3/5 inch needles....Question

[caregivertech1]

Anyone ordering 3/5" needles from Fresenious? Our nurse called them today and said they didn't carry them.

[obsidianom]

We are at a Fresenius clinic. We got them to ok 3/5 needles . We love them . They come from Medisystems which is a Nxstage company. I would never go back to longer needles which can damage the fistula.

[caregivertech1]

Thanks Dr. O.  Does your Fresenious clinic order directly from Medisystems and has them shipped to you directly? I called Nxstage and Fresenius and got absolutely no help. If my clinic goes outside NxStage and Fresenious wonder how it's billed.

[PrimeTimer]

Not sure but I would think your Fresenius nurse could have your Neph write a prescription for the needles and set it up for direct delivery to you. And if it's a written prescription, I'd think your insurance would cover it like any other prescription written by a doctor. Good luck, hope it works out for you. We use the 1 inch 15 gauge blunts on my husbands buttonholes, no problems. I think regardless of needle kind/size, the idea is to take your time and go slow, no matter how proficient you become. Never rush needles! 

[obsidianom]

Thanks Dr. O.  Does your Fresenious clinic order directly from Medisystems and has them shipped to you directly? I called Nxstage and Fresenius and got absolutely no help. If my clinic goes outside NxStage and Fresenious wonder how it's billed.

WE went to our home nurse and got her on board with it . She then had to go to Fresenius and get them to ok it. It did take a month or so to go through the corporate chain but it was approved. When we need needles we just let the nurse know and she has the clinic order them and give them to us.
We actually use 2 different sizes. I use 16 guage on the arterial access and 15 guage on the venous. It seems to work better on my wifes fistula this way. 
In the end if your doctor and nurse agree you need a 3/5 neeede for medical reasons, they really have to provide it.
Our argument was the fistula is short and I need to move around as we use sharps. The shorter needles allow me to safely go to the edges of the fistula and not infiltrate.

[caregivertech1]

I called Medisystems today and they also confirmed they only ship to providers, ie Fresenious . I then called my clinic back and gave them the MS phone #. We'll see where this goes but at least there's now a direction. Thanks.

[caregivertech1]

I called Medisystems today and they also confirmed they only ship to providers, ie Fresenious . I then called my clinic back and gave them the MS phone #. We'll see where this goes but at least there's now a direction. Thanks.

Upon further review,  my clinic informed me today that Fresenius does not order from Medisystems, so no 3/5" needles for my wife as of now. I will now start writing letters up the chain of command to complain about this and ask for clarification. I'm sure we will prevail in the end. Is there ANYONE reading this post other than Dr. O that is using these needles?? If so how do you get them? Thanks.

[noahvale]

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[PrimeTimer]

Unless you already did, I would bring it up with your Nephrologist. Perhaps your Neph could write a prescription for the needles you are needing and the nurse could fax it over to Medisystems, who hopefully would be willing to ship the needles to your clinic/Nephrologist's office. My husband kind of had a similar situation that involved a blood test that his Fresenius clinic said they no longer perform. I called our insurance company and they said they would cover the cost of the lab test so long as the doctor ordered it (wrote a prescription for it). So, we brought it up with my husband's Nephrologist at his appointment (which is at a Fresenius clinic). His Neph was happy to write a prescription for the lab work (she actually seems kind of disgruntled that "Fresenius" said they no longer perform this specific blood test we were requesting). My husband then went to a lab that our insurance company covered and had the bloodwork done. I hope you stick to your guns on this. If you can/want to, please keep us updated on what becomes of it. Seems to me that anyone willing to learn and do hemodialysis should have whatever it is they need in order to perform this lifesaving procedure comfortably, confidently and safely. Good luck.

[obsidianom]

I called Medisystems today and they also confirmed they only ship to providers, ie Fresenious . I then called my clinic back and gave them the MS phone #. We'll see where this goes but at least there's now a direction. Thanks.

Upon further review,  my clinic informed me today that Fresenius does not order from Medisystems, so no 3/5" needles for my wife as of now. I will now start writing letters up the chain of command to complain about this and ask for clarification. I'm sure we will prevail in the end. Is there ANYONE reading this post other than Dr. O that is using these needles?? If so how do you get them? Thanks.

You should push this up higher. Fresenius indeed DOES order from Medisystems. They do it for us.
Back when we first started dialysis and we wanted to take it home , our clinic manager hated Nxstage and basically told us Fresenius wouldnt do Nxstage for us . We are at a Fresenius clinic. So I got our nephrologist on board for it and she told us she would over ride anything Fresenius refused , and she did. Soon after that everything was okeyed for Nxstage and we got trained . What is interesting is that now 2.5 years later the clinic ONLY uses Nxstage for the home patients. They LOVE it!   They watched my wife for over a year and saw it work so well , then they started to train the nurses and then more patients.
 The bottom line is, you CANT take NO for an answer. You have to fight the local clinic . Get your nephrologist onboard and then fight the clinic and go over their heads to Fresenius directly. There is NO rule at the corporate level that Fresenius cant order from Medisystems. Your clinic is the problem.  Just keep up fighting until you get it. If your nephro orders something , they CANT say no. Period. That would violate the rules and you could go to medicare with a complaint . That would scare the crap out of them as a medicare audit is HELL!  (I used that threat to our clinic about using Nxstage).

[Hemodoc]

 I use NIPRO needles and find them to be even better than the Medisystems needles. The JMS "blunt" needles FMC is using were HORRIBLE. Let me say that again, increadibly horrible. They messed up buttonholes I had workign on Medisystems for year. They wouldn't give me Medisystems at my FMC unit, but I like the NIPRO better so it worked out. I took one of the JMS "blunts" to my clinic visit and showed my nurse how  much they hurt and how sharp they were and she agreed and switched immediately without the usual fuss.

Not sure if they have 3/5's but I suspect that they should. FMC does carry these needles and although they are a slightly bit sharper than the Medisystems, I actuallyl prefer these.

[caregivertech1]

Thanks for all the very helpful comments and suggestions. I do have the verbal OK from my neph and home nurse. I will definitely push this request as high as I need to(really like the medicare angle). My clinic probably operates like most "one size fits all". I use JMS 1" blunts and Nipro 1" sharps (when I have to). My wife's upper arm fistula is very surface oriented and am pretty sure a shorter needle would be much better and give us more options. I should probably get the neph's OK in prescription form. I'll keep everyone up to date. Thanks again.

[caregivertech1]

After a bunch of phone calls and emails by our clinic nurse we were able to get the Medisystem 3/5 inch needles. We used the blunts for the first time today and what a difference. The access was very simple and I felt like I could direct the needles  more to the dead center of the fistula vs the 1". Also a huge positive so far is the reduction in both the arterial and venous pressures. Compared to the average of  the last 5 days to today's treatment, at 350 Qb our venous dropped from 163 to 143 and the arterial from 124 to 112. Wow!! After I get more experience and more data from the 3/5" I'll report back. Think about this. We were trained to do Qb 500 and we did so for 2 years. Our arterial pressures were 190 and venous 280 (vs now 112 and 143). No wonder we had a revision. Question is now....Can I increase the Qb a little to shorten the run. Pretty sure that's a no. I feel right now my wife's fistula will last forever. Hopefully no more fistulagrams and especially revisions. This board is really awesome.

[PrimeTimer]

Congrats on remaining steadfast on your insistence for shorter needles! Sounds like it is already paying off. Ahh..it's always nice to have immediate results!

[obsidianom]

After a bunch of phone calls and emails by our clinic nurse we were able to get the Medisystem 3/5 inch needles. We used the blunts for the first time today and what a difference. The access was very simple and I felt like I could direct the needles  more to the dead center of the fistula vs the 1". Also a huge positive so far is the reduction in both the arterial and venous pressures. Compared to the average of  the last 5 days to today's treatment, at 350 Qb our venous dropped from 163 to 143 and the arterial from 124 to 112. Wow!! After I get more experience and more data from the 3/5" I'll report back. Think about this. We were trained to do Qb 500 and we did so for 2 years. Our arterial pressures were 190 and venous 280 (vs now 112 and 143). No wonder we had a revision. Question is now....Can I increase the Qb a little to shorten the run. Pretty sure that's a no. I feel right now my wife's fistula will last forever. Hopefully no more fistulagrams and especially revisions. This board is really awesome.

Good job.   In answer to your question, NO.   Dont increase blood speed above 350. That seems to be the cut off for when the turbulance begins to blast the fistula walls to damage it. Also on NXstage you really gain nothing. It is really the volume and speed of the DIALYSATE that controls the time on machine and the clearance. You can shorten the run by simply speeding up the dialystae. On the other hand the time on machine is still important in overall long term health.