Position of needles...

[tyefly]

      I was wondering what most of you are doing or having done with the positioning of your needles.....
   I realize that buttonholes are the better choice  but I was wondering if any of you are placing the needles retrograde/antegrade   or   antegrade/antegrade  in the fistula......    I was reading somewhere  maybe on DSEN   that Bill Peckham has changed his positioning  to  antegrade for both needles....   I am trying to find more information on that particular position and what the benefits are....  I am going to email Bill with the same question as well.....  let me know on some of your positions...... thx   kathy

[Bill Peckham]

That was this post. I changed the direction of my needles to antegrade/antegrade (antegrade means the needle is pointing towards the heart, with the blood flow; retrograde means the needle is pointing away from the heart into the blood flow) after a presentation by Dr. Agar. Unfortunately that was a practice presentation to demonstrate the internet technology and the presentation itself was not recorded.

However there is a very good paper on Home Dialysis Central by Zbylut J. Twardowski, MD called Constant site (buttonhole) method of needle insertion for hemodialysis. Dr. Twardowski writes:
      "Puncture direction. Both needles were inserted in an antegrade direction that facilitated hemostasis after dialysis and decreased chances of hematoma formation. Antegrade needle direction does not predispose to recirculation. The recirculation may happen only when the flow through the dialyzer is higher than the flow through the fistula."

hemostasis means that you stop bleeding; hematoma is bruising but Dr. Agar went farther pointing to structural damage done.

Agar illustrated this very simply. Imagine someone holds a sheet of paper in front of you and you stick a needle through at an angle. A little flap of paper is created where the needle enters. That is basically what happens when you cannulate only the 'flap' is on your fistula. Now imagine blood rushing by the flap. With antegrade sticks the flow of the blood is pushing the flap closed.

With a retrograde stick the blood flow tends to push the flap open. Agar had slides of microscopic examination of the fistula wall after retrograde sticks and after antegrade sticks ... the retrograde fistula showed more damage.

[tyefly]

    Thx  Bill        That makes complete since.. with the flap analogy.....    and thx for the information....
                   I am sure this will help me make a better choice.... now I just have to figure out how to get that angle with my upper arm fistula......  but that is another story.....   

         take care    Kathy

[Zach]

Agar had slides of microscopic examination of the fistula wall after retrograde sticks and after antegrade sticks ... the retrograde fistula showed more damage.

Did the microscopic examination of the fistula wall show any "hanging shads?"   

[tyefly]

       I  was also wondering if the arterial or venous pressures are different  in using antegrade / retrograde  positions....     Has anyone experience this....    Bill   have you notice a change in pressure after changing to both antegrade.........

     thx  kathy

[BigSky]

Mine used to be both antegrade and then I switched my arterial to retrograde.  Seems to work better for me that way.

[del]

Hubby does arterial down, venous up using buttonholes. Has worked perfect and no fistula problems since he started hemo 9 years ago.

[Ang]

the  train  of  thought  in  my  centre  is  that  antegrade/retrograde  works  better,  i  try  it occassionally  when  i'm  moving  spots  as  button hole  is  a  no no

[willowtreewren]

HI, Ang,
Why is the button hole a no no for you??

Aleta

[monrein]

Probably has a graft instead of a fistula.