Frustrating day with dialysis

[Adam_W]

The last week or so, I've been slowly getting back to using my graft. It is still in a state of working fine for a while and then screwing up. Because of that, I still have to rely on my catheter. Well, I was having trouble with my graft today, so I go to hook up with the catheter. I went to remove the old heparin from the arterial side, and nothing would come out into the syringe. The bloody arterial side was clotted! So there I am with a screwed up graft AND a screwed up catheter! Long story short, I couldn't dialyze. A little later, I remembered a previous time I had a clot in my catheter, and with guidance from my nurse over the phone, I did a "self de-clot" by slowly and carefully aspirating mixtures of saline and heparin through the catheter. I hung a saline bag, drew up several syringes of heparin, and got to work. After a while of VERY careful and slow flushes of the heparin/saline mix, I started to pull the syringe back, and I suddenly felt a pop, and all this nasty looking clotted blood just spurted into the syringe. I put a fresh saline syringe on and again tried to aspirate. The flow through the catheter was perfect! No sluggishness or resistance with either pulling or pushing the syringe. Unfortunately I still wasn't able to dialyze because I had already set my machine to drain the remaining dialysate, and you can't re enter treatment mode after you start draining. 

Now, the part that I'm still mad about.

I mentioned that my graft is still acting screwy, and my nurses want me to come into the centre on Monday to dialyze, so they can see exactly what the problem is with my graft. Over the period of time I've had this graft, I've had one declot done, and three or four fistulagrams. It is documented that my graft has a history of developing stenosis, and that is causing these problems I've been having. One of my nurses (who happened to be the on-call nurse that I talked to about this latest problem) is ABSOLUTELY CONVINCED that these problems are because I'M DOING SOMETHING WRONG WHEN I'M STICKING MYSELF! She has the attitude that if I come in Monday, and they show me how to cannulate "correctly", I will never have problems with my graft again. She was also saying that maybe I should let my dad handle all the sticking. Gee, that would mean I would have to live with my parents the rest of my bloody life, or find someone else to stick me, even though I can stick myself! I've never had a single problem with any of my home dialysis staff at this centre, so it makes this situation extra bad for me. This nurse is very nice, and (usually) very skilled. One thing she doesn't seem to realize though, is I was sticking my graft JUST FINE before she even became a nurse at this centre. She has NEVER touched my graft, she has NEVER stuck it, and she has NEVER seen me stick it. She may be an experienced nurse, but the graft is in MY F'ING ARM! No one knows my access better than I do! It's assumptions like that that just make me want to  Alright, I feel better now.

Adam

p.s. Hey Kitkatz, can I borrow your big stick when I go in on monday? 

[petey]

Adam, sorry about the trouble you're having.  You're right -- nobody knows your body and your access better than YOU!  Go in there Monday and prove to them (because you already know it) that you're the best cannulater (is that a word?) on your access.  When Miss Nurse says you are cannulating expertly, just smile at her and nod (have that "I told you so" look on your face).  But, just in case, hide Kit's big stick under your blanket!  Hope it goes good on Monday.

[tamara]

Show em up on Monday Adam, who knows their fistula more than a self cannulator NOBODY.

At least if you go in on Monday and there still is a problem, hope it stuffs up for them too and she will see hey this really needs to be fixed !


Take Care and let us know how you go


Tamara xxx ooo     

[willieandwinnie]

Hey Adam, Can't those "royal nurses" get an attitude . When did you last get a good treatment? What has vascular said about your graph? Len had about a 3 month period that all we did every other day was run to DC and have the graph roto-rooter out. He had a terrible narrowing in his chest, near his arm pit that they had a hard time opening up. I feel for you, I really do. I want to tell you something that the only dialysis nurse I liked told me. She said that the catheter needed to be cleaned out every couple of days to pervent clotting. I flushed that sucker about 3 times a week even when we used it, and Len's worked until the day they removed it. Don't you have any bags for your NxStage? Is there anyway to can order some to have on hand for emergencies? petey is more diplomatic then I am, I'd tell that nurse that I know my graph and body, and she doesn't. I hope you get things straightened out. I just hate to think your missing your treatments over this.

Take   and use it until somebody listens to you. Please keep us updated. This really sucks.  

[boxman55]

I am impressed at your degree of expertise Adam. It can't hurt to hear the nurse out first then  her. Good luck...Boxman

[devlinswife]

I think I know how you feel, I don't do dialysis at home, but I do try to stay VERY involved in my care, as you all said who knows your body better than you. I have wonderful nurses, but they have just hired several additional (our unit has grown a lot) and they come in there thinking they know everything. Well I tell them you may know everything there is to know in the books, but I NEVER go by the books, if you don't believe me go talk to the Dr or one of the long time nurses. Don't be afraid of them it's your life!

[stauffenberg]

The basic rule in medicine is that if something goes wrong, first blame the patient.  If the blame won't stick to the patient, the people to blame instead are, in order, 1) the nurse; 2) the intern; 3) the least senior doctor; 4) the senior doctor; 5) the almighty manufacturer of the drug that isn't working.  If the blame ever has to higher than the nurse or the intern, something is wrong with the system.

[Sluff]

I am impressed at your degree of expertise Adam. It can't hurt to hear the nurse out first then  her. Good luck...Boxman

At least you'll know what her final words were.

[jbeany]

Grrrr!   

Just how exactly does she think sticking a needle in is causing a stenosis?  Hello?  My surgeon managed to imply that my home dialysis was what was causing my graft to stenosis.  Umm, hello - it's been doing that since I started dialysis 14 months ago - and I've only been on home hemo for 8 months.  So what was causing it when I was in center?  Duh!  Stauffenburg's right about "first, blame the patient!"

[kitkatz]

Use the big stick as needed.     I am sorry you have been having so many problems with your graft.  It is a bummer I know.

[paddbear0000]

Sorry to heart this. I know just how you feel. Nurses seem to think they know more than the doctors themselves sometimes. I can't wait to hear how Monday went!