Needles without Lidocane?

[Rerun]

Lots of people use the needles without lidocane.  I never have.   The needles look huge.  But, last night they talked me into it.  The first one was fine.  Hurt about the same as a lidocane hurt.  The next one hurt like a sonofabith.  It hurt all night!  Eight hours of hurt.  There is no way that will happen again! 

                   

[MooseMom]

I'm glad you brought this subject up because I'm interested in what people do re pain prevention.  My mom uses some expensive spray, and I've heard other people talk about Emla creme.  Since I'm not on D yet, I am trying to decide what might be best for me to use when the time comes.  Why would one not use any pain relief stuff?  Does the fistula eventually get so tough that it doesn't hurt any more?  What do most people start off with?

I'm so sorry it hurt you so much.  At least you know now!  Do you think you will stay with lidocaine or will you use something else eventually?

[cookie2008]

I have buttonholes and use the emla cream only on my arterial buttonhole my neph does not want me to use it at all due to the risk of getting a tunnel infection in my buttonholes. 

[SkyDancer]

My mom uses Ethyl Chloride spray.It works for her,but if the techs don't wipe her arm with an alcohol pad right after they use it,it "gums up" the needles like glue when they go to take them out of her arm.one time she had to be stuck with no pain blocker.They let me hold her hand,but it hurt her pretty bad.Her insurance used to cover the spray,but now we have to pay out-of-pocket for it.She does have lidocaine cream,but it doesn't seem to help her too much.

If you can get stuck without using anything,I say more power to you. You all are strong to endure D anyway,but WOW! I couldn't do that if I had to.

[lola]

Otto never used anything? He says it takes to long for anything to work so he'd rather just get it over with....

[monrein]

We're all very different with regard to pain, just like we are with so many things.  I've never used anything and was told that lidocaine can cause problems for a fistula.  I've also never bothered with emla cream since I find the sticking not so bad.  It was a mental rather than a physical hurdle for me and I practiced by pinching myself hard, hard, hard.  Now THAT hurt and it would be even worse if someone else was doing the pinching too.  For me, doing my own sticks hurts less, way less than when someone else does it because I'm concentrating hard and I find I need all the sensation I can have to feel the area and locate my sites and depths.  I feel competent and independent and in control plus I have no anxiety whatsoever about just who is going to poke me.  I used buttonholes the second time on D and the ladder technique for 5 years the first time.  One of my buttonholes ran right through a nerve but I never bothered to establish a new one since I knew what the feeling was like and what to expect so it wasn't a big deal.
My first fistula did get much less sensitive over time as the scar tissue developed but it was also much tougher to penetrate the scar than when the fistula was newer and the needles went in as if through butter.  My husband tried doing my needles once...bad idea...into the vein, through the vein, into the bone of my forearmh.  He was surprised at how sharp the needles were.  Duh.
Most of us here in Canada don't use any numbing.

Now, having said all this about the 15 gauge needles...I get a cold and I'm in misery, as if someone has decided to torture me to the max.  Makes no sense but I can't tolerate being stuffed up etc. 

[pdpatty]

The techs that use a touriquet hurt me far more than the needles. I do not use anything to numb it.

My fistla is right above the bend in my right arm. It has always been numb since the surgery almost 4 years ago. There is no tech that can make me say `ouch' when sticking me.

[sullidog]

I use emla cream for a while, then I just let them stick me, it doesn't hurt cause by the time I stop the emla my graft has gotten scaring.
Troy

[Brianna!]

When I was at Children's Hospial, I wasn't allowed to use anything. I asked why I can't use anything and they said "It doesn't hurt that bad." Yeah, whatever. When I visited a different center in Boson, I used the shots and I liked them alot. I didn't feel any pain with them. Now at my new center I use the cream. My insurance doesn't cover the spray, and when I did use the spray a couple times, it felt like my skin was on fire, because it was so cold. So, I've used everything, I think. The cream works fine for me, as long as I have the cream on at least a half an hour before.

[boswife]

hubby gave it a go without and said it felt like the needle to numb anyway and hasnt gone back.  He was also told that it was better for his fistula so that was his biggest incouragement.  Two rather than four *sticks* was also a pluss. 

[Ang]

Lots of people use the needles without lidocane.  I never have.   The needles look huge.  But, last night they talked me into it.  The first one was fine.  Hurt about the same as a lidocane hurt.  The next one hurt like a sonofabith.  It hurt all night!  Eight hours of hurt.  There is no way that will happen again! 

                   

you  live  and  you  learn,lidocaine  all  the  way

[monrein]

http://www.scribd.com/doc/9141411/On-Course-With-cannulation

I found this pretty detailed link about cannulation and proper care of a fistula.  I chose to use nothing for numbing but I am prepared to accept the "pain" which was very tolerable for me personally, in order to get the longest trouble-free use from my fistula.  However, some find the pain intolerable and must use a numbing agent.

Be aware that a topical agent, spray or cream, is a better choice for the life and efficiency of your fistula since lidocaine shots can cause scarring (and we have enough of that already) and also vasoconstriction, when the vein shrinks away and tightens up a bit making it more difficult to insert the needle.  If I needed to use a numbing agent I would definitely steer clear of the lidocaine shots.

[MooseMom]

Oh, it just looks so complicated.  How are sick people supposed to manage all that?  I know that it is best to do your own dialysis, your own sticking, your own buttonholes, your own record keeping...I just get so tired of having to do everything myself and doing everybody's thinking for them, and I'm not even on D yet.  Is there ever a time when it is acceptable to let your guard down just for a nanosecond and trust that someone else can me competent?  When I think about all of the training I'm going to have to do, I just don't know if I can manage it.  It's hard enough right now just to get out of bed and face each day as it is.

[karen547]

I don't use anything but to each his own I guess! I think my threshold for pain is high anyways, and the spray, well on the box it says causes kidney failure after prolonged usage, and that to me is counter active.

[RichardMEL]

Rerun - if the needle hurt for 8 hours that's nothing to do with having or not having the lieocane in my view - that only lasts a relatively short while. Maybe the needle was touching the side of your artery or something and that's why it hurt. Did they try and move it till it was more comfortable?

I have that sometimes (and I only used local shots my first time, then didn't bother after that). I'm aware putting them into the arm is bad for it, and you still have a needle going in - I prefer 2 rather than 4.

[SkyDancer]

I don't use anything but to each his own I guess! I think my threshold for pain is high anyways, and the spray, well on the box it says causes kidney failure after prolonged usage, and that to me is counter active.

Karen, my mom uses the spray because the cream doesn't work well for her.I wasn't aware that it can cause kidney failure.Thanks for the info.Mom says that she will use spray anyway because her kidneys are totally shut down and she is not a candidate for transplant.She's on dialysis for the rest of her life or until she chooses to stop.

[murf]

I used Emla cream successfully for years at my first center. When we got shifted to a new center, the nurses did not know how to needle. I remember one nurse after the fourth unsuccessful jab stating quite proudly that she is now taking lessons. Please take your (expletive deleted) lessons on someone else's arm or even a dummy. Thereafter I changed to PD.

[Trikkechickk]

The techs that use a touriquet hurt me far more than the needles. I do not use anything to numb it.

When I was in=center, I had the tech put the tourniquet over my shirt sleeve - now they do it for everyone.

I also found it the needle is inserted slowly, just a quick pinch & that was it.  When the needle is jammed in, yes, it hurts.

[Chris]

When I was on dialysis, I tried the cream, the freeze spray, and the lidocain injections. My center wanted to try to get patients to stop using these as much as possible. I was nervous as h*** to try without it, but found out it only hurt a little more. It got better as I did it more, but was also put on xanax befor dialysis and I did not look while they put the needles in (still grabing the arm on the chair tightly!).
 
Do what you feel comfortable doing, sometimes you need to build up a tolerance and other times there is no way in h*** that one will never do that again. But with the trouble you have had at the center, it may be best to stick with the lidocain?

[thegrammalady]

my response is, you don't think it hurts much, i'll just poke you first and we'll see what you think. someone who says it doesn't hurt much isn't a very caring person. i use cream most of the time, putting it on about an hour and a half before my on time. the only time i use lidocane is when i have something to do and leave home early. i've been stuck a couple of times without anything and it's not for me.

[bdpoe]

Hi. I have two people who with lidocain can stick me without pain and get a good flow.
All the others, even with Lidocain, hurt me bad.
I'm convinced it's Experience, Empathy and Having "the right Touch" that makes the difference.

Good Lord, I even had a woman INFILTRATE me when taking a needle OUT!

I have a very sensative fistula and am picky about whoi sticks me.
Unfortunately I get a lot of retribution for this.
............bdpoe

[kidneysblowingchunks]

I've been on the needles for about 6 or 8 weeks now. Because of transportation and waiting room issues, I have had the lidocaine cream wear off by the time my chair opened.

I get the lidocaine shots each time though. Pain varies from a small pinch to pretty high. This varies among the staff members I have learned further on.

The thing that has me curious is why the "push" hurts when they depress the plunger to give me the lidocaine. I thought it had something to do with the speed at which the med was administered.

[Rerun]

Time is money.  I have one tech who is new and goes slow and it doesn't hurt.  The seasoned techs shove it in and it stings pretty good.  I've learned to just get it over with and move on to the needles and hookup and go home.

It is lidocane shots for me.   

[RightSide]

I use the EMLA cream--when I remember to put it on.   With EMLA, the only time I feel pain is when the tech infiltrates me.

Sometimes, I've forgotten to put on the EMLA before going to dialysis.  But even then the sting of the needle sticks is no big deal.

[monrein]

Time is money.  I have one tech who is new and goes slow and it doesn't hurt.  The seasoned techs shove it in and it stings pretty good.  I've learned to just get it over with and move on to the needles and hookup and go home.

It is lidocane shots for me.   

This view (and I feel sure that Rerun is not the only one who feels this way) is hugely concerning to me since my understanding is that consistent use of lidocaine shots can be detrimental to the longevity of a fistula.  If this understanding is incorrect, I welcome new information, but my medical personnel were firmly against it. Those of us who are "doomed" or "destined" to be on dialysis, as well as the medical professionals who work with us, have a duty of care to get the maximum potential from our accesses.  Veins for fistulas are not unlimited...they are precious and we, the patients, are the ones who suffer when fistulas are compromised.  Some practices are not good for fistulas, flipping needles is another thing that is common practice in some units and yet my understanding is that this can scrape away bits of tissue from the inside of the vein and that is not good in the longer run.
We need nurses (or techs) who will work with us to cause less pain WITHOUT damaging our lifelines.  Pain can be limited, (cream or spray) perhaps not eliminated, but the big question is how long do you want your fistula to last and not cause problems and eventually trauma when we run out of potentially new accesses.  If some nurses can cause less pain than others due to more patient sticking techniques then they need to train the others to do better and we should not have to resign ourselves to time-saving but detrimental practices. 

I chose to do my own needles, precisely in order to retain this modicum of control over what is done to me and to my fistula but I totally understand that many cannot do this.  It makes me sad, actually it makes me angry, that patients are having to use lidocaine shots when perhaps with a bit more care and better sticking techniques they would not need to do so.