Severe fistula pain

[jo]

Hi everyone,

My mom always feels uncomfortable with a dialysis technician who doesn't poke her very well before dialysis. Today, the same technician kept poking her even after my mom saying it was very painful. Somehow, she got the needle in and started dialysis. With lidocaine, my mom didn't feel any pain for the first 15 mins. After 15 mins, she had consistent pain in her fistula throughout the session. They were trying to pull 3.8L off her and at some point, they slowed down a little bit because of her pain in the fistula, and my mom said that the pain reduced a little bit when they slowed down. The pain became worse towards the end of the session and we asked them to stop. All they managed to take off is only 2.5L for 4 hours. It's been 4 hours since dialysis was completed, but she says she still has the pain and it hurts. What could be the problem? Does anyone think the technician might have messed up the fistula access? Please let me know. Thanks.

[cassandra]

Dear Jo, it could be a bit infiltrated. The area around the poking could become black/blue. Ice might still help. The 3.8 liters is a lot to take off. Is it poss for your mom to drink less?
I hope your mom's in less pain now.

Lots of luck, and love, Cas

[jo]

Dear Jo, it could be a bit infiltrated. The area around the poking could become black/blue. Ice might still help. The 3.8 liters is a lot to take off. Is it poss for your mom to drink less?
I hope your mom's in less pain now.

Lots of luck, and love, Cas

Thanks Cas. She doesn't drink much, but she gains weight between sessions somehow. At the end of dialysis, they give her about 600mL back so I am not sure. She is still sensitive to a touch in the fistula area and it hurts, but no discoloration or bruises as of now. They use buttonhole on her while sticking. Do you think it is infiltration for sure which could also be caused by blunt needles? If you think that's what it is, what should we do to help the pain subside? It's been almost over a day now and do you think ice might still help? Or is it too late?

[PrimeTimer]

Hi everyone,

My mom always feels uncomfortable with a dialysis technician who doesn't poke her very well before dialysis. Today, the same technician kept poking her even after my mom saying it was very painful. Somehow, she got the needle in and started dialysis. With lidocaine, my mom didn't feel any pain for the first 15 mins. After 15 mins, she had consistent pain in her fistula throughout the session. They were trying to pull 3.8L off her and at some point, they slowed down a little bit because of her pain in the fistula, and my mom said that the pain reduced a little bit when they slowed down. The pain became worse towards the end of the session and we asked them to stop. All they managed to take off is only 2.5L for 4 hours. It's been 4 hours since dialysis was completed, but she says she still has the pain and it hurts. What could be the problem? Does anyone think the technician might have messed up the fistula access? Please let me know. Thanks.

Are your mother's buttonholes or fistula new? Does the same technician stick your mother each time or different technicians? Are they experienced at sticking buttonholes and stick the needles in at the same angles and depth each and every time (that is important). One buttonhole track may be deeper or at a different angle than the other. My husband sticks himself but I help him. I learned to take notes until I could remember the angles and depth he uses for each buttonhole. He uses 15 gauge blunt needles. We use 3 pieces of tape on each one to secure them so they don't dislodge and the tape also helps keep the needles from moving around. He's only had his fistula a little more than a year. His arterial buttonhole is always a little more sensitive and painful than his venous buttonhole. He doesn't use lidocaine out of fear that anything emollient could carry bacteria down his buttonholes and cause infection but many people use lidocaine with no problems and wipe it off real well before needle sticks.

My husband does home-hemo and he had to learn to stick the needles in at the exact same angle and depth each and every time. I've noticed that when his blood pressure is up or high, the needles hurt more. I've also noticed that when his blood pressure is low, his fistula arm starts aching during treatment. We also notice that gaining/losing weight seems to also affect how his buttonholes feel to him. Heat seems to help his pain. I heat up a rice bag in the microwave and lay it alongside his fistula arm when it hurts. I also slide a big soft oven mitt over his hand (the one on his fistula arm) to keep his fingers from going cold or getting stiff. He says this helps. I don't know if your center has any heat packs but if so, might be worth a try. Also, even tho your mother might gain weight in-between sessions doesn't mean that all the weight is fluid. Maybe they are taking off too much fluid from her. Like I said, the days when my husband hardly gains any weight and has low blood pressure, his arm aches during treatment while on the other hand, if he gains weight, the arm doesn't hurt but putting in the needles do. Anyways, everybody is different. Your mother is lucky to have you on her side. Hopefully both of you can speak to the technicians and figure out why her buttonholes hurt so much. Kidney patients are courageous people!

[cassandra]

Thanks Cas. She doesn't drink much, but she gains weight between sessions somehow. At the end of dialysis, they give her about 600mL back so I am not sure. She is still sensitive to a touch in the fistula area and it hurts, but no discoloration or bruises as of now. They use buttonhole on her while sticking. Do you think it is infiltration for sure which could also be caused by blunt needles? If you think that's what it is, what should we do to help the pain subside? It's been almost over a day now and do you think ice might still help? Or is it too late?
[/quote]

Didn't realise she used blunts, is the pain subsiding a bit? Once I had pain in my BH, had it all checked out for infection, but wasn't. I think it was either a piece of hard skin that was stuck in the track, or a scrape caused by the (not so very) blunt needles I use to scab the BH. Is it checked for infection?

Oh, and I still use lidocain cream on that BH as it never stopped hurting after that period (1+ year ago)

Good luck, and love, Cas

[jo]

Hi everyone,

My mom always feels uncomfortable with a dialysis technician who doesn't poke her very well before dialysis. Today, the same technician kept poking her even after my mom saying it was very painful. Somehow, she got the needle in and started dialysis. With lidocaine, my mom didn't feel any pain for the first 15 mins. After 15 mins, she had consistent pain in her fistula throughout the session. They were trying to pull 3.8L off her and at some point, they slowed down a little bit because of her pain in the fistula, and my mom said that the pain reduced a little bit when they slowed down. The pain became worse towards the end of the session and we asked them to stop. All they managed to take off is only 2.5L for 4 hours. It's been 4 hours since dialysis was completed, but she says she still has the pain and it hurts. What could be the problem? Does anyone think the technician might have messed up the fistula access? Please let me know. Thanks.

Are your mother's buttonholes or fistula new? Does the same technician stick your mother each time or different technicians? Are they experienced at sticking buttonholes and stick the needles in at the same angles and depth each and every time (that is important). One buttonhole track may be deeper or at a different angle than the other. My husband sticks himself but I help him. I learned to take notes until I could remember the angles and depth he uses for each buttonhole. He uses 15 gauge blunt needles. We use 3 pieces of tape on each one to secure them so they don't dislodge and the tape also helps keep the needles from moving around. He's only had his fistula a little more than a year. His arterial buttonhole is always a little more sensitive and painful than his venous buttonhole. He doesn't use lidocaine out of fear that anything emollient could carry bacteria down his buttonholes and cause infection but many people use lidocaine with no problems and wipe it off real well before needle sticks.

My husband does home-hemo and he had to learn to stick the needles in at the exact same angle and depth each and every time. I've noticed that when his blood pressure is up or high, the needles hurt more. I've also noticed that when his blood pressure is low, his fistula arm starts aching during treatment. We also notice that gaining/losing weight seems to also affect how his buttonholes feel to him. Heat seems to help his pain. I heat up a rice bag in the microwave and lay it alongside his fistula arm when it hurts. I also slide a big soft oven mitt over his hand (the one on his fistula arm) to keep his fingers from going cold or getting stiff. He says this helps. I don't know if your center has any heat packs but if so, might be worth a try. Also, even tho your mother might gain weight in-between sessions doesn't mean that all the weight is fluid. Maybe they are taking off too much fluid from her. Like I said, the days when my husband hardly gains any weight and has low blood pressure, his arm aches during treatment while on the other hand, if he gains weight, the arm doesn't hurt but putting in the needles do. Anyways, everybody is different. Your mother is lucky to have you on her side. Hopefully both of you can speak to the technicians and figure out why her buttonholes hurt so much. Kidney patients are courageous people!

It's been six months since she had the fistula and the buttonholes. No, the same technician doesn't stick her. New technicians every day and that's the problem. This lady especially doesn't do a very good job, although, she claims that she has over 10 years of experience, but a new technician pokes my mom with her not feeling even a little bit of pain. I am not sure if they are experimenting with my mom or if they are really experienced. We haven't seen patients with buttonholes there, I might have to ask them. As I said, only a few poke her with little pain with this lady being the worst. I might try heating up the rice bag and see if that helps. She still has the pain and I am not sure if she will be able to do dialysis tomorrow. I am very worried, and yes, kidney patients are courageous, but only the affected families know how much pain and suffering one has to go through. Thanks for your comments.

[jo]

Thanks Cas. She doesn't drink much, but she gains weight between sessions somehow. At the end of dialysis, they give her about 600mL back so I am not sure. She is still sensitive to a touch in the fistula area and it hurts, but no discoloration or bruises as of now. They use buttonhole on her while sticking. Do you think it is infiltration for sure which could also be caused by blunt needles? If you think that's what it is, what should we do to help the pain subside? It's been almost over a day now and do you think ice might still help? Or is it too late?

Didn't realise she used blunts, is the pain subsiding a bit? Once I had pain in my BH, had it all checked out for infection, but wasn't. I think it was either a piece of hard skin that was stuck in the track, or a scrape caused by the (not so very) blunt needles I use to scab the BH. Is it checked for infection?

Oh, and I still use lidocain cream on that BH as it never stopped hurting after that period (1+ year ago)

Good luck, and love, Cas
[/quote]
Pain has reduced a little bit, but not much. I am not sure if she will be able to do dialysis tomorrow. We haven't checked for infection as this started on Saturday. We have to do it tomorrow. I am not sure why they employ such nurses in a facility where people struggle for life. The pain started right after the technician inserted the needle and the pain is still there. What do you think might have happened? Thanks Cas.

[PrimeTimer]

Maybe your mother's Neph should order a fistulagram to be performed to check for any damage, infection or stenosis going on. Have her A/V pressures been okay or too high or too low? Sometimes a change in pressure is a sign of stenosis or a narrowing or even clotting and that an angioplasty (balloon) will be needed to open it back up. My husband has had several revisions/angioplasties performed on his fistula. They get him in the morning, do the angioplasty in about an hour and we are back to doing his dialysis treatment that afternoon. Sure hope they figure things out for your mother. I hate see my own husband in pain, especially when there isn't much I can do for him. But a good vascular surgeon may help. You'd be surprised at how quickly they can make little revisions and have the patient back to dialysis that same day. Hang in there and take notes, as far as the angle of the needles and depth that are used on each buttonhole so when you get one that goes in smooth, you can remind them about it next time, particularly the tech that has been having trouble, maybe she needs to be reminded of which angles and depth to use with the needles. I keep a journal so that we always know what angles and depths are needed on each buttonhole in case there is ever a question about it, especially after having any revisions made. Good luck! Don't be afraid to take charge and show them that you are eager to learn what it takes to help your mother best as HER advocate. This might mean allowing only certain techs/nurses to stick her and who knows, maybe at some point she can learn to stick herself with your hands being her guide, a sort of tandem-stick. That is what my husband and I do. At least you come here with questions and for support so you obviously want to help your mother -you are on the right track so don't give up. Someone on here will help you figure this out for your mother.   

[cassandra]

What happened today?

Love, Cas

[jo]

Maybe your mother's Neph should order a fistulagram to be performed to check for any damage, infection or stenosis going on. Have her A/V pressures been okay or too high or too low? Sometimes a change in pressure is a sign of stenosis or a narrowing or even clotting and that an angioplasty (balloon) will be needed to open it back up. My husband has had several revisions/angioplasties performed on his fistula. They get him in the morning, do the angioplasty in about an hour and we are back to doing his dialysis treatment that afternoon. Sure hope they figure things out for your mother. I hate see my own husband in pain, especially when there isn't much I can do for him. But a good vascular surgeon may help. You'd be surprised at how quickly they can make little revisions and have the patient back to dialysis that same day. Hang in there and take notes, as far as the angle of the needles and depth that are used on each buttonhole so when you get one that goes in smooth, you can remind them about it next time, particularly the tech that has been having trouble, maybe she needs to be reminded of which angles and depth to use with the needles. I keep a journal so that we always know what angles and depths are needed on each buttonhole in case there is ever a question about it, especially after having any revisions made. Good luck! Don't be afraid to take charge and show them that you are eager to learn what it takes to help your mother best as HER advocate. This might mean allowing only certain techs/nurses to stick her and who knows, maybe at some point she can learn to stick herself with your hands being her guide, a sort of tandem-stick. That is what my husband and I do. At least you come here with questions and for support so you obviously want to help your mother -you are on the right track so don't give up. Someone on here will help you figure this out for your mother.

They just did a fistulagram recently like a month ago. Her blood pressure fluctuates during dialysis. All she could handle is 2 hours and after that, her blood pressure doesn't cooperate at all. We will make her lay flat and the BP will increase a little bit and they will start pulling more fluid, and the blood pressure drops again in 15 mins where they will stop pulling fluid, etc., We are still trying to figure out her dry weight. We are not sure if the drop in BP is because of the fact that she already achieved her dry weight or if it's something else. Thanks for your support.

[jo]

What happened today?

Love, Cas

Wow, thanks for remembering. She did a little better than usual today. As per your advice, she put ice yesterday and the pain went away late night yesterday. I'm very grateful and thankful to you. Today, she explained to the supervisor about how she suffered with pain over the weekend and the supervisor asked an efficient person to stick her. Thank God. Hopefully that other lady would never ever stick her. Thanks for the love and care Cas. I hope you are feeling better too.