Infiltration

[AnnieB]

Happened the first day *groan*. Now my AV fistula has a nasty bruise and my arm is still really sore. The person that stuck me the first session was a tech that *seemed* like she knew what she was doing. Now I know better, and she is now officially on my list of people to never stick me again.  Last night the person who set me up was (I think) the best sticker in the unit. I think they must have felt sorry for me since my arm looked so ugly and made sure I got someone more proficient this time. BUT I have to say, this process hurts like hell, getting used to it. The needles going in weren't too bad; I was able to handle that okay with the EMLA cream. But sitting there for three hours was pretty difficult. So far I haven't sworn at anyone, though. Can't guarantee it will stay that way.

[Simon Dog]

Infiltrations are more likely when a fistula is new.   I had one one of my first in-center needle treatments, and a really big one on my final regular in-center treatment before going home (sort of a going away present).   It is not reasonable to conclude someone is a bad sticker because of a single infiltration, however, you may have other valid reasons to have come to that conclusion.

Remember, you have a right to demand a "good sticker" and should exercise this during the first few months while your fistula continues to mature.

[justagirl2325]

I've done that twice to my husband since we started using his fistula 100% of the time (since February).  It never feels different.  Now I just go really slow when I insert his needles and watch it like a hawk for the first 30 seconds or so after dialysis begins.

[Rerun]

I feel your pain.  My loop graft is giving us fits.  My tech is the best but I think I'm giving him an insecurity complex.  It happened 5 sessions ago so now I'm on the Deep Purple week.  Looks awful. 

 

[Simon Dog]

I've done that twice to my husband since we started using his fistula 100% of the time (since February).  It never feels different.  Now I just go really slow when I insert his needles and watch it like a hawk for the first 30 seconds or so after dialysis begins.

Do you flush the lines with saline after connecting?  If so, you can usually detect an infiltration at this time - unless the infiltrate comes from moving the already placed needles.





sp mod Cas

[Michael Murphy]

One of the first things you notice about a hemo dialysis patient is the ugly bumps on the fistula.  These are created over time by the pressure caused by the blood pump.  While unsitely they do serve a useful purpose.  Several months ago I was talking to a tech about infiltration and how I don't move my arm to avoid infiltration.  I then told her I was worried if I needed to use a new tech.  She laughed and told me with the state of my fistula she could stick me from across the room. The anyurisms (ugly bumps)  in my arm are ideal for putting needles into.  So the lesson here is that for the first 6 months or so you will be difficult to stick then you will get easier and easier. 
Your other problem is you are going to be in that damned chair for a long time 3 times a week.  If your butt hurts bring a cushion, always bring a blanket and if you like one a pillow.  I bring a iPad so I have something to do for 4.5 hours.  I even have a holder for my iPad so I can use it one handed.  Getting through a session is easier if you are comfortable.  I also have a 6:00 AM start time so with luck I will get a 1 to 2 hour nap in , makes it seem shorter.  Since you are new watch the other patients and see how they deal with the sessions.it gets easier as time goes by, you adapt and learn how to deal with the problems.  Good Luck you will do fine.

[PrimeTimer]

I've done that twice to my husband since we started using his fistula 100% of the time (since February).  It never feels different.  Now I just go really slow when I insert his needles and watch it like a hawk for the first 30 seconds or so after dialysis begins.

Do you flush the lines with saline after connecting?  If so, you can usually detect an infiltration at his time - unless the infiltrate comes from moving the already placed needles.

You are absolutely right about that. Flushing the lines or, what I use to call "testing the lines", also helped us to avoid alarms. If I could not manually flush and draw the saline back and forth in the lines where it felt very fluid and smooth and instead felt resistance (as if something was blocking the flow), I knew to adjust my husband's needles BEFORE we hit the GO key.   

[Simon Dog]

I also find that when I let the lines fill with blood, there is sometimes a bubble.   I do my flush with 7cc of saling in a 10cc syringe that allows me to pull any bubbls into the syringe, let them float to the top, and do my flush/line test with no bubbles.  The line volume should be printed in the needle wrapper (it 2.6cc for the lines I use)

[SutureSelf]

One of the first things you notice about a hemo dialysis patient is the ugly bumps on the fistula.  These are created over time by the pressure caused by the blood pump.  While unsitely they do serve a useful purpose.  Several months ago I was talking to a tech about infiltration and how I don't move my arm to avoid infiltration.  I then told her I was worried if I needed to use a new tech.  She laughed and told me with the state of my fistula she could stick me from across the room. The anyurisms (ugly bumps)  in my arm are ideal for putting needles into.  So the lesson here is that for the first 6 months or so you will be difficult to stick then you will get easier and easier. 
Your other problem is you are going to be in that damned chair for a long time 3 times a week.  If your butt hurts bring a cushion, always bring a blanket and if you like one a pillow.  I bring a iPad so I have something to do for 4.5 hours.  I even have a holder for my iPad so I can use it one handed.  Getting through a session is easier if you are comfortable.  I also have a 6:00 AM start time so with luck I will get a 1 to 2 hour nap in , makes it seem shorter.  Since you are new watch the other patients and see how they deal with the sessions.it gets easier as time goes by, you adapt and learn how to deal with the problems.  Good Luck you will do fine.

You have been given horrible info on aneurysms.  An aneurysm is a weakening of the fistula wall from overuse in a small area (unlike the buttonhole technique where one uses the exact same spots).  Aneurysms SHOULD NOT be used for cannulating.  From Home DialysisCentral.com:

Prevent Aneurysms In AV Fistulas


An aneurysm is damage to a blood vessel wall from placing needles into a very small area on your access. If there is very high blood pressure or a stenosis, this pressure can cause the fistula wall to balloon out. As a kid, you may have blown a balloon up so far that it burst. An aneurysm can burst, too. Know what signs to watch for, so a problem site can be fixed in time to save your life:


Improve Cannulation Technique

A fistula or graft is made for putting needles in. But, putting them in the wrong way can harm an access. (T)here are three ways to put needles in a fistula or graft:

Site rotation
Area puncture
Buttonhole technique


Of the three, the Area Puncture Technique is the most likely to cause aneurysms. Avoid this! If you rotate sites, it is vital to stay at least ¼" away from the last sites and use the whole length of your access, not just parts. Keep your needle tips at least an inch and a half apart, too. NEVER cannulate aneurysms or pseudoaneurysms because of:

Potential hemorrhage (large amount of blood loss)
Exsanguination (massive amount of blood loss)
Death

Always use a tourniquet to cannulate a fistula —no matter how big it is, old it is, or how skilled you are. All tourniquets should be placed loosely on your upper arm, above the bicep. But, never use a tourniquet on an AV graft – it is full and firm already and will not stretch any bigger.

Here's the link to the full article.  Well worth the read:

http://homedialysis.org/life-at-home/articles/art-of-making-your-fistula-or-graft-last

[SutureSelf]

Happened the first day *groan*. Now my AV fistula has a nasty bruise and my arm is still really sore. The person that stuck me the first session was a tech that *seemed* like she knew what she was doing. Now I know better, and she is now officially on my list of people to never stick me again.  Last night the person who set me up was (I think) the best sticker in the unit. I think they must have felt sorry for me since my arm looked so ugly and made sure I got someone more proficient this time. BUT I have to say, this process hurts like hell, getting used to it. The needles going in weren't too bad; I was able to handle that okay with the EMLA cream. But sitting there for three hours was pretty difficult. So far I haven't sworn at anyone, though. Can't guarantee it will stay that way.

I feel your pain!  I'd say the vast majority of us who have fistulas experienced a few infiltrations during the first few weeks of cannulation, especially if the fistula didn't have time to properly mature before using.  However, believe it or not, the best way to prevent further infiltrations and fistula damage is to learn how to self-cannulate.  Plus, it hurts less because you are in control and can feel what's going on in your fistula while inserting the needles.  PLEASE read the following info from HomeDialysisCentral.com.  It's a good explanation on why And how to do self-cannulation.  Best wishes - SutureSelf

http://staging.homedialysis.org/life-at-home/articles/put-in-your-own-dialysis-needles

[Michael Murphy]

I have the techs or nurses move every time I go, my aneurisms are not huge just  there.  I have a large bulge that runs from my elbow to my wrist. Feels like a snake under my skin.  I also go to the vascular surgeon for a sonogram every year just to be sure.

[dialysisuser82]

   Your fistula is new so it will need time to develop and exercise.  Infiltration is normal. The immediate thing to do is ask for an ice bag to put on the infiltrate side to stop swelling. Please continue to put

ice or gel-ice on your arm at least 3- 4 times the first 24 hrs.  the following day, use a cloth begin with warm water place it on the infiltrate side, increase the hot water with the cloth which will bring the

blood clod to dilate on the surface. Hot cloth absorbs skin directly.  Do a few time fast with hot cloth- you will see blood surfacing in pink form which means blood clod is dissipating.

 Ask nurse in charge to see if your fistula is on the surface i.e. very superficial so they do not need to go deeper.

[justagirl2325]

Interesting you both say that about the saline flushes.  We do that and both times I've infiltrated him they flushed just fine, I never noticed anything until just after he started dialysis (arm expanded as it was filing with blood) and quickly turned it off and waited a day.

[needlephobic]

Well I have Been finally getting stuck everything going good till I got this tech nice lady but wonder about her work ethics. She started infiltrating my fistula every other treatment.the last time she stuck me she turned the pump on and boom another infiltration well she stuck me got me running again she pulled out needle and put a fistula clamp on me so I took a nap.woke up my arm was hurting and swollen with the fistula clamp still on lose to a hour so I took th clamp off and boom another infiltration arm swelled  like a football they blamed me for that one but the clamp was on the needle  the charge nurse put in. The charge nurse said can't use fistula so go ahead and hookup one line from chest Cather and remains line from my fistula which should remove all lines and ice my arm in which they never offered me one my arm looked like Popeyes arm after that doc order them not to use fistula.untilled healed. Been using chest cath same lady gave me a saline + blood shower,one dat  then next treatment just a saline shower. Now the are useing a computer program to schedule when we have treatments and how many staff the need at certain times if you arrive late you get written up. Another thing no more hectoral now got too take
Calciton leant hectoral  cause I work great with it and it Ida have too thing do not get a choice well that's what happening to date