New Fistula

[Sugarlump]

My new fistula got used for second time yesterday, with one needle and everything went fine. Even my arm wasn't as stiff this time.
Walked out of unit and got as far as opening car door to get in and as I looked down, suddenly realised  that blood was spurting out from my arm at a great rate.
My cardigan already soaked through and dripping.
My first thought was don't get in the car (brand new car!!!!)
My second was to faint!!!!
My third grab a pad and press it on the fistula...somehow...

Fortunately a dialysis nurse appeared in the car park with a wheelchair patient and my other half called out to him, and he came over to help.
And we got it back under control.

But it shocked me. (The amount of blood and the speed)
(Bearing in mind I have only had dialysis lines for past 8 years)
Please tell me this doesn't happen very often???

     

[obsidianom]

Yes it is scary how fast fistulas bleed. The first time we used my wifes at home I peeked too soon while waiting for it to clot and the blood spewed all over
 me and the wall behind me even. What a mess! It scared the crap out of me. I almost didnt want to use it again. Over time I have learned how to control it. Your unit will learn the nuances of yours too and be able to stop that . Its new to them dont forget. Everyone is different.
I use a pressure dressing on my wifes for 2 hours with guaze and a lot of tape. I dont go around the whole arm obviously but can still put a lot of prssure on it without damaging it. It took a few times to get the hang of it and get the correct amount of pressure. If you are worried about bleeding when you leave , ask them to do the same or do it yourself . It will get easier.!!   
Remeber if it happens again to immediatly put your fingers /hand over the hole with pressure directly on it. It may bleed fast but it is a relatively small hole so it is amenable to direct  local pressure.

[Sugarlump]

Yesterday a less than hugely experienced nurse did my needling. She had done it previous session with Head nurse present.
First needle went in fine.
Second needle went in okay, but pressure very low and she fiddled around with needle then suddenly wham and OUCH!!! needle gone through vein? and bruise rapidly forming.
She took it out, blood squirting everywhere. So she only used one needle, split into two. But I noticed in four hours I only processed 22litres!!! Does this mean a poor session for me? (Normally process 66)
What actually happens when they put needle in wrong place? Not keen on her having another attempt on my arm.
It all rather unnerved me..

[obsidianom]

It sounds like she infiltrated . Basically she probably went through the side   or bottom of the vein  and out causing a hole that allowed blood to enter the surrounding tissue causing a hematoma (pooling of blood in an extra vascular space rather than in the vessel). It is easy to do with sharp standard long needles. That happened to us once and it was miserable . We use shorter needles now to reduce the risk as long 1 inch neeedles have a greater chance of doing that . We use 5/8 inch needles now. Also I start slow at first at blood speed 180 and carefully watch for any signs of an infiltrate (swelling of the arm near the needle) . i keep my finger on the stop button so i can stop immediatly if i see it . That way it is all water at first rather than blood . water infiltrate is less damaging and less of an issue and heals faster than a blood infiltrate.
Yes you probably got less than normal dialysis with what occurred based on the mount of blood processed.  I would try to get only experienced nurses to do it for awhile. You could try to learn to self cannulate in clinic and reduce the chances of problems as you get better at it. 

[Sugarlump]

It sounds like she infiltrated . Basically she probably went through the side   or bottom of the vein  and out causing a hole that allowed blood to enter the surrounding tissue causing a hematoma (pooling of blood in an extra vascular space rather than in the vessel). It is easy to do with sharp standard long needles. That happened to us once and it was miserable . We use shorter needles now to reduce the risk as long 1 inch neeedles have a greater chance of doing that . We use 5/8 inch needles now. Also I start slow at first at blood speed 180 and carefully watch for any signs of an infiltrate (swelling of the arm near the needle) . i keep my finger on the stop button so i can stop immediatly if i see it . That way it is all water at first rather than blood . water infiltrate is less damaging and less of an issue and heals faster than a blood infiltrate.
Yes you probably got less than normal dialysis with what occurred based on the mount of blood processed.  I would try to get only experienced nurses to do it for awhile. You could try to learn to self cannulate in clinic and reduce the chances of problems as you get better at it.

Unfortunately, because i am at a small satellite unit, we only have two nurses on each day!!!! So I am going to run into problems on the days the two lesser experienced nurses are on.
Monday Head Nurse is on, so I will raise the matter with him.
Have a huge bruise on my arm now along the line of the top needle site... Is it still alright to needle bruised site the next time?

[obsidianom]

Try to go beyond the hematoma when they cannulate the second (venous) line so it pushes fluid back beyond the damaged area if possible. It should be ok .

[cameron fields]

Sugarlump, so sorry to hear it. Unfortunately, that happens sometimes when you are on dialysis. It may be due to an infiltration or it may be simply due to the fact that your nurse did not put enough pressure on the fistula when bandaging it. She may have put the bandages on too loose in fear that if they were tight it could damage your fistula. I know that my dad waits a number of minutes before leaving to ensure that his fistula does not bleed. Still it does sometimes after he leaves his center, unfortunately.

There are several reasons that cause patients to experience excessive bleeding after completing their dialysis treatment. If you are worried about how to stop excessive bleeding without doing lasting damage to your fistula, you should apply direct pressure to the exact place that is bleeding.

The only time you should apply pressure outside of the exact place that is bleeding is when you have lost sight of it, due to large quantities of blood. Press down on the arterial end of the fistula, which is usually the end closer to the hand. This will block the flow of blood enough to remove the gauze and excess blood from the bleeding site so you can see where to apply pressure. Once you have put pressure on the correct spot, you should remove your finger from the arterial end. Putting too much pressure on too wide of an area of the fistula can be detrimental to the health of the fistula. That is why you should avoid carrying heavy objects, even purses, with your fistula arm, and that is also why you should only be applying pressure to the bleeding site.

Wishing you the very best!,
Cameron - http://kidneybuzz.com/

[okarol]

Cameron - after dealing with you constantly promoting your website on our facebook group, I am telling you now - it will not be happening here.
I know you know what I am talking about and I recommend you heed this warning. If you want to participate here you cannot post that link. Period.

okarol/admin

[Sugarlump]

    
Despite all my problems, including a dose of pnuemonia last week, my new fistula is working really well.
Good flow and pumpspeeds of 350 with no problems. Starting to clear 80 litres in a 4 hour session instead of my
previous 50's with my line.
It is making me feel so much better so thank you Mr Vascular Specialist Surgeon from Addenbrookes