First time for fistula

[YLGuy]

I have a couple of questions.  Tomorrow they are going to try and access my fistula.  They tried 2 weeks ago but they were unable to do so.  I so want this catheter out of my chest.  I used to work in an animal hospital and I am familiar with placing catheters in the arms of animals.  I believe that I could just as good as a job if not better than the D nurses.  Do you think the center will allow me to do it myself the first time out of the blocks or am I required to have some kind of training first.  After the fistula is working fine does anyone know about how much time before I can have the catheter removed?  Is the removal of the catheter usually an outpatient procedure done at the hospital?  On Monday I asked the D nurse if they used the buttonhole or ladder techique and he said ladder.  Is this good or bad?  I know that I should be asking my doctors these questions but I believe that I would get a much more straight forward answer from the IHD community.

[Hanify]

I can't answer your question re the fistula cos I never had one.  But I did have a catheter - several actually.  The removal is really easy.  They just pull it out.  It tugs a bit but isn't too bad.  They'll wait till they're sure your fistula is working, then just pull it out at dialysis one day.  I think Dan said they were waiting 2 weeks for his.  Yay.  Something to look forward to eh?

[Chris]

I am pretty sure you wthey would want to train you first as they would on the buttonhole technique I read about in the forums that a few members do, but that requires special needles too. It also  depends on what your center allows so just ask and explain experience.

[monrein]

I have a couple of questions.  Tomorrow they are going to try and access my fistula.  They tried 2 weeks ago but they were unable to do so.  I so want this catheter out of my chest.  I used to work in an animal hospital and I am familiar with placing catheters in the arms of animals.  I believe that I could just as good as a job if not better than the D nurses.  Do you think the center will allow me to do it myself the first time out of the blocks or am I required to have some kind of training first.  After the fistula is working fine does anyone know about how much time before I can have the catheter removed?  Is the removal of the catheter usually an outpatient procedure done at the hospital?  On Monday I asked the D nurse if they used the buttonhole or ladder techique and he said ladder.  Is this good or bad?  I know that I should be asking my doctors these questions but I believe that I would get a much more straight forward answer from the IHD community.

You might want to ask for their best "needle" nurse to start you off with the cannulating but let them know that you want to move pretty quickly to doing it yourself.  At first the fistula can infiltrate (or "blow") quite easily as it's new and not very tough or accustomed to the blood flows required for D.  Have the nurse talk to you about all aspects of her technique, why she's going where she's going, what she's feeling for etc.  You should wait until your fistula is 100% reliable every time before removing the catheter, although of course if actual problems with the cath arise then it might go earlier.  With laddering, you want to be sure and really ladder consistently, always moving up the fistula rather than just using the "easiest", tried and true needle spots.  This is to avoid aneurysms and in my experience nurses are often in too much of a hurry to always tackle the trickier spots on the ladder.  I did buttonholes my second time around and liked them a lot.  They are supposed to be good for prolonging the life of the fistula.  You can research them here on IHD, and your clinic can order the "blunt" needles for you.  You start with sharps to establish the tunnels and then switch to blunts.  Having the exact same person each time is important for the buttonhole technique so if you can be that person, all the better.  I don't think blunts are any more expensive than the regular sharps so I don't see why they'd object to getting them for you.

Removing the catheter is an outpatient procedure and is no big deal under most regular circumstances.  They remove it at the hospital here in Canada but I don't know what happens where you live.

[dwcrawford]

Please let us know your experience.  Selfish reasons:  Mine is coming up in a matter of weeks...

[Tinah1968]

I use a fistula and they want to start doing the Buttonhole Technique on it soon. They are going to start using the blunt needles on Friday. So I will let you know how that is. I can't stand the sight of a needle going into my skin so I think that I am SOL on the doing it myself part. (Once the needle is in I am fine I just can't watch.

[YLGuy]

  They were able to access the fistula on the first stick!  They only used 1 needle in the fistula and the return they did in my catheter.  They wanted to see how it went.  It went very well.  I don't know if Friday or Monday they are going to try and use my fistula for both.  They also were open to teaching me how to do it myself and have no problem using the buttonhole method later.

[monrein]

Sounds excellent YLG.

[willowtreewren]

Hi, Marc,
This is good news. 

I asked again at our clinic if they would let us do button holes and got a non-answer. I love our nurses, but they are a very reactionary bunch. They had one bad bleed experience with button holes and won't do them again. Ugh.

Aleta

[paris]

Glad to read your post and that things are going ok.   

[Chris]

That's great Marc. Glad your center is helpful.

eta, sorry to hear. That's not good medicine if one bad experience makes them stop and not understand why and move forward. The old department head of the my transplant center was like that. Two people went into rejection after getting the flu vaccination and then had a policy of no one there getting vaccinated.

[Ken Shelmerdine]

I've had my fistula needled 5 times now. 1st one was successful and the next two failed. But the last two sessions worked a treat. They are just using one needle at the present and one line from my cath. I'm not sure if you are allowed to eventually do it yourself at my clinic but I'm going to ask next time I go. I do know they use the ladder technique but not buttonhole as yet.

 I've found that with the smallest needles which they use on me at the moment, the needle penetration is almost painless.
Does the pain increase significantly with larger needles and does your arm become permanently sore when it's been needled many times?

[silverhead]

Aleta, why not start doing buttonholes yourself?, seeing as you are doing the sticks there is no reason why not doing it would be such a bad idea, as far as getting blunt needles, cross that bridge when you get to it, We tried using them, but Sharon heals so quickly that they did not work well for us, so we use sharps every time, but still use the same poke site every time. It has worked for us for 2 years.....

[monrein]

I've had my fistula needled 5 times now. 1st one was successful and the next two failed. But the last two sessions worked a treat. They are just using one needle at the present and one line from my cath. I'm not sure if you are allowed to eventually do it yourself at my clinic but I'm going to ask next time I go. I do know they use the ladder technique but not buttonhole as yet.

 I've found that with the smallest needles which they use on me at the moment, the needle penetration is almost painless.
Does the pain increase significantly with larger needles and does your arm become permanently sore when it's been needled many times?

I could never feel any difference between 17, 16 or 15 gauge needles.  None at all.  The hurdle presented by the needles really is 100% psychological, I've experienced this personally and discussed it with several fellow patients who found the same thing.  Also if you do it yourself, your concentration basically means that any pain is so secondary to your goal of successful needle insertion that it becomes very minor and insignificant.  I've never found lido or emla cream necessary either (I like being able to feel where the needle goes and how it's reacting there) and I think there's a huge psychological barrier there too, although of course we each have a different level of tolerance for pain or discomfort.   

[dwcrawford]

God I hate needles.  The surgeon says  go with button hole (it'll  last longer).  The Neph says whatever I want to do. The various nurses disagree (with each other).  One nurse says learn to do it myself.  I'm confused and the time is getting near to start getting poked.  Keep on  talk about it people.  I'm reading everything you say.

Pain threshold is next to nothing here... especiall when it comes to needles and blood.

[monrein]

dwc, I've said this before but maybe it was before you joined so here goes again.  You know how if someone else pinches you hard it feels very very different than if you pinch yourself as hard or even harder than they did?  Needling is a lot like that in my experience.  The idea of a needle and the idea of a pinch are different in our minds however even though the actual sensation is quite similar.  I used to practice pinching myself before starting D for the first time to get myself prepared for what it might feel like.  I sometimes pinched so hard that it broke the skin and yet the pain was entirely bearable.  My needles never caused as sharp a pain as all that pinching and yet at first I felt apprehensive about needling while I could pinch myself anywhere anytime, no fear.  After my first successful needling of myself I found myself immediately leaning over the other side of the chair and throwing up because of the anticipation of it being awful.  I was so surprised because I didn't actually experience it as painful, but it was mentally harrowing.  My mind thought it would be different than it actually was and I guess I flooded my body with adrenaline or something.  Eventually I found that I entered a kind of calm, meditative zone for needling.  Slow, methodical, focused on the feel of the vein, visualizing the angle, the depth, the success, concentrating on breathing and most importantly, stopping to regroup my thoughts and my focus if necessary.  I liked buttonholes because in short order there is a certain predictability.  Same hole, same angle, same depth, same sensation.

[Hanify]

Ah Monrein, I have this mental image of a pretty blonde woman walking around pinching herself in a shopping mall, and other people going 'what the??'.  Laughing with you, not at you of course....

[dwcrawford]

All of that makes sense.  I think I'll take the surgeons advise about the button holes.  He says it will make the fistala last longer.  I think I will take Jamie's advise (the nurse who will teach me) about doing it my self (and Moreins) because 1. it  makes sense that I wouldn't hurt me as much and 2. some of those techs looks like idiots (just looks mind you.  I'm sure they are quite adequate.)

[willowtreewren]

Monrein, I totally empathize with your getting so wrought up before sticking yourself. Before I stuck my husband the first time I thought I would puke.

I talked with the nurses who came out to the house today again about button-holes. My husband is so easy-going he would do it just as well as letting me stick him. They said to bring it up with his neph the next time we are in - just a couple weeks from now. they said that he is very conservative, but I want that fistula to last a very, very long time. I can be very persistent, so I am just going to keep bugging them until they let us go with button holes. The head nurse said that they could get the blunts for us. 

Aleta

[Pam]

I want button holes too. This is my 5th week and they keep telling me they won't start button holes until i am using the bigger needle.

Ken I have no pain in my arm but the bruising is terrible.

[YLGuy]

       I just got home from D.  They were able to use my fistula with both needles!  They said that if it works for 2 weeks they will remove my catheter.  It was a great way to start my weekend.  I am going camping with the YMCA father/son program.  This should be interesting trying to set up camp with one arm (plenty of other dads to help me out).  I am mostly worried about my renal diet.  I got my labs back today and they are all good.  I want to keep them that way.          

[willowtreewren]

Yay!

Keep those labs in line! 

We find that with a little planning, we can do nearly everything we want.

[Ken Shelmerdine]

Monrein I agree with you. I have realised that the anticipation of pain is probably worse than the pain itself. I find that when I watch them needle me instead on turning my face away the pain seems to be le.

When I was having my fistula done I was hooked up to a BP machine and though I was feeling no pain my BP went through the roof. I think that being unable to see what was going on gave me a feeling of not being in control. I asked the sureon to remove the screening so I could watch the operation and and after that my BP came right down.

I think it's the same with needling and I think the difference is that when you watch you know exacxtly when the sting will occur and therefor the shock (and that's what I think mainly it is) is much less. That's my take on it.

[YLGuy]

Yesterday=Bad day,  Today=Good day!

Yesterday...I weighed in at my normal 78 kilos.  I usually leave weighing 75 kilos.  The tech made a comment that I had gained weight.  I was thinking I always gain the 3 kilos back.  Last week I had lost a little extra weight and they changed my dry weight in the computer.  They pulled too much too fast.  10 minutes before I was done I had the worst cramps in both calves I have ever had in my life.  It was horrible.  I was yelling out in pain.  They had 2 people trying to stretch my muscles and 2 people trying to hold me down.  They gave me 300ml's and then another 300ml's.  I could barely walk the rest of the day.  They both still hurt today.   

Today...I went to the hospital this morning and they removed the catheter from my chest/neck.  I get to take a real shower on Thursday!!! 

[dwcrawford]

Surgeon says tomorrow is first stick day but I say Monday when my favorite nurse returns from vacation.  He drew a road map on my arm and says to not wash it off until I let them stick me.  Lol... that could be a while.

My question is:  I have this Lidocaine and Prilocaine Cream.  I know to put it on 1 hour before and wrap in saran wrap (or an occlusive dressing).  What nobody seems to know is how much to I put on where where (just where he drew for them to stick?)

Yesterday three people were holding down an old lady while she yelled for God to come help her (one was her daughter).  He didn't come.  Does it hurt that much?  What if I curse at them?