First use of your fistula

[MooseMom]

There's a post in the INTRODUCTION forum outlining the proper protocol for the first use of an AV fistula, and it raised all sorts of questions.  Sorry, I don't know how to post a link to the discussion, but I'm sure you all will find it.  Is it true that most techs don't know how to put the needles in a new fistula?  How do you protect your fistula if the people entrusted to use it don't know themselves what to do?  Could you all please tell me about what happened the very first time yours was used?  You know, I am so tired of having to keep on top of everyone; no one is getting my referrals right, everyone seems to be incompetent or not paying attention, and I'm exhausted and I don't know if I am going to be in good enough shape to monitor the tech who first uses my fistula.  The poster said that medical personnel in a hospital have more experience with using new fistulas...is this true?  I don't even have mine yet, and already I'm reading that you basically can't trust anyone to help you protect it.  How many of you had your fistulas ruined by incompetent techs?

[Joe Paul]

 I tried pasting the link to " Important protocol for first-time fistula users" but it wouldn't work. Its probably on my end though.

[monrein]

There's a post in the INTRODUCTION forum outlining the proper protocol for the first use of an AV fistula, and it raised all sorts of questions.  Sorry, I don't know how to post a link to the discussion, but I'm sure you all will find it.  Is it true that most techs don't know how to put the needles in a new fistula?  How do you protect your fistula if the people entrusted to use it don't know themselves what to do?  Could you all please tell me about what happened the very first time yours was used?  You know, I am so tired of having to keep on top of everyone; no one is getting my referrals right, everyone seems to be incompetent or not paying attention, and I'm exhausted and I don't know if I am going to be in good enough shape to monitor the tech who first uses my fistula.  The poster said that medical personnel in a hospital have more experience with using new fistulas...is this true?  I don't even have mine yet, and already I'm reading that you basically can't trust anyone to help you protect it.  How many of you had your fistulas ruined by incompetent techs?

Slow down again MM.  You don't have to cover all the bases in one day.  One puzzle piece at a time, remember.  When the time comes to use your fistula, you're going to ask for the most experienced needler they have.  In fact you're going to insist upon it...in the nicest of all possible ways of course.  You will have read tons of stuff here about how to treat and care for a fistula and you'll have to trust the unit at least a little, until your fistula adapts to dialysis.  Ask questions, ask them to explain what they're doing and why.  You'll start to feel your vein for yourself, taking notice of where it lies under the skin, where it narrows or goes deep etc.  This may sound like a foreign language right now but you'll know what I mean in time.
Your very best bet for your fistula is to do your own needles and before you recoil in horror, let me tell you that the peace of mind and sense of competence and control that comes from this is huge.  That's a discussion for later on and we can talk about how to prepare for this, physically and psychologically, the latter being the bigger piece.
In the beginning, a fistula is nervous itself and not very strong or robust (just like it's owner...that's how I felt anyway)  and there can be hurdles with the needles BUT it and you will get the hang of things and anxiety doesn't help. 

[Rerun]

Good post but should not have been an "introduction"  I PM'd him so that we could get that information in General Discussion.

Here is the link to the introduction:  http://ihatedialysis.com/forum/index.php?topic=18076.0


Rerun, Moderator

[Pam]

Moosemom....Monrein is right you've got to find a way to calm down ! It's important to learn everything you can and yes this site is one of the best tools we can have.
I was a worrier. The hardest thing I had to learn was to take things in stages. Today is here and tomorrow will take care of itself. I learned that the "what ifs" are few and far between.
Pam

[sullidog]

I was knervous too but it really wasn't that bad. I don't know if all centers do this but my center will start with one needle while using the other in the catheter, then eventually go to using the fistula only. They also will start with the smallest needle and go up.
Troy

[MooseMom]

This may shock you all, but the idea of placing the needles myself does not horrify me.  I understand the advantages of doing this myself. 

[MooseMom]

Monrien, I read your post on another thread where you explained laddering.  Should I talk to someone at the clinic about buttonholes and/or laddering BEFORE I actually start dialysis (but after I get my fistula)?  I have no idea how experienced any of the techs are at the clinic; what is the most politic way of finding out?

[monrein]

When you visit the clinic you'll be going to you can ask whether they have experience with buttonholes but there's no rush with this.  You will be using sharp needles at first and laddering or at least using different sites until the fistula is mature enough to handle the bigger needles and the pump speeds.  Buttonholes can be established later, you won't be starting with them. 

[MooseMom]

When you visit the clinic you'll be going to you can ask whether they have experience with buttonholes but there's no rush with this.  You will be using sharp needles at first and laddering or at least using different sites until the fistula is mature enough to handle the bigger needles and the pump speeds.  Buttonholes can be established later, you won't be starting with them.

I guess the maturation process continues even after first use.  That's something I had not really considered. 

[Stacy Without An E]

I know over the last six years I've been on Dialysis I've learned one important rule: pay attention.  Some days I don't follow my own rule simply because I'm so sick and bloated with toxins that my thinking isn't straight, but its good to check what they're doing throughout the time you're being hooked up to the machine.  Don't worry, you'll learn what works for you in just a few treatments.

The first few sticks on my fistula, everything was fine after the needles were pulled, but then I had this terrible burning pain.  Sometimes the needle sticks will bleed underneath the skin.  It subdues within minutes, but its not pleasant.  This occurs during the maturation process.  My fistula has been problem free ever since while they continue to stick the same spots (buttonehole)

I've always felt that the level of care in Dialysis clinics should be the same everywhere, but for a majority of clinics it comes down to the financial bottom line.  That translates into paying less experienced staff less salary to save money in the long run.

Good luck and be patient.  Your fistula will be thrilling in no time.

[MooseMom]

Knowing how much of a weenie I am, I hope you all will be proud of me when I tell you that I actually went to the dialysis clinic today, on the spur of the moment, to meet the social worker and to ask a few questions.  Since I had no appointment, the SW didn't have a lot of time, but she was very nice.  I asked her if there are techs or nurses there who specialize in sticking new fistulas.  She said, "Oh yes!" and went on to explain that they have very strict protocols in place for patients with new fistulas.  They have a team of "Master Cannulators" specifically trained for this purpose.  That made me feel better.

What didn't make me feel better was that their shifts are 5:30 AM, 10:30 and 4:30 PM, all of which I hate.  I was hoping for something around 2:30.  Five thirty is too damn early, 10:30 cuts into my swimming time (at our pool, they have adult swim 11:30 to 1:00, and it's nice and calm before the kids come in at 1) and 4:30 means that my husband will be home before I will.  Hmmm....maybe he can start dinner....hmmmm.....might not be so bad.....

Oh, and they have wi-fi, but I can't plug in anything.  Bummer.

[monrein]

Good on you for popping in on the clinic like that Moose Mom.  Great news about the "master cannulators" and do they have experience with buttonholes?  Having someone else start dinner sounds like the way to go.  Myself, I preferred my sessions a bit later in the day since I often felt a bit wiped afterwards so it was good to have the mornings and afternoons free to do stuff (even to do some dinner prep in fact) and be able to basically veg once I got home.

I'm so very glad that you're starting to feel better about all this but I really wish none of us needed to go through this. 

[MooseMom]

I didn't ask about buttonholes because the SW was in a bit of a hurry; I didn't have an appointment, and I didn't want to intrude upon her time any longer.  But I got her email address and will ask about that and other things as they occur to me (usually at 3AM when I can't sleep).

I am hoping to get a slot at 4:30, that way I can get my housework done, do the shopping and plop something into the slowcooker before I have to leave.  But since I don't know when I will actually have to start dialysis, I didn't want to tempt fate (ie, make that fateful day come sooner rather than later) by asking what they had available now.  I am hoping that for once in my life, I will catch a break and get a chair in that later time slot, but I don't do optimism.

I wish none of us had to go through this, either.  It seems like such a gob-smackingly enormous waste of time and energy, not to mention money.  While I am grateful that dialysis even exists, I can't help but be mindful of how wasteful it all seems to be.  Just the bureaucracy of it all is enough to fell whole forests.

[monrein]

Just a quick comment on the optimism thing.  I used to be very optimistic and I basically still am but now I hope for the best but prepare for the worst...in that order.  I try to dwell on the positive but never ignore the negative.  I do smile a lot but have shed buckets of tears.  I try to remember the smiling and forget the tears.

All of this works very well, except for when it doesn't.    

[MooseMom]

Just a quick comment on the optimism thing.  I used to be very optimistic and I basically still am but now I hope for the best but prepare for the worst...in that order.  I try to dwell on the positive but never ignore the negative.  I do smile a lot but have shed buckets of tears.  I try to remember the smiling and forget the tears.

All of this works very well, except for when it doesn't.   

Exactly.  I am more optimistic when I feel there is good solid evidence backing up that optimism.  Don't tell me "It's all going to be OK" if you don't know your GFR from your creatinine or your potassium from your phosphorus because then I won't believe you.

I always try to be prepared because in my experience, most surprises turn out to be bad. 

[RightSide]

The first session with my new fistula (and for several weeks afterward), I was to use only one needle.  That is, a needle to draw arterial, and one tube of my trusty ol' catheter for the venous.

My center kindly assigned me one of their more experienced techs.  The cannulation went well.  The three hour session went smoothly--until the very end.  Then without thinking, I reached up with my dialysis arm for something--and promptly infiltrated.  My arm was bruised for a week.

For this reason, I strongly urge you to ask the tech to tape your fistula arm to the arm of the chair, so you can't move it till the session is over.  This will help train you to keep your fistula arm perfectly still for the entire session--until it becomes a habit for you.