Fistulagram

[Genlando]

I had a fistula placed on my right arm about 2 months ago.  Per doctor's orders, I did the rubber ball squeezes several times a day.  So far, the fistula has a strong thrill and bruit.  I thought everyting was good to go.

That was until last Friday.  The surgeon scheduled me for a fistulagram for this Friday.  He didn't give any reasons for wanting to do it.  However, the people at the center told me that he's concerned that there might be some issues with my fistula, and that they may have to perform an angioplasty.

I've got  plenty of questions, and nobody at my dialysis center provided me with any answers.  How long does it take for them to perform this procedure?  How long is the recovery time? Can I drive to the Access Center myself, or should I have somebody else drive me there?

[Hazmat35]

1st off, good for you that you had a Fistula put in.  You'll be glad you did.

I had one put in last September, and have since has a Fistula Gram and Angioplasty on mine.  The reason was that the vien / artery had narrowed and was restricting the proper flow of blood. 

Both of mine were done under "local" anesthetic with a little something to relax me.  The go in with a very small wire in your veins and try to clear any obstructions or insert a ballon and blow up the vein to stretch it back to size. 

I was never unconscious and was even talking with my surgeon and his staff during the procedure.    Believe me, I am not one for medical procedures, so this was amazing to me, that they didn't knock me out and that I made it through without getting sick, but it was pretty simple procedure. 

I would not recommend that you drive yourself home afterwards.  They will give you some meds, to relax you and they last for a while.   My whole procedure was about 45 minutes.  I was in an out of the hospital in 2 hours. 

After my procedures, they starting using the Fistula the next time I had dialysis!  I was back in business!  I had a lot of clotting and my vien also narrowed, so they had to widen it and remove some of the clots. 

Good luck! Don't worry, it is NOT that bad!  You won't feel a thing . . HONEST!

[gothiclovemonkey]

i think hazmat answered everything
just wanted to add ,ive had quite a few of these done, and they really are more scary sounding than they actually are. They did twilight for one of them, the others were local, but they gave me a pill seditave, since im a chicken lol so i did not drive, u can call and ask what they do where ur at. Different hospitals do different things.
good luck

[albiecl]

Hiya, I had a fistulagram in London on Saturday.  I'd had my fistula created last november and it had only been used twice so after a long ole wait I finally got an appt for the fistulagram.

They first of all xrayed my arm to see if there were any blockages and when they found one they needed to use the balloons. They gave me a local anaesthetic and then inserted a balloon to try and widen the narrowing but it didn't widen it enough so they put a super duper balloon in for further widening. This did a better job but my narrowing must have been tight so they put a stent in.  For me the it was very uncomfortable when the balloons were in, in spite of them giving me pethidine but everyone is right the waiting and the unknown is so much worse than the actual procedure.

Good luck with yours and ask lots of questions of the surgeon before and during (if you can).

[sullidog]

Yes, the above is correct and you may feel a bit of disconfert when they inflate the balloon but it doesn't last long.
Troy

[galvo]

Yep. I agree with the above comments. I heard some horror stories about the procedure but mine, only a few weeks ago, went much like hazmat's.

[murf]

Hospitals in my area will not discharge you unless someone picks you up. So, I strongly suggest do not drive,

[gothiclovemonkey]

when i had the balloons, i was under twilight, because that is a little more painful, when the balloon is inflated... it feels like someone was pulling my arm,  kind of pinching as well, so they gave me more drugs and i fell asleep lol

[Genlando]

Thanks everybody!   You answered all my questions and addressed any concerns that I had about the procedure.  My son is going to take me over to the hospital tomorrow, per your recommendations.

[Hazmat35]

Thanks everybody!   You answered all my questions and addressed any concerns that I had about the procedure.  My son is going to take me over to the hospital tomorrow, per your recommendations.

Good luck, Genlando!  Just remember to relax, and don't be nervous.  I've been there, it isn't as bad you might think it will be. 

Also remember when you are done, to keep working the ball.  That will only strengthen your Fistula and HELP you in the future.  Just a few squeezes several times a day is all you need.  While you are driving or watching TV!!!!!  I have one in my truck, and at my desk at work! 

[galvo]

All the best, Genlando. Give us a report afterwards.

[Genlando]

UPDATE:

The Dr that was supposed to do the procedure was involved in an accident this morning, so they pushed back my fistulagram to October 7.  I guess the 8 hours of fasting last night was just a rehearsal! 

[murf]

Bad luck about the delay. If you are like me you 'psyche' yourself up for a procedure. The actual operation is not too bad. Quite relaxing in fact. Get a good hours sleep.

[Genlando]

I went in for my fistulagram this morning.  Like all of you said, the procedure was relatively painless.  Here's the results from the procedure:

1) My fistula has not matured as well as it should have after almost 3 months.  The doctor suspects that this is because the fistula was placed on the same side as my catheter. 
2) I had some clotting in some areas--even though I'm taking coumadin.
3) There was extensive interaction between the fistula and other blood vessels on the right side of my body.   I therefore might require additional surgical intervention. Does anybody know what they're talking about here?
4) They moved my catheter to the left side of my body.  I'm now sore as hell--even though I'm taking Vicodin every 4 hours.

In other words, it appears that I'm going to have more delays in getting rid of my catheter.  Which brings me to an important question:  Is it possible to switch over to  NXStage if you still use a central catheter for access? I would also assume that they would provide training on sticking my fistula when it is finally ready for use.  Or will they require me to wait for when my fistula's ready?

[MooseMom]

I honestly don't have any answers, but I wanted to swing by and hear what you found out.  When you do get your answers, report back because I'd like to know!

[greg10]

..
In other words, it appears that I'm going to have more delays in getting rid of my catheter.  Which brings me to an important question:  Is it possible to switch over to  NXStage if you still use a central catheter for access? I would also assume that they would provide training on sticking my fistula when it is finally ready for use.  Or will they require me to wait for when my fistula's ready?

Sorry to hear about your delays, I hope they get resolved smoothly and quickly.
As to the NxStage question, yes it is possible to use your catheter with NxStage, but I would think switching accesses while training would depend on the discretion of your training center.

My NxStage training center was good enough to help us through a tough period when we had clotting problems with the graft which could not be resolved and a catheter was put in.  The center provided us with training with the catheter even though we started out with the graft.  The training on the catheter is straight forward and is in some ways simpler than using a fistula and I am sure you can handle it.  I would hope your center could provide you with training for the fistula at a later date when you are ready.  You really need to get to know your NxStage training personnel and talk to them about your situation, I think you will find them to be accommodating.

Having said that, don't rush into NxStage if you are not comfortable with the situation.  Switching accesses is not that easy on a patient, nor is it easy on a trainee.  It is also not a bad plan to have some time to heal meanwhile and let the professionals do the dialysis in-center.

[vcarmody]

 :
My husband seem to have had the same problem as you with his fistula. It was put in April 2009. It was still not mature in September so he had a fistulagram the doctor said he had some branches and would need some intervention. He went to that doctor two more times and both times he just did some ballooning but never took care of the "branches".  Cookie2008 goes to our center and suggested her vascular surgeon. We took her advise and went to see him. He put in 15 coils in my husband fistula to block of his branches. What a difference he fistula was so strong after that and sticking it was so much easier. So glad Cookie recommend him. My husbands fistula is functioning great now. We do Nxstage and run at a blood flow of 470-500.

[Genlando]

Sounds like some good advice, vcarmody. I'm going to give my current surgeon one more chance this week.  If he doesn't seem to have a good game plan, I'll kick him to the curb.  I was surprised when the Access Surgeon said that I should've never had my fistula on the same side as my CV catheter.  I would have thought that a vascular surgeon would know that.

[Hazmat35]

Glad to hear that things went fairly well for you!  We told it was not a big deal! 

I've had (2) fistula grams, mainly because of excess clotting.  At the center, they would have to stick me 3 to 5 times, to find a good spot, and then WHAM, the needle would pick up a clot and we'd have to start over. 

Now, things have been running smooth @ 500 flow.  So far so good, anyway! 

[cookie2008]

I went home with nxstage using a permacath, when it was time we had no problems with sticking my fistula.