Pulling your own needles

[Treasure]

Greetings, greetings. I've got the cannulating down fairly well now, but how the hell do you pull your own needles? My fistula is located on my left inner elbow-area. I am right handed. I haven't figured out how I can pull the needle, hold my holes and not bleed to death, hehehe. um...wait, that's not funny.

please explain your technique in as much detail as possible...or point me to a video if anyone knows of one.

[Bill Peckham]

I've been pulling my own needles since August 2002 - starting out it is was the scariest part of self-dialyzing but now after pulling over a 1,000 2,500 needles it feels pretty routine. I'll try to describe it, I've been meaning to put a video together, my to do list is pretty long it's on there somewhere.
 
The basic maneuver is to pull with two fingers and hold a four by four with two fingers. My fistula is right forearm, I'm right handed. I pull my venous needle first so I need to pull the needle in the direction of my wrist. I could do this by using my right hand to pull the needle line but usually I hold a previously prepared 4 x 4 (I fold six 4 x 4s before treatment into .5 x 1s , held together with a small piece of tape) centered on the needle with my thumb and first fingers while grasping the needle line between my second and third fingers. To pull I'm basically separating my first and second fingers - you don't have to go far. Some times I pull half way and re-grip/recenter the 4 x 4 before pulling all the way out.

I think pulling your own must be good for the fistula because I can feel when to apply pressure, I don't apply pressure before the needle is out. I often swap out the first 4 x 4 for a fresh one. I do this by holding the site with my second and third fingers and picking up a fresh 4 x 4 with my thumb and first finger. Holding the fresh 4 x 4 abutting the initial 4 x 4 I just slide the new one into place. Once I am satisfied that the site is not bleeding/seeping I use a clamp to continue holding the venous site. The clamp is basically a big/wide ziptie with a fat square bulging inward so pressure can be focused on a spot. I tighten the clamp only as much as needed being sure to not apply too much pressure.

With the venous under control I pull the arterial. I can do this by holding the 4 x 4 with my second and third fingers, grasping the needle line between my thumb and first finger.

[Rerun]

I think I could follow this.  I would love to see a video. 

                                                   

[angieskidney]

I think I could follow this.  I would love to see a video. 

                                                   

Me too and I expect BillP to be fast with one





 

[renal30yrs]

If Davita or Fresenius have not made such a video available us consumers should demand one to be made ASAP.

[kitkatz]

I have pulled one needel by myself over the years. My center does not like to do that technique.  But some fo these nurses have worse technique than I would have.  Have you ever had the "oops I pulled it out without realizing it" needle?  I hate those ones.  Blood goes everywhere.  I just grabbed the spot and held on tight.

[Treasure]

Thanks for answering my question, Bill. I'm going to print out your technique and take it to dialysis and have one of the techs read it to me while I give it a try. That will give the techs something to do now that I stick myself...hehehe...

Thanks again...

[BigSky]

I've been pulling my own needles since August 2002 - starting out it is was the scariest part of self-dialyzing but now after pulling over a 1,000 2,500 needles it feels pretty routine. I'll try to describe it, I've been meaning to put a video together, my to do list is pretty long it's on there somewhere.

So are you able to reach to unhook the lines first to do your rinseback then pull them?

[Bill Peckham]

So are you able to reach to unhook the lines first to do your rinseback then pull them?

Yes, I do need both hands to connect/separate the tubing pre/post treatment. With a standard length needle (the length in reference to the tubing) I have no trouble disconnecting the venous but since the arterial tubing has to make an one eighty to get the connector to my right hand it is just barely long enough however, did you know that Medisystems maker of the buttonhole needles makes a 15g with 16" of tubing? I think the standard is 12". (All humility aside I was one who suggested it, I wonder if that got the ball rolling? As long as I'm not being modest I also take credit for introducing the buttonhole technique to Holland. Now let's see my other suggestion: a half inch needle - access to more of the fistula). To my knowledge these have become available in just the last year. With 16" of tubing it makes making the connections a breeze. There are also various extenders available - well not extenders per se, but in effect e.g. they're tubing segments with a needle port built in but they provide several inches of line in the process.

[Bill Peckham]

I have pulled one needel by myself over the years. My center does not like to do that technique.  But some fo these nurses have worse technique than I would have.  Have you ever had the "oops I pulled it out without realizing it" needle?  I hate those ones.  Blood goes everywhere.  I just grabbed the spot and held on tight.

No, I have never had a needle accidentally dislodge but are you saying a nurse/tech inadvertently pulled a needle? I've had - on many occasions had the staff person pull the needle line without really remembering that I am attached. I learned early on to always hold the needle line with my left hand when they are in the process of disconnecting or connecting me. They'll start pulling and I 'll give a little yank back. My way of communicating "Get your head in the game!". When I was incenter that would happen it seems monthly, I had forgotten about that. Now I like to pull my own needles all the time, at home and when I travel.

You are right about grabbing and holding on tight. I suppose in my car analogy that would be the equivalent of having the airbags deploy. It's a last resort but it works. I've seen dialyzors who start bleeding after treatment, sites were done and then bust open, just hold out their arm waiting for help. Talk about learned dependence.

[renal30yrs]

Any kind of tissue damage to your dialysis accesss area is a bad news.  Inproperly pulled needes can cause some damage.  After I jumped a few times after poorly skilled techs mangled needle pulling I said "let me do his part now on".

[angieskidney]

I felt like pulling my needles for the first time ever today because there was this trainee. And she started pushing down on the needles before they were pulled out. I told her not to do that and told her why. Shouldn't that have been the regular nurses job to tell her that?

[renal30yrs]

My unit is chronically understaffed.  It a real dread when you had to be taken care of by a green or careless tech.  Do absolutely insist on doing whatever the part you can do  Inserting the needles is the only thing I an not manage on my own.

[angieskidney]

My unit is chronically understaffed.  It a real dread when you had to be taken care of by a green or careless tech.  Do absolutely insist on doing whatever the part you can do  Inserting the needles is the only thing I an not manage on my own.

Yeah me too! Not with how hard they are to slide in yet. But when they are ready oh boy I will be so proud of myself if I can not only pull them out on my own but cannulate myself as well! 

[renal30yrs]

Wish you the best of luck

[angieskidney]

Wish you the best of luck

With all the advice around here I think I should be okay! I mean .. I have learned so much from here and a couple other sites. I should be fine. Just the fear.

[renal30yrs]

I'm a middle aged man who's been doing this for all these years and yet can not manage the needles.

[Bill Peckham]

I do understand. I had to stick myself in virgin arm space today. I hate the idea of infiltrating myself.

One thing I've heard from other dialyzors is that to get their head around self cannulation it helped to "play" with a needle. See if they'll let you take a needle home. Hold it. Look at it. Really look at it. Cannulate an orange a few dozen times. Have a shallow fistula? Cannulate an apple. Try to get the needle through the skin of the fruit but not into the "flesh". Maybe it sounds weird but has helped others imagine themselves cannulating their own access.

Having green staff come at me with a needle was what got me to give self-cannulation a try. If you can bring yourself to self-cannulate you'll be happy you did. Self-cannulation makes dialysis less stressful.

[Epoman]

I do understand. I had to stick myself in virgin arm space today. I hate the idea of infiltrating myself.

One thing I've heard from other dialyzors is that to get their head around self cannulation it helped to "play" with a needle. See if they'll let you take a needle home. Hold it. Look at it. Really look at it. Cannulate an orange a few dozen times. Have a shallow fistula? Cannulate an apple. Try to get the needle through the skin of the fruit but not into the "flesh". Maybe it sounds weird but has helped others imagine themselves cannulating their own access.

Having green staff come at me with a needle was what got me to give self-cannulation a try. If you can bring yourself to self-cannulate you'll be happy you did. Self-cannulation makes dialysis less stressful.

That is it in a nutshell, and when you do self cannulation with a buttonhole, the stress is gone, at least in my case it's gone. I don't even think about the needles now.

- Epoman

[angieskidney]

You guys are the ones who have encouraged me farther than I would have ever imagined me going.

Have a shallow fistula? Cannulate an apple. Try to get the needle through the skin of the fruit but not into the "flesh".

I don't really understand the difference between the skin and the flesh.

[jbeany]

The skin is the peel, the flesh is the white stuff they make into apple sauce.

[angieskidney]

The skin is the peel, the flesh is the white stuff they make into apple sauce.

Well ya that is what I thought. I guess I didn't word it right. I meant, how can you just cannulate the skin and not the apple itself??

[Treasure]

Yay! I pulled my needle yesterday for the first time. Thank Goddess that the Allient is a single-needle system, hehehe.

The techniquie I tried is like the one Bill mentioned earlier on. It worked like a charm.

That's one more hurdle I've jumped. Now if only we could  move on to the blunts...

[Bill Peckham]

Great news Treasure. I look forward to reading more about your experience with the Allient.  Do you have to use a single needle? I would like to understand more about single needle dialysis with the Allient.