Fistula jumping

[Julie]

We do home hemo.. my husbands arterial needle area gives us a hard time during some treatments and not on others. We've tried postitioning the needle different ways and making sure theirs enough slack on the lines. At times it's not bad, but other times is alarms frequently. Any tips/ suggestions. He is not dehydrated when this happens.

[PrimeTimer]

If you are using the Buttonhole Method, you have to be sure to insert the needle at that same angle and depth each time. We use to do home hemo and I got pretty good with adjusting the needles whenever the cycler alarmed (we used the NxStage cycler). I learned to slowly pull the arterial outward (but not all the way out) til it stopped alarming and then retaped it in place. Sometimes I had to carefully tilt the needle up or down until it stopped alarming. Sometimes I had to "pillow" the needle by folding up some gauze and carefully putting it underneath the needle wing and taping it in place. I learned that sometimes it alarmed because the needle more or less was sucking the wall of the inside the fistula. Thru trial and error, we learned to insert the needles "straight" down the "center" of the artery or vein. Much like taking a sewing needle and centering it down a drinking straw, making sure it doesn't touch the sides. These are all things that I am sure your dialysis nurse could show you. Took many many times to get it right but eventually we caught the hang of it and I'm sure you will too. Just take your time and never rush a needle. Be sure to always wash and glove up. There are probably a lot more helpful suggestions about needles in the NxStage section on this site.   

[PrimeTimer]

Meant to add that blood pressure and how much fluid your husband has on-board may also be affecting placement of a needle. Fluid can make an artery or vein seem higher/lower within a fistula or even change the angle of the fistula. Picture the fistula being a little sailboat floating on top of water...sometimes the tide is high and above the rocks, sometimes it's low...sorry if this is a corny analogy but was all I could think of for now.

[Michael Murphy]

The question I have is how long has he been on hemo.  If it's a year or less he has not started to have the large fistula lumps (aneurysms).  These things may be ugly but they create a wider area to stick, this makes infiltrations much less likely.  Plus if the needle is close to a sidewall of the fistula it interferes with the flow if he has been on several years in gore this.

[Julie]

Thanks for ideas everyone. The first fistula creation was not successful so this one has only been in use since October. We use sharps, they will no longer teach button home in our center. The spot we have to work with is very small because it's curves. Has anyone tried not putting the needles in all they way? Would that be helpful? His fistula is not deep in his arm at all. You can almost see it, it's so close to the skin, which is nice. I'm wondering if maybe the end of the meedle could be sucking against the curve part? 

[Michael Murphy]

I do not canulate myself but will watch when they play around after they are in.  First I have seen needles pulled back about 3/8 of a inch, or rotated 180 degrees to get better flow.  Since it's such a new fistula it hasn't had time to go to aneurism yet.  Once he gets the lumps every one hates there will be a lot of space.  In the beginning I was so upset I actually looked into having a dotted line tattooed to show where the bloody thing went it curved like a snake from my wrist ro my elbow

[Julie]

Meant to add that blood pressure and how much fluid your husband has on-board may also be affecting placement of a needle. Fluid can make an artery or vein seem higher/lower within a fistula or even change the angle of the fistula. Picture the fistula being a little sailboat floating on top of water...sometimes the tide is high and above the rocks, sometimes it's low...sorry if this is a corny analogy but was all I could think of for now.

I actually enjoy this analogy prime timer!! Makes sense because there are times his fistula is straighter than others. I never realized fluid had anything to do with it.

[Julie]

Meant to add that blood pressure and how much fluid your husband has on-board may also be affecting placement of a needle. Fluid can make an artery or vein seem higher/lower within a fistula or even change the angle of the fistula. Picture the fistula being a little sailboat floating on top of water...sometimes the tide is high and above the rocks, sometimes it's low...sorry if this is a corny analogy but was all I could think of for now.

I actually enjoy this analogy prime timer!! Makes sense because there are times his fistula is straighter than others. I never realized fluid had anything to do with it.

We thought about rotating last night also. With his needles it is doable without moving the blue flaps.. just worried about the needle scraping the fistula if we did it wrong... before my husband needles.. I feel the fistula and draw a little dot in the direction he has to aim.. he knows past the dot it dips or curves etc.. so that's our visual of where to aim without infiltrating. It's not really endorsed by the hospital, but it works for us so we do it anyways.

[justagirl2325]

We've had tons and tons of trouble with my guys fistula over the years (2.5 now).  Arterial seems to be a problem for him related to arm position.  He sits in a chair and if his arm is on the arm rest the arterial pressure is too high.  If he lowers his arm to beside his leg on the chair "boom" arterial pressure instantly drops and dialysis goes smooth.

[Julie]

The 2nd post was supposed to be a reply to your post Michael Murphy... still getting used to using this forum!!

[Michael Murphy]

Thanks for the reply, the one thing I really hate about dialysis is the lack of patient education.  I have seen people who haven't been told as the fistula enlarges the experience gets easier.  People start with a new fistula and imagine years of the pain and frustration not knowing it gets better. I only found out when I mentioned to a tech that I was always afraid I would get infiltrated.  She laughed and said "I could stick you from across the room". The only thing dumber is discovering that star fruit (cambola) can kill us.  Found that little tidbit on this website.  A fruit that can kill ESRD patients I still think that should be the first thing they tell us.

[Julie]

Yes. That is great to know. Have never heard of that before.

[Simon Dog]

I have been on hemo for 4 years, 3+ of them home, and have had excellent luck with my fistula.  Minimal bumping, no revisions other than an intitial one to get it working, one fistulagram which concluded "nothing to see her folks, move on..".

I use blunts and find that flipping the needle lowers my VP  and AP by about 20 points.   I know some of the literature says "don't flip any kind of  needle", but my care team told me it  is safe with blunts, and my experience seems to confirm that.

[Julie]

 

We've had tons and tons of trouble with my guys fistula over the years (2.5 now).  Arterial seems to be a problem for him related to arm position.  He sits in a chair and if his arm is on the arm rest the arterial pressure is too high.  If he lowers his arm to beside his leg on the chair "boom" arterial pressure instantly drops and dialysis goes smooth.

So the lowering of the arm has seemed to help.. thanks for the tip!!