Fistulagram

[Ken Shelmerdine]

I thought a fistulagram was just an observation procedure as I have had previously where they do an ex-ray and an ultrasound scan and send the results to the dialysis clinic where it's then decided what course of action to take.

Yesterday they did the fistulagram and the treatment on the same day. Nobody had told me this at the clinic. I knew what the surgical procedure might entail but I just wasn't ready to have it sprung on me the same day. 

Although my fistula is working it seems to be maturing very slowly as I have two veins developing and it was thought that eacjh one was stunting the development of the other. Also they haven't been able to get the pump speed past 250 because pressure builds up and the machine alarms and it was thought that maybe some stenosis (Vein thinning) had taken place in one area of the one of the veins. (The one that's used for needling)

The treatment entailed a wire inserted in the vein near the top of my arm I don't know if they had a camera on but the surgeon was watching a monitor screen. He shoved it down almost as far as my wrist. It showed a slight stenosis in two places. So far so good. Then they sent a balloon down the wire to about halfway between my wrist and elbow. Then out came the laughing gas WTF! This was supposed to numb the pain when they inflated the balloon. I had a few gulps and then they inflated the balloon. H-O-L-Y S-*-*-t *^&"!!#""" ABSOLUTE AGONY!! More gulps of laughing gas but I wasn't laughing. Then they moved it up a few inches an inflated it again. Not quite as bad maybe the gas was kicking in and then it was finished. I said what about the extra vein? The surgeon said that the fistula was good and the main vein will develope eventually but the second vein could provide an alternative should the other main vein pack up. So he said he wasn't going to tie it off.

I then had to wait until the gas wore off for about an hour. I swear if I had known about all this I wouldn't have arrived in my car.

I was booked for dialysis in the afternoon but my arm ached so badly I couldn't face the needles and I still felt a bit woozy from the gas so I phoned and told them I wasn't coming. The Sister said 'No you mustn't do that you can't miss you're dialysis'! I replied ''No I shouldn't have to miss dialysis but non of the staff at the unit prepared me for what happened this morning and if they had I could have arranged a swap with somebody from the Tuesday slot!

Anyway I didn't go I just took 2 paracetamols and slept all afternoon. It's Tuesday now, I'm at work and I feel OK just a slight ache in the arm but I feel well pissed off with my normally excellent clinic for not making me aware of what was going to happen yesterday  

   

[okarol]

UGH! Ken, I am so sorry, that sounds gruesome! I have heard the fistulagram being referred to as the scan, and the procedure to open the vein as the fistutlaplasty. I cannot imagine why the didn't prepare you, especially about notifying you that you cannot drive after sedation! I hope you feel better today. {{{HUG}}}

[billybags]

That seems a bit naughty! You should have been told you were to have the procedure. I know my husband had to go for a scan and thats all they did. Hope every thing is ok.

[Rerun]

I had an experience like yours only my vein split when he ballooned it.  All I heard was "oops" from the Radiologist and then me yelling "oowwie owwie" and then I went black and woke up in a hospital bed.  I will never let a Radiologist do another fistulagram.  I make my vascular surgeon do all of them and I insist on being put out or at least drugged up REALLY good.

Sorry this happened.  Do it different now that you know.

[RightSide]

Did they inject a contrast dye into your veins for the Fistulagram?  If so, then you really should have tried to get dialyzed afterward if possible.

That contrast dye is known to be nephrotoxic.  If you have any little bit of residual kidney function left, there's about a 1-3% chance that the contrast dye will destroy that residual kidney function, leaving you with a GFR of zero, basically.  The best way to prevent that is to dialyze the dye out right after the Fistulagram is over.

My advice to anyone having a Fistulagram who still urinates or has any residual kidney function left:  Arrange to be dialyzed that same day after the FistulaGram is over.

[Melissa]

Hi Ken,
That is ridiculous that they did not tell you more about it.  I am sorry it was so bad.
That happened with me when I had an angiogram for my heart - I was in agony.
But for my fistulagram I had some truly great drugs....I am sorry you did not.  I was able to dialyze afterwards but it did hurt.  I was back to "normal" in a couple of days.
You will probably feel better after dialysis, after all the dye (if you had it) is out of your system.
Feel better!

[Ken Shelmerdine]

Did they inject a contrast dye into your veins for the Fistulagram?  If so, then you really should have tried to get dialyzed afterward if possible.

That contrast dye is known to be nephrotoxic.  If you have any little bit of residual kidney function left, there's about a 1-3% chance that the contrast dye will destroy that residual kidney function, leaving you with a GFR of zero, basically.  The best way to prevent that is to dialyze the dye out right after the Fistulagram is over.

My advice to anyone having a Fistulagram who still urinates or has any residual kidney function left:  Arrange to be dialyzed that same day after the FistulaGram is over.

OMG Rightside I didn't know this. Yes they did inject a dye made my hand go hot. I didn't go to dialysis that afternoon because my arm felt too sore. Wish to god I had now. having said that, still peeing OK and BP is normal so  hopefully I'm not in the 1-3%. Thanks for that info.

[RightSide]

That contrast dye is known to be nephrotoxic....

My advice to anyone having a Fistulagram who still urinates or has any residual kidney function left:  Arrange to be dialyzed that same day after the FistulaGram is over.

OMG Rightside I didn't know this. Yes they did inject a dye made my hand go hot. I didn't go to dialysis that afternoon because my arm felt too sore. Wish to god I had now. having said that, still peeing OK and BP is normal so  hopefully I'm not in the 1-3%. Thanks for that info.

When you have your next blood labs, you can see if there's been any change in your creatinine.  But the odds are very much on your side.  I didn't mean to scare you, just warn you for the future.

Here's a Wikipedia article on so-called "contrast-induced nepropathy"--and ways to deal with it:

http://en.wikipedia.org/wiki/Contrast-induced_nephropathy

[Ken Shelmerdine]

Rightside. Had my blood labs done last week and there's no change very much from last time so I got away with it. Thanks for the info though, and I won't be taking any chances in the future. 

[RightSide]

Rightside. Had my blood labs done last week and there's no change very much from last time so I got away with it. Thanks for the info though, and I won't be taking any chances in the future. 

I'm glad to hear it!

The odds were always on your side.

OTOH, the probability of dying in a plane crash is just 0.000002, and yet many passengers have flight insurance.

Maybe they should sell Fistulagram insurance.