canulation and the flash

[boswife]

 thought i was done with the computer for the eve and then i found myself sitting here getting angry again at my thoughts........ While i am sticking my hubby, i am very new so, to me, when i see the flash i know im in and can level off.  My trainer doesnt want me to go by that but to go by feel.  Well, i have to 'learn' the feel IMHO so i 'need' that flash to help me learn.  Am i wrong in that? After i got my hubbys V for my first time, (i did go by the flash) and leveled off, i was worried that i didnt see the pulse.  Trainer said she 'tricked' me by clamping it after the original flash so i  wouldnt depend on that.  It's really bugging me but mabie she's right. Anyone have experience with that??   I just dont know wheather i can just tell her to leave it alone and let me learn, or, trust that she, through experience, knows whats best.  Dang it's hard being new at this

[MooseMom]

I have zero experience in this, but a few thoughts crossed my mind.  Please disregard them if they are irrelevant.

I am guessing that the flash is like training wheels.  They are useful tools for the beginner, but there comes a time when the training wheels have to come off.  Sometimes we get a little too comfortable with those training wheels, and they begin to hold us back.  Far from giving us confidence, they can become a crutch.  Perhaps the trainer was thinking that now was the time for your training wheels to come off.  I'm thinking that if she really didn't have enough confidence in your abilities, she would have kept the training wheels on for a little longer.

I suspect that deep inside, you know she's right.  And that's a GOOD thing!!  It shows that she really thinks you are progressing well!  It says a LOT for you!

[Desert Dancer]

Why doesn't your trainer want you to go by the flash? When I was in training they told me that's exactly what I was supposed to look for, and to level off and go in as soon as we got it. 

[boswife]

Oh moosemom, this morn when i read this, i wanted to jump through the computer and hug you... I get so full of self doubt that it was a good read for me this morn.  I was happy to see my trainer there nice and early so i could ask her my question about this.  She was very open and didnt close off her ears or anything..lol  She told me that yes, the flash was fine to be consious of but not to dwell on.  She wanted my focus on the feel and then be fine and happy with flash, but dont concentrate on it.  I understood better and once again, i slid that needle in, FELT what i was doing, YES slid and felt...  slow and sure.  I was worried about not being able to feel much with the sharp, but as i slid it in, I said, yes! i feel a slight 'feeling' and i think thats it!!  and then sneeked a peek..tee hee.. and sure enough, what i thought was the 'feel' was right, the flash was there and pulsing and then i leveled off, and drove it home..lol.. slowlyyyyy!   So, another good day, im feeling good!!   Got the A too, but now have got that one 5x and V 2x  Feeling better every day..
And Dancer, that 'flash' is what everyone in center told me was how they learned too so that what was really botheriing me.  (and making me mad) It's a great 'tool'  and i like it, but i do now understand to put my 'focus' on the needle, feel etc, and use the flash as the YES point..lol

[vcarmody]

Wow, I still go by the flash.  Once I get the flash then I go by the feel.  Once I know I am in I can tell if I hit the wall and can adjust my angle.  My trainer always said to look for the flash and then level out, the feel came with time.  My way works great for me, and obviously for my husband to sense I never infiltrated him (none of the techs or nurses that had to stick my hubby can make that same claim) 

[MooseMom]

If a patient is training for NxStage and is trying to learn how to self-cannulate, is the procedure much different than if you are the caregiver?  If I want to self-cannulate, will I have the same training as you all, flashes and all?  I know that's a dumb question, but if you're coming at yourself from an odd angle, well, it just seems like it would be so awkward.  How do they even begin to teach self-cannulation?

[willowtreewren]

MM,
Being a self-cannulator (word??) you will be able to feel from both the outside with your needle hand and the inside from the fistula. My husband CAN self-cannulate and HAS when he goes in-center if I have to travel without him. I slightly infiltrated him once, when he didn't give me the ouch signal fast enough. We don't have button holes and I was in a difficult area of his fistula.

Aleta

[boswife]

Aleta, if i might ask, why no buttonholes??

[willowtreewren]

Our clinic doesn't support them, BosWife. 

They gave us a real run-a-round. First I asked the neph and he said to ask the vascular surgeon. The vascular surgeon said to ask the neph. So when I asked the neph again, he said to ask the nurses. The nurses said they had never done that at this center. Then Carl got cold feet and said that he wasn't convinced that he wanted them. Ha ha ha.

So, we ladder. Carl isn't really interested in doing nocturnal, so we are just going to continue with the laddering. He has an awesome fistula and I am careful to baby that thing.

Aleta

[boswife]

Gosh Willow,, i wonder if they need an education???  they are a wonderful thing and it took a bit of reading to hubby and then convincing the'center' for hubby to go for it.  now, nearly the whole center is lined up to have it done.. Whats kind of funny is that now we are in the center where it's all nurses that have been there for 20 or more years, and they are only done when you are going to go on Home D.  I think that is bcause in reality, only one person should needle them once established and i do believe that to be true in our case.  When my hubbys was done it was a beautiful thing to watch the 'establisher' needle him.... then after a few weeks of others tryig to find the 'track' i think is what made it not so perfect.  Now, what sort of got to me is, here i am, starting my hubbies new buttonhole, and i AM going to be the only one using it so who will be to blame then..lol  Anyway, the great thing is, if there is any issue, you can always still use your ladder method.  Well, i guess you can tell im sold on them :-)

[Bruno]

Willow, I cannulate myself 4 times a week and I always go by the flash. What I do is stick the needle in and wait till I get the flash and then observe it (it needs to be pulsating otherwise it may be clotted) and then flatten the needle and push it home. I usually find the venous a bit harder to stick than the arterial (because its deeper and moves more) and I use buttonholes. They are much less painful for the patient and you don't have a bleeding problem afterwards. But maybe your access does not allow that?
But if you are laddering because your doctor doesn't like buttonholes, well sorry, but he is wrong.