Switching from a catheter to a fistula

[justagirl2325]

Hi all. I apologize if this has been asked before...I searched "fistula" and there was 132 pages of results and frankly ain't no one got time to go through that (wow).

My husband's dialysis need came on suddenly, well suddenly because he didn't see his kidney doc for a year and a half and in that time frame went from 22% to 9%.  So he received a catheter just below his neck and started dialysis that same day (last July).  He's become quite handy with it, he hates the feeling of something in his chest but it works well for him.  Nine months no problems.  We do home hemo (overnight) and he showers and everything. 

He had a fistula "installed?" in January and he is back in centre for the nurses to establish the button holes.  He is having second thoughts of doing this on his own.  He hasn't said why for sure, but it might be a combination of the needles and his bad eyesight.  I don't have time until after April to learn this myself - needles don't scare me and I have good eyesight.  He is worried that it would be putting too much pressure on me to do that for him everytime.

Should we just stop and go back to the catheter?

[MooseMom]

How one decides to receive dialysis is a profoundly personal issue.  So I will give you the "standard" answer that can apply to most patients, and you and your husband can go from there.

Try to find out why your husband is having problems inserting his own needles.  Chances are he and his team can find a solution.  It takes practice, and his dialysis nurse should be able to help.  Surely he cannot be the only patient in his clinic who does home hemo, so I would be shocked if his clinic can't offer support in this regard.

If you don't have time to learn how to insert his needles until after April, well, April is almost halfway over already.  I'm sure he can use the next couple of weeks to identify the problem and try to find an answer.

If you were to learn to insert his needles, would that be putting too much pressure on you?  Do you think you could do that?  There have been several caregivers who have posted here on IHD about their experiences in learning to insert needles.  Maybe some of them can give you some tips.

Please do all you can to keep from having to go back in center for any great length of time.

My mother had a catheter for 18 months (they had trouble installing a working fistula), and she was scrupulous in taking care of it.  She never had a problem, but she WAS extremely careful.  She was very lucky.  So, as long as your husband is careful, he can continue to do home hemo via his catheter until he is more confident in needling himself.  There is no huge rush.  Get the buttonholes well established, and then go from there.

Good luck!!!

[Michael Murphy]

He does know that with button holes he will use blunt needles.  Not the sharp needles used in center hemo.  I am thinking of starting home hemo and was put off by the needles then I found out with button holes you pull the scab off them and insert a blunt needle in the hole. 

[jeannea]

This is the kind of thing I think it's too easy to get nervous over. He is nervous or the first time didn't go well. Then the next time he's thinking he can't do it and it doesn't go well. Then he's thinking that he can't do it and he can never go back to home hemo and it's a mess etc. This may or may not be true but it's too easy to get into that kind of thinking. See if it's ok with him if he just tries twice then lets the nurses do it. Next time, same thing. Eventually, without pressure, he may have it.

And really, the end of April will come quickly if you have to help him.

[PrimeTimer]

My husband has been on dialysis for nearly 19 months. We've been doing home-hemo for about 16 months. He has a fistula, uses buttonholes and self-cannulates using 15-gauge blunt needles. He's diabetic, experiences diabetic neuropathy in his hands and feet and has to use reading glasses to cannulate himself. As his carepartner, I shine a bright mini-flashlite on his buttonholes so he can see it better and I use one hand on-top of his to "guide his hand and the needle to the buttonhole". Altho it is still stressful for us, we've gotten into a pretty good routine and at this point, my husband doesn't always need my hand to guide his to the buttonhole. I am both impressed and relieved about him gaining the confidence. Once, when he was sick and in the hospital, he had to have dialysis there and the nurse did not know how to cannulate buttonholes so I cannulated him. Couldn't believe I did that but just from helping him, I learned which angles and depth that his needles needed to be inserted...I was really surprised at myself but now I know that if I have to do it, I have the confidence to. As for the blunt needles, some days are more painful than others but lately, my husband has been saying that sometimes he doesn't even feel the needle go in anymore....it slides in like butter! SO...with all this being said, it can be done. While it can be a little tense, the more you do it the easier it gets or rather, less tense it becomes. I am so glad my husband and I BOTH know how to cannulate him. It has really paid off. Good luck with whatever you guys decide but hopefully you can continue doing home-hemo and will have the chance to build up your own confidence. I'm terrible when it comes to handling stress, I hate that new things can be so scary! 

[Michael Murphy]

What made me even consider it was watching a tube video of a patient self cannulating with blunt in buttonhole.  He made it look easy.

[justagirl2325]

Thanks everyone.

PrimeTimer, that sounds exactly how I think our experince will go.  When we've done home hemo I would hold the flashlight helping him see how / where to connect the catheter... I know excactly what you mean.

He gets to try to needle himself with the blunts Wednesday at the hospital for the first time.  I wish I could be there.

[Simon Dog]

Should we just stop and go back to the catheter?

No.

[justagirl2325]

So his nurse told him that since he will be trying to insert his own needles tomorrow, if it goes well he can go back to home hemo immediately. 

I think that is the stupdiest thing I've ever heard.  So in her world, it's ok that not only will I not be trained, I don't even get to see it first hand before we do it at home. 

He thought that was fine.  I'm not comfortable with that.  I've asked him to keep attending the hospital until I can get there at least once (May 1 would be my first opportunity).   

He agreed.   

[Simon Dog]

I would suggest that a patient do several jabs/sticks/punctures (using all the words staff are trained not to use for the sake of being un-pc) him/herself before going home.   Confidence is the name of the game.    If the clinic is doing its job, your home treatment RN will always be available to help, and you can get a clinic treatment quickly, or someone can come to your home to help, if you miss a treatment due to cannulation problems.

My care partner is well versed in how to handle emergencies, but has not training on cannulation, and does not want to have any part of violating my epidermal perimeter.

I do my cannulation alone (but with someone in the house).   I have found I have fewer problems without an audience.