  My first day, we ran at 150 and then went slowly from their.  I did not get to a 15 ga needle for about 3 months.  No big deal in my case since I still had quite a bit of residual renal function.

You may want to look at some of the European protocols for fistula usage since they start at 6 weeks as a matter of practice.  They have excellent results.  I am not familiar with how they advance or how quickly, so you may look into this on the internet and see what you can find.

As in all things, discuss these issues with your team.  Secondly, be very careful about how soon you try to self cannulate.  I only had one infiltration in my first year.  Not fun at all because the blood in the tissues causes inflammation which renders your arm sore and black and blue.  I waited to attempt self cannulation after the techs had aleardy established my sweet spots and what angles to insert.  Unlike a tech who can feel the fistula under their fingers, when self cannulating, it is a blind stick based on the landmarks on your skin showing you where to go.

This will be one more issue to work out with your team.  Go slow, have good control over all of the issues.  Protect your young fistula at all costs.  It is your only bridge to life while on dialysis.  That at times may mean protecting your fistula from your own enthusiasm.  Sticking a large needle in your own arm is not easy.  I did not sleep much the night before I stuck my own arm for the first time even though I have been sticking needles in other peoples arms, bellies, shoulders, knees and chest, neck and even passing tubes through the heart into the lungs. 

So, be patient until all issues are right before you consider sticking yourself.  You will need a sweet spot, landmarks and a steady hand.  The angle must be the same each stick and that is why you will need a mole, a scar or something that gives you the direction and angle to go down to the millimeter.

So, keep learning Tyefly, you are doing great.  Patience and the right time for all things will be a hard thing to learn as well.  Find someone that is really good at sticking since you will likely need dialysis before the usual time most folks have.  I had my fistula on Sept 1 and started dialysis Feb 1.  It was just the right time.  My first 15 ga was in May, about 3 months.  As long as you are doing well at a lower rate, there should be no hurry and that will give you the time to let the fistula mature.  There probably is no reason to stick yourself until the techs can get a 15 ga in easily and you know how they are doing it.  It will be hard at first to even watch the needle go in your arm.  That is a very natural reaction.  It took me about 4 months to get to the point where I did not close my eyes and grimmace.

I applaud your courage and enthusiasm, but remember that patience is a very important part of protecting your fistula.  Keep talking with your team and develop your own approach before you start and set some goals on how rapidly to proceed.  Everyone is different so what works for me may not apply to you.

In any case, that is how I started on dialysis getting up to speed.

Take care, and keep researching.  You have learned a lot for someone that has yet to even start dialysis.  By the grace of the Lord, all will go well for you.

Peter

[tyefly]

   Thx Peter..... you always have great information and nice things to say......   The information here has been so helpfull and I do appreciate everyone opinions and experiences......  IHD  to me is the best site with the most experienced people......     

      I still find it alarming that so many people have real problems with hemo, BP drops, cramps, headaches, and just that wash out feeling.....  I am going to do my best to try to control all of that... I realize that there will be some adjustments but the one thing that I know I will not deal with very well is when someone says there is nothing that can be done, or this is normal to crash and everyone does it......   I wish there was more that can be done to help those people who are in the clinics doing in - center dialysis a better quality of life.... I wish that more centers would have a option of daily hemo for those that cant do it at home but would like a better dialysis treatment option.....    I guess for some people  the three times a week works and for others it doesn't..... but they don't have any other choices......either because they cant do it at home cause they have no partner or they feel that having a professional close by is a safer feeling....   I sure hope that Davita or some of the other centers will start with a daily in-center option, or maybe the doctors can start prescribing something  like that......  All the information that I have read  clearly shows that in - center  3 times a week is a very minimum was to maintain health....
     Well    thx again for the information.......  Kathy