The case of the failing fistula...

[Meinuk]

Ok, I'll try and keep this short.  I am in the middle of all my doctors trying to figure out what is wrong, so I though I'd ask all of you if you've had any experience with this.

My arterial pressure drops - sometimes at the beginning of treatment, most of the time 2 hours into a 4 hour run.  We've ruled out needle placement, and we've ruled out blood pressure issues.  I about to go in for my second fistulagram, but the surgeons (I've gone to 2) can't see anything wrong, except for a small aneurysm (will be fixed soon). For now, I have a perm cath, so I have alternative access, and when I start nxstage in the fall, I'll be doing shorter daily treatments, so I'm not too worried, it is just that everyone seems so perplexed with my fistula acting this way.

Anyone out there have chronic arterial pressure problems?  If so, what was the resolution?

Thanks,

Anna

[Joe Paul]

A woman at my center has about the same problem. The Surgeon who put hers in says the fistula goes into spasms, causing poor flow. What they are is doing for it, is using the arterial on the fistula and her cath for the blood return. They claim in time the fistula will mature enough to overcome the pressure issues. I hope they figure out what the problem is for you, and a way to overcome it.

[skyedogrocks]

My husband Rob has continually had fistula problems, his is at the wrist.  He has lots of clotting issues, and I mean within milliseconds of the needle going in.  He had a fistula gram done and they said the access wasn't the best, so he had another one put in on his uppper arm before it completely stops working.  He had so many catheter infections, going back on it wasn't going to happen.  His access works fine for a while and then goes batty. 

He does Nx Stage home hemo now.  Since his upper arm is ready to use, he is going to go to the dialysis center, have his nurse put the needles in, flush and then cap off.  He'll go home and immediately jump on his machine.  Only bummer part about it is, he has to go back to 17 needles and slowly work back up to 15.

Can they put a new fistula in?  Is that an option?

[Meinuk]

Thank you both for such quick responses!  Any and all information is really helpful for me to try and get my head around this.  I feel like the combined knowledge of this group is such a great resource!  (thanks again Epoman, if you hadn't started this site, I would have been just a person in a 30 chair dialysis unit relying on a couple of doctors, some overworked techs & nurses and google!)

His access works fine for a while and then goes batty. 

He does Nx Stage home hemo now.  Since his upper arm is ready to use, he is going to go to the dialysis center, have his nurse put the needles in, flush and then cap off.  He'll go home and immediately jump on his machine.  Only bummer part about it is, he has to go back to 17 needles and slowly work back up to 15.

Can they put a new fistula in?  Is that an option?

That sounds really familiar.  I clot quickly as well, then of course, I bleed like crazy because of the heparin.  I'm still on 15's and my access is "like a garden hose".  One surgeon suggested a graft, but with my clotting, a graft could be even more trouble.  I am hoping that we can nurse this fistula along until I get a transplant.  Hopefully in the fall when I am on on home hemo, if I go low and slow daily it will be ok.  I really don't want a new fistula.  I've had this one for two years now, and using it for six months - I just feel like we're missing something and it should be working...  Your husband's dialysis routine sounds like a lot of work, hopefully his fistula will mature and all will be well!  I'm jealous that he is able to dialize at home - I am impatient!!!

What they are is doing for it, is using the arterial on the fistula and her cath for the blood return. They claim in time the fistula will mature enough to overcome the pressure issues.

That is what we do now.  I use the fistula for a couple of hours, we wait through 5 alarms, then we swap the arterial line to the cath as a return, and we pull from the venous side of the fistula.  (it sounds backwards, but it makes sense, as I am prone to sudden infiltrations ) - What is crazy is that for 4 months, I dialized without a problem, running pump speeds of 500. It has only been since late April that we've been having pressure problems.   Originally, the perm cath was placed because we had too many infiltrations.  (don't get me started - I was going to start learning to cannulate myself, and establish button holes, but we can't do that now because of the arterial pressure drops)

[keefer51]

My first fistula was small and wasn't really matured. They used it anyway. They would hook one to the catheter and one to the fistula. It had allot of problems so they finally stopped. My second fistula was the same way. I had so many infections they kept hoping it would work. I now have a working fistula in my left arm. I wouldn't let them near this one till it was matured. They told me the problem was i had bad veins.