Dads Fistula is swollen afer 2nd dialysis

[Roxanne610]

We have a question his arm wasnt swollen from the 1st treatment but now it is red and swollen the nurse said as long as his hand doesnt hurt it is fine they will just keep an eye on it...the did not attract fluid,,just cleaned blood 2 1/2 hours....Is that normal?

[qwerty]

Was it the first time the fistula was used? Also is it warm to touch? Is it tender to touch or does it ache without any touch? Sometimes after the first use it can although shouldnt leak under the tissue after the needle is pulled and patients have gone home. Usually you will see a bruise if this is the situation. In these cases if they have a cath still in I will give the fistula/graft a few days to rest and heal. Also be sure who ever is prepping the site before cannulating him is using the proper techniques to clean the site. We use betadine first allowing it to dry then use alcohol which should be wet when they cannulate him. I have seen patients develope cellulitis which basically is an inflammation or possible infection of the surrounding tissue. Try some ice on it to start with but no more than 20 minutes at a time as it can burn just like heat can. If it continues by the next treatment then the doctor should be notified and assess it also. Immune systems are already somewhat compromised and the last thing he needs is an infection in his access.

[Roxanne610]

Thank you....ok i will definately find out... IM READY TO KILL SOMEONE THERE ...Dialysis nurse rubbed his arm so much when they obviously see that his skin is so thin and dry rubbed it so hard he almost bled to death....................You have to see what these stupid no common sense.  And on top of that they pulled the tape off so hard it tore his skin like a knife slit it...Wait till I get up there tomorrow I am putting in such a complaint I have had it....You tell them over and over again and they dont friggin listen do you have to slap them upside there head to make them understand?

[qwerty]

You can also request they dont use tape on his skin after they pull the needles. They have to use some during treatment as it's more important to ensure he doesnt dislodge or infiltrate a needle accidently. But they can do it with minimal tape if they they do it properly. Have them tab the ends. I have several patients thier skin is so thin even the paper tape tears them which in itself can lead to infection. I wrap the gauze I place over sites with kerlex or bandage wrap using absolutely NO tape when I pull thier needles. You also can get the self adhering wraps similar to an ace bandage at the drug store which is reuseable for several times if kept clean. I only use a little tape to secure the needle during treatment and I tab the ends to make it easier to remove so I dont have to dig at it to get it off. If they tell you it cant be done then you insist!!! I also dont permit my staff to pull 2 needles at once either nor ever use 2 clamps at once which I have seen in other clinics. This can cause issues with not only thier access but the outer laying skin due to the increased pressure and tape to secure both. If they are doing this insist they dont. Ask for a view of thier policy if need be. It's your right to question and recieve an appropriate explanation. Hope this helps

[Roxanne610]

Thank you!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!  I will do trust me,,,my mom is like that too but for some reason she is paralyzed right now with all thats going on with my dad....My dad told me he told the morning nurse and how about this they didnt listen!!!!!!!!!!  So the day nurse came in when we were there around 12.  She tried to use tape for his intervenous I fought her down to add more gauze so not too much paper tape was even on him....I am writing down everything you say and bringing it there tomorrow and to dialysis center when we go there...

THANKS SOOOOOOOOOOOOOOOOOOOOOOOOOOO MUCH...

[boxman55]

What causes the skin to get thin??   Boxman

[monrein]

Prednisone and old age are two causes.  My skin is extremely thin due to long term prednisone.

[Roxanne610]

Thanks yes,,,,its the pred and he lost so much weight too and these stupid nurses are in too much of a rush up there....They are making matters worst

[cris]

Is your dad's access swollen on the spot only or the arm is bloated? If the swelling is just on the spot and it's red, they are right, watch out for infection. If your dad's access is barely new and it's swollen like most of the arm, this is just normal, have him elevate the arm, when his lying down, raise the arm above the head, this should help the swelling down. have you listened to the beat of his fistula, is it good?

love,
cris

[circleNthedrain]

While I was on prednisone during my working transplant period, my skin would just roll off.  Now that I'm back on dialysis and no more pred., my skin has toughened up again.  There is always a silver lining.

[Roxanne610]

The neph said this is normal because its a new fistula so thats why it looks like that when they use it in the beginning its not used of dialysis...I guess it has to get broken in per say As far as prednisone he will be on that forever due to his liver transplant so his skin will stay like that unfortunately....



THANK YOU EVERYONE FOR ALL YOUR HELP IT MAKES ME FEEL SO BETTER TO GET ANSWERS AND SUPPORT AT SUCH A TRYING TIME...

XOXOXOXOXOXOXOXOXOXOXOXOXOXOXOXOXOXOX

[boxman55]

What causes the skin to get thin??   Boxman

what causes it to happen if you haven't taken prednisone. Can warfarin cause it? My hands peel like a banana any simple contact with something if I bang it just a litte. I know this is somewhat off topic, sorry...Boxman

[monrein]

Warfarin can cause bleeding under the skin.  It's a blood thinner so bruising can happen more easily.  I think it has to be checked regularly, like monthly(?) to be sure the levels aren't too high.

Not at all sure about the peeling though, Boxman.

[boxman55]

what I meant was nics and scrapes occur so easily right know I must have 11 little cuts and tears

[circleNthedrain]

Boxman, I'm not sure which drugs other than pred may cause this.  I had this problem for many years and it was really annoying.  I was bruised and bleeding all the time!  I am amazed the problem seems to be gone and I can only attribute it to the transplant drugs I no longer take.

[monrein]

http://www.mayoclinic.com/health/warfarin-side-effects/HB00101

Here's some info on warfarin (brand name Coumadin).

[boxman55]

Thanks monrein. I absolutly hate taking that crap...Boxman