Fistula placement ?

[paddbear0000]

When I stopped by my neph's office to get some papers today, the receptionist was telling me about my appointment for my vein mapping. She said that they will do both arms to determine which arm it will be placed in. I wasn't feeling well and didn't want to prolong being there by asking questions. Is there really a possibility that they will place my fistula in my dominant arm???!!! How am I supposed to function at my full ability if the fistula is in my dominant arm?  Does anyone have theirs there? Are there any limitations because it is?

[G-Ma]

My fistula was placed in my dominant arm (upper).  Limitations of course are lifting.  Can't do crosswords or any writing at dialysis.  Otherwise it hasn't bothered me.
Ann

[paddbear0000]

Oh man! There is no way I can sit and do nothing at dialysis! I plan on bringing lots of puzzle books and most importantly, my laptop, which requires using my dominant hand (obviously!). I am left hand impaired!!

[G-Ma]

I have been VERY left handed but am forcing myself to begin using my right hand for various things.  Writing for me is a joke tho.

[RichardMEL]

This is interesting. I thought they will only place a fistula in a dominant arm in extreme circumstances. It always goes in the non dominant - either lower then upper arm, and then they will go to the other side if they have to, but it is generally not done that way. Luckily mine's in my left (non dominant) lower arm. I had to move my watch from there and learn to putting it on the other arm, but apart from that it's been fine.

[G-Ma]

My first graft, now non func, was on right forearm so vasc surgeon opted for left upper for this one.

[thegrammalady]

my first fistula was in my lower right wrist, i wright left handed, however i a ambidextrous and writing is about the only thing i do left handed (most of the time) even though it was in my right wrist i managed to crutched several baby blankets without upsetting the machine. the current fistula is in my upper right arm and i still use both hands at dialysis. i'll repete myself again. it's a machine, we tell it what to do, it doesn't tell us. obviously i'm not dancing a jig, but i absolutely refuse to sit completely still. you can call me a little trouble maker, but it's worked and worked well for 3 years.

[paddbear0000]

If they put it in my dominant arm, I'll have to become a troublemaker too!

[monrein]

This is interesting. I thought they will only place a fistula in a dominant arm in extreme circumstances. It always goes in the non dominant - either lower then upper arm, and then they will go to the other side if they have to, but it is generally not done that way. Luckily mine's in my left (non dominant) lower arm. I had to move my watch from there and learn to putting it on the other arm, but apart from that it's been fine.

That was my exact experience RM. 

[G-Ma]

My fistula is so sensitive that moving my wrist sets the machine off so I'm useless.

[RichardMEL]

It's interesting when I first started I found the machine was sensitive to very VERY small movements... now (2.5 years on) I can actually move a fair bit.. not that I do of course.. I've gotten pretty used to keeping it still, but if I need to scratch or move a little or use it to help do something like unwrap a sandwiches or something it's OK I can do it and no problem. Anyway if the machine alarms I'm usually OK to reset it fine. Not a biggie. I like that the staff trust me. They even let me help another patient the other day while I was waiting for my machine to finish testing and they were all busy. I felt useful for a change The old patient now calls me doctor! 

[Wallyz]

There was a good post about fistula placement over at SEOTN:

http://www.billpeckham.com/from_the_sharp_end_of_the/2008/12/which-fistula-first.html

Dr Laird and I disagree about some things, but this is an important discussion.

In summary, America needs to improve vascular surgery fistula training programs, utilize microsurgical techniques more frequently, avoid sacrificing ANY viable distal vessel, adopt constant site cannulation techniques and stop divisive and egocentric debates on issues already settled in other nations. It is time for all renal care physicians to gain maturity in fistula placement and maintenance techniques enjoyed by the other nations and become once again the advocates of excellence that we were once known.

Demand a lowerf istula, becuase if an upper arm fistula fails, you cannot get  a lower arm fistula on that arm.  If the doctor complains, get  a better doctor.

[skyedogrocks]

Rob's first fistula is in his lower left arm (he's right-handed).  His second was placed in his upper left arm.  However, it didn't work that well and his then vascular surgeon said a third fistula would need to go in his right arm.  Since he's an electrician this was a big blow to him.  His neph got him a second opinion and we are so glad he went!  Rob's new vascular surgeon was able to take a vein from his right arm and make a natural vein graft with his upper left arm fistula.  It works fantastic and we are so happy he had this option.

Definitely get a 2nd opinion if your vasular surgeon wants to do it in your dominant arm.  There are many different options.

[kitkatz]

I can move around quite a bit. I had a tech complain at me because he was worried I would pull a needle out.

[paddbear0000]

Don't they tape the needles down like they do IVs?   

[monrein]

Yes we do tape the needles down but often, especially at the beginning when the fistula is new and immature, arm movement can cause a prick in the vein and it swells up because of blood pumping into the surrounding tissue.  This is called infiltration or blowing the vein.  It requires another needle usually.  This gets better as time goes by and the fistula gets tougher.  I worry much less about this when using blunts with my buttonholes than when using sharps.

[Sunny]

Based on the information referred to in Wallyz post regarding Dr. Laird's opinion ( seebillpeckham.com), I am now educated enough to know I will be demanding a fistula in my non-dominant lower arm for my 1st placement. This is considered the "gold standard" based on plenty of research. Don't let anyone talk you out of it without good reason. This is where 1st placements should always go.

[paddbear0000]

Why is placement in the lower arm first, better than in the upper arm?

[monrein]

Because if you go with the upper arm first then you can't do lower arm next so you're eliminating needlessly a very good potential access.  The order is forearm, non-dominant arm, then upper arm, then forearm of dominant arm and then upper arm dominant.  Sometimes a fistula can be done elsewhere if there are extenuating circumstances.  The biggest issue for us who must face the possibility of D over time, is the issue of a viable access so this order becomes important.  An exception must be made if the vascular system in any of those spots is not good enough to support a functioning fistula.

[paddbear0000]

I'm a little worried because I had my vein mapping today and the tech said i had extremely small veins! Yikes!!! I'm not so sure I want I in my leg. Nor do I want a catherter. I love my showers! Once I'm done washing, I just stand or sit under the hot water until the hot water starts to run out! That's how I get warm for about an hour!

[David13]

Fistula placement is a very important decision.  Get a second or even a third opinion before you decide.

[Chris]

When I had my fistula, my surgeon asked which was my dominant arm. I use my right side mostly for writing, but can write with my left, but it is not as strong. My surgeon preferred not using the dominant arm so that I and other patients still had full function. If you do not want it in your dominant arm nd both sides are good for placement, then tell your surgeon not to put it in your dominant arm. Remember it's your body and life, not theirs and they won't have to deal with it.the fistula was put in by my wrist in my left arm and then the graft in my left upper arm.

[Tinah1968]

I also had small veins. I had a Fistula placement Oct. 12, 2007.. When they did the mapping they were going to put it near the wrist. but the veins there were to small and it ended up near my Elbow. With that said an operation taht should have take 20 minutes took 2 1/2 hours and instead of just once scar I have 7 up and down my arm from them having trouble with putting the veins together. Be sure that you tell them where you want it.. And be sure that you let them know that you would preffer to have it in the NON-Dominant arm.. And only in the Dominant arm if totally necessary.