Needle Direction

[Cincygrandma]

Hi to All.  I started HD in center in Nov. 07.  Have a fistula in left lower arm that is kind of deep on upper? end.  I can't remember which they call upper and lower, but I'll call the end nearest the elbow the upper.  I've had terrific pain during most of my cannulations and 3 infiltrations so far, but during this period I've also had about 4 "nearly" painless cannulations so I know it can be done.  I've overheard the techs talk on occasion about putting both needles in one direction, and think that's been done with the exception of 2 or 3 times.  My problem is I can't stand to watch them put the needles in and often there's 2 or 3 techs working on me.  Last week a tech who I'd had fairly good luck with a couple previous times did the cannulation.  The upper needle went in with no problem.  When she went to put the lower needle in, I thought she was putting it in from an odd position.  Anyway she couldn't get it placed and called for help.   Don't know what the 2nd tech hit but I had an excruciating pain in the low end of my fistula.  It really didn't feel like the pain I've had when they hit a nerve.  Those usually travel down into my hand and fingers.  I had a painful treatment and when she went to take the needles out I noticed the lower one was pointing toward my fingers instead of toward my elbow.  I asked her about it and she said I think we were supposed to put both needles in same direction on you.   Question:  Is there a "typical" way for needles to be inserted?  What reason could cause a problem when needles are going in different directions?  Has anyone out there any experience with this?  Thanks!

[boxman55]

the two needles are called arterial and venous. I always have had mine inserted in the same direction but I have seen pictures of it being done the way you described. So I don't think it is a wrong way to do it it just might not be right for you. I would suggest that next time you are "in the chair" demand that the head access nurse come over and explain what the tech's are up too. Infiltration is not fun, hitting nerves is not fun, you shouldn't have to deal with that on a regular basis. Know whats going on and why...Demand attention...Boxman

[jbeany]

The arterial needle can be positioned in either direction in the blood flow.  It's usually easier to put both in the same the direction, although you may actually get better lab results with them in opposite directions.  The tech wasn't necessarily doing something wrong - but if it doesn't work that way for your access, then there's no reason to do it.  If it causes you pain, and hits your nerve, then don't let them do it.

For the quick explanation of how it works - the blood flows thru your access by entering on the arterial side, making the loop and exiting out the venous.  The venous, or blue needle, should always be placed so that the blood returning thru the venous tube enters with the direction of the blood flow as it exits the fistula.  The arterial, or red needle, can be placed so that it is pointing the same direction as the venous, and the blood is flowing past the entire body of the needle, or placed in the reverse direction, so the needle point is headed into the blood flow.  It's good to learn which direction the blood is flowing in your fistula, especially if you ever go to a different center.  The techs and nurses will frequently ask if you are "red-thumbed" or "blue-thumbed", which is a way to tell which side the venous and arterial tubes should be attached on.  You'll get inadequate dialysis if the two are reversed.  If you have a non-traditional orientation to your fistula, you might be like me and be "red-handed" instead.  (My needles are placed one on top of the other, instead of side by side.)

[Ang]

i  reckon  it's  horses  for  courses,what  ever  works  well  for  you.

me  i  have  the  needles  both  up  and  up  and  down,  i  have  about  5  sites  i  rotate  around  where  i  think  i  can  get  the  best  flow  as  i  reckon  me  veins  are  starting  to  narrow  again

[del]

Huby does arterial down venous up.  His buttonholes are done that way.

[boxman55]

I was told today that the venous is always on top and facing up towards the heart. The arterial can go up or down. For me they place both up in line (one above the other)...Boxman

[petey]

My husband's needles (Buttonhole Technique) are: arterial -- thumb-side and goes in pointing up toward his elbow (his fistula is in forearm between elbow and wrist but closer to elbow); venous -- pinkie side and goes in almost (but not quite) perpendicular to arterial -- this one ends up pointing toward his tummy/chest.  This, however, is the way his buttonhole was developed.

When he was in-center, needles went in all different directions -- basically, any way the tech/nurse could get them in.  They infiltrated often  and hit nerves often    We complained constantly.  This was tough on Marvin -- we love buttonholes!
 

[Cincygrandma]

Thanks for the info you all provided.  I asked the tech last night about their procedure and she said they normally do one up (venous) and one down (arterial), but with mine they do both up (unless they forget).  I talked to my Neph today about how things were going, and he suggested I keep an eye on them and subtly question them if I have concerns.  He knows I'm more the timid sort and I know you at IHD have told me to I guess to "carry a big stick".  As I learn more about what may be causing the pain and problems, etc., with my fistula, I will definitely let them know though.  The techs do sometimes actually scare me with things they forget or appear to not understand.  It seems to be a very friendly working atmosphere (for the most part), but sometimes I think to the point of distraction.   By the way, haven't heard the "red" or "blue" terminology used yet!