Needle Clots

[LisaBart]

This may have been covered but to save me searching -

Do you have needles clot at beginning of dialysis session and they have to pull out and put it in another spot in fistula?
Alan is only 3 weeks on dialysis and it happened for 2nd time Wednesday. Both times it was same area of fistula and they had to move down....
This worries me doing home dialysis, like how will I know if that's the problem or I have hit a vein wall or something.
Am having doubts re home dialysis ...maybe because its all still so new....I do help where I can at the renal unit so far...I reckon I could take his needles out already...
not put them in yet tho !

[iolaire]

I wonder if Alan might be able to notice any difference in the feel of the vein/fistula area when they flush the line and it clots versus when it doesn't?

I have not had a clot like that since I started in December.  But they do check the lines with saline or heparin especially the line going into my arm.  Its fairly common that I'll feel it throb against the vein when they do this check and I complain, then they put a bit of gauze under the needle to jack it up a bit, or they try flipping the needle. 

[obsidianom]

This may have been covered but to save me searching -

Do you have needles clot at beginning of dialysis session and they have to pull out and put it in another spot in fistula?
Alan is only 3 weeks on dialysis and it happened for 2nd time Wednesday. Both times it was same area of fistula and they had to move down....
This worries me doing home dialysis, like how will I know if that's the problem or I have hit a vein wall or something.
Am having doubts re home dialysis ...maybe because its all still so new....I do help where I can at the renal unit so far...I reckon I could take his needles out already...
not put them in yet tho !

First off, it is too soon for home dialysis. I recommmend at least 2 months of STABLE in center dialysis that you can watch and learn from and he sees how it feels and he responds before you do home dialysis.
Over time they should figure out why he is clotting and fix it . That way when you go home it will no longer be an issue. I have NEVER had a clot on my wife at home in over 2 years. They need to se if its his fistula acting up or their technique. 

[Simon Dog]

I found that my needles clot if I put both in and then do the flushes.  The clotting is minor, but enough to prevent blood from flowing into the line when I loosen the cap, and easy to break by pulling back on the syringe (I put 7cc in a 10cc syringe for flushing so I have room to do this).  I have recently changed my procedure, and I now do my flush as soon as the needle is in and secured with a single piece of tape.  This has eliminated the need to "break the clot", and the blood always flows freely when I unclamp and loosen the cap on the line.

.I reckon I could take his needles out already...not put them in yet tho !

Tell him to put his own damn needles in      Unless he is disabled, has parkinsons, or some other disability, the best thing is for the patient to do his/her own needles.  It's also a handy skill for the patient to have if he needs to temporarily go in-center, or get dialysis while in the hospital.

[DeadAlive]

Are you sure the needles are not just clotting because the nurses are taking too long to insert it?

In my early days of dialysis it seemed like every other needle would clot up whilst they were trying to needle me ... they were taking too long with needles inside my arm but not inside my fistula.

The truth is they were just missing my fistula too often, needling needs to be fast and precise (no missing the vein then "wiggling" it about for 20 second) i was so worried so often that my fistula was going to clot up i had to do soemthing about it.

I decided the nurses were not sucessfull enough at needling me so i started needling myself and personally i never had a needle clot up since. I must of needled myself over 3000 times and never had 1 clot during the needling of my fistula.

[DeadAlive]

I just realised some people use dry needles ..... i don't.

I use wet needles on a small syrineg all filled with saline.

[Michael Murphy]

 :The one thing I have noticed in 18 months of in center dialysis is that the nurses and techs have a easier time putting the needles in to my fistula. I believe that because that while my fistula was 2years old when I started dialysis it was not noticeable by looking at my arm.  In the last 18 months it has grown into a long bump that runs from my wrist to my elbow.  I think that since it is now so much larger it should be easy to hit.  I have not been infiltrated in over a year.  In addition the only time they had to remove clots was when I stupidly fell asleep on the arm with a fistula. 

[PrimeTimer]

This may have been covered but to save me searching -

Do you have needles clot at beginning of dialysis session and they have to pull out and put it in another spot in fistula?
Alan is only 3 weeks on dialysis and it happened for 2nd time Wednesday. Both times it was same area of fistula and they had to move down....
This worries me doing home dialysis, like how will I know if that's the problem or I have hit a vein wall or something.
Am having doubts re home dialysis ...maybe because its all still so new....I do help where I can at the renal unit so far...I reckon I could take his needles out already...
not put them in yet tho !

You are not alone with your fears. My husband started dialysis in Sept and we've only been doing home hemo for barely over 8 months. "Needling" is still our most stressful part. My husband puts in his own needles (he uses the Buttonhole Method) and I pull them after treatment. He has an AV fistula on his upper left bicep and wears reading glasses. It is hard for him to see exactly where he needs to put the needles (imagine trying to look at something from upside down). To help him, I gently and slowly "guide" his hand to the needle hole and then he's the one that actually inserts it. He's had many angioplasties and one stent done to his fistula due to narrowing, which they say is not uncommon during the first couple years for a fistula. Each time they've ballooned it (angioplasty), the fistula has moved a little. Sometimes to the left, a little to the right, sometimes it's more shallow, other times deeper. Also, his weight, fluid retention and blood pressure seem to affect the angle or depth of his fistula. In fact, after his last angioplasty, he can put in the venous needle but it won't go in quite as smoothly as it should so rather than leave part of it sticking out during treatment (that's not always so good) or risk pushing it in too far/too hard and infiltrating (which is bad), he puts it in as much as he can or is comfortable with, holds it until I take over and then I "finish" inserting it for him. It's taken many months but we have both learned how to feel for his fistula and the "thrill and bruit". Not easy! Especially on a new fistula, it can be hard to feel the flow of the blood. And then just when you get use to knowing where it's at, boom! He has to have another angioplasty and the direction changes and we have to learn where it's at all over again! And while he feels for his fistula with his fingertip, I do better by feeling with the "second pad" of my finger just above the second knuckle.

As for clotting, after my husband inserts his needles, I "prime the lines" and then check each one by gently flushing with saline back and forth, testing the pressure and feel of the blood flow). Please ask your nurse about this because they may not want your husband having the saline flush. I've had a needle clot even after doing a saline flush while I was messing around with the other. In that case, we've had to pull the needle, hold pressure several minutes and then start over with a new needle and test it again with another saline flush. It happens. If it happens often, then it's time to tell the nurse and perhaps visit the vascular clinic to have his fistula checked. That's why it's important for your husband to feel for the "thrill and bruit" every day. If he doesn't feel it and it's only "pulsating", time to call the nurse -fast. 

Anyways, whether you're the one inserting or removing or watching, needling can be very stressful. Takes time to get over the anxiety and even then it is still a little stressful. But, you will slowly get use to it and it won't be quite as scary after a while. When my husband was recently in the hospital, he had to have dialysis. He was so out of it, he could not put in his needles. Up until then, I had never put them in. But, when the nurse at the hospital picked up a needle and then turned to ask me about putting in the needles and from the way she was holding it, I panicked. Before I realized it I sprang into action and ended up putting in the needles myself, which probably saved my husband's "Buttonholes" from being ruined. The "Buttonhole Method" is another topic tho...My point is, is that when it comes down to it, your knowledge, experience and determination will take over and override your fears. Maybe not always but even so, that's okay.

If your husband is unable to needle himself and you think you can learn it, then one way you can practice is to cut a piece of the tubing that comes with the needles, tape it down over a block of Styrofoam and then take one of the needles and start practicing insertion and watching the needle go thru the tubing, making sure you don't pierce/infiltrate the wall of the tubing. It may not be a perfect way to learn but it at least helped give me an idea.

Best of luck to you, I'm sure you've already seen some but there are lots of "needle" threads here on the ihd site and then there are youtubes on the Internet. Just keep in mind, it is going to be stressful but it does get easier. And then you go thru stress again...then it gets better, then stress again and then...    

[LisaBart]

Thankyou  for all your replies and great information.
His fistula has been ballooned once already since it was first done.  Maybe sometimes they are a little slow with the needles...his veins are shallow apparently and they always check with the ultrasound machine...well depends which nurse he has, but they all seem very capable and experienced. They do flush the line, it's all new to me so am learning slowly. I don't hang around and wait for him that's for sure...
Alan has peripheral neuropathy, feet lower legs and fingers....maybe once button hole is established he may be able to do his own.....
Am definitely not rushing the home dialysis!! 6 months will be fine !! But is he is more comfortable going to the unit then he can stay there....it's 5 minutes away...and he has fun with the nurses lol


 I am hating the 3.30pm - 7.30pm time slot, very inconvenient and I am finding I am rushing everywhere from 3pm! Tonight was crazy as I need some me time, and I paddle outrigger canoes...tonight I paddled...son wanted to be somewhere, then salon needed closing, then pick Alan up...it's nice to sit and have a cup of tea!  It's so dreary seeing everyone hooked up to lines....I kinda breeze in and chat and say hello to anyone who needs a cheer up LOL They probably think...here comes the crazy lady ... I just try and be friendly

[iolaire]

It's so dreary seeing everyone hooked up to lines....I kinda breeze in and chat and say hello to anyone who needs a cheer up LOL They probably think...here comes the crazy lady ... I just try and be friendly

I think that is good.  In my center people nod and say goodbye when they leave but there is really no chatter or comradeship. 

Versus last week I was traveling and in Cape Town South Africa in a center where everyone was quite boisterous - including the head nurse and techs - and everyone talking to the group at 6 am when they arrived.  That seemed like a much more positive and supportive environment.  If fact I was late for my second shift and they had noticed and wondered where I was - that type of thing makes you feel valued by the group - even for someone that is in that center just twice.

[LisaBart]

A couple of the nurses at our unit are a lot of fun, even the one I first thought was a nasty old grump....she is actually lovely.  Got to remember they have their own life issues, she travels from 45 minutes away (that's a long way on our island) and has beaten cancer once already....and then cares for sick people so it's nice to be good to them.  At xmas I took a big flower arrangement for the staff and Alan hadn't even started there yet...I think too the fact that my husband is a kinda youngish 59, looks like a younger version of Colonal Sanders, was in his younger days mistaken for Billy Connoly, and doesn't mind a laugh...is in his favour. They threaten him with needles and he advises them about their plumbing...got to make the most of a bad situation. It just takes one person to break the ice

[amanda100wilson]

I reccomend wet sticks so the lines and needles are primed with saline prior to cannulation.  This method really does help if clotting is a problem during cannulation.  Your nurses should know how to do it.  If they don't, then they may not be the right people to train for hone dialysis.  You should not be sent home until you are confident on how to do all the treatment.