"new" fistulae

[MooseMom]

I am confused about what is exactly meant by "mature" fistulae.

My fistula is over a year old.  I have not had to use it yet.  Is my fistula "mature" or not?

Is there a big difference between using a fistula for the first time if it is, say, 6 months old as opposed to it being a year old?  I am assuming there's not any difference at all, but I may be wrong.  Anyone have any answers?  Thanks.

[jbeany]

Mature initially refers to a fistula that has been in place long enough for the initial surgery to heal.  In theory, it's ready to be used - although the first bit of sticking is still going to have a high probability of infiltrating.  It has to build up some resistance to the increased blood flow and the walls will gain strength from that happening regularly.

[lmunchkin]

Fistulas are like "Sex", when a virgin, its new and its painful.  But the more you do it, the better it gets!!  God forgive me for using this analogy, but it is a perfect one to use!

lmunchkin     

P.S.  MM, you may have a great fistula, but when you first use it, it may hurt, but over time it will get better!

[willowtreewren]

Same report here, MooseMom.

Carl had his fistula for over a year before it was used. It had developed nicely and everyone was thrilled with how big it was.

BUT, it was still puny and a virgin. He was infiltrated a couple times at the beginning because the vessel walls were not as tough as they eventually got.

Heck! When I had a colonoscopy earlier this month, I knew the moment they infiltrated me. I got the black and blue bruising, too, but not as much because the needle wasn't as big.

When I was cannulating Carl, if I even barely nicked the wall of the fistula, he could tell me. Even better will be if you cannulate yourself. You really can feel it.

 

Aleta

[noahvale]

*

[Ang]

after surgery you are told  to use a sqeezy ball evry day to make sure the matures, this usually occurs 6-8 weeks post surgery


1 year old fistula , should be roaring to go

[MooseMom]

OH, I just assume that I will be infiltrated sooner rather than later.  That ia practically a given.  I have every intention of learning how to stick myself.  Out of all of my fears about dialysis, needles is not one of them. I know most people freak out the most about the big needles, but for whatever reason, I am a bit sanguine about that...for now.

Noahvale, thanks for the link.  I had in fact read it some time ago, but it was good to reread it.  I noticed that Stuart Mott contributed to the presentation.  I have read some of his posts on Home Dialysis Central.  He seems to really know what he is doing.

[woodsman]

MM get a ball and squeeze it often this will be a huge help in development of your fistula.

[HILINE]

OH, I just assume that I will be infiltrated sooner rather than later.  That ia practically a given.  I have every intention of learning how to stick myself.  Out of all of my fears about dialysis, needles is not one of them. I know most people freak out the most about the big needles, but for whatever reason, I am a bit sanguine about that...for now.

Noahvale, thanks for the link.  I had in fact read it some time ago, but it was good to reread it.  I noticed that Stuart Mott contributed to the presentation.  I have read some of his posts on Home Dialysis Central.  He seems to really know what he is doing.

why do you want to stick yourself?





EDITED: Fixed quote tag error - jbeany, Moderator

[Desert Dancer]

My fistula is over a year old.  I have not had to use it yet.  Is my fistula "mature" or not?

A year old fistula, and you don't even need it yet? Now that's how it's SUPPOSED to be done! By the time you're ready to use it, it should be rip-roaring and ready to go.

I started using my fistula when it was only seven weeks old. The nurse who created my first set of buttonholes infiltrated me twice but it wasn't because the fistula was weak, it was that it had moved and developed a 'dip' so she ended up going through it instead of into it. If I'd had my fistula a year before I needed it that probably wouldn't have happened because it would have been pretty much finished growing and moving.

I've been sticking myself at home for eight months now and have never infiltrated myself, not even when creating my replacement set of buttonholes. (Knock wood)

[PatDowns]

why do you want to stick yourself?

Quite simply, it hurts less (especially using the buttonhole technique), and since you are in control, it is less likely that your access will be damaged.  No one is going to better protect and preserve your access - your lifeline while on dialysis - than yourself.

Other reasons why to self cannulate:

- It is less stressful and anxiety causing since no longer having to worry about who will be inserting the needles.  Not all staff members have good cannulation technique, especially those techs fresh out of med tech school.

– It's less painful, mainly because you're concentrating on getting the needles in as opposed to anticipating the pain from someone else doing it.

- You know right away if you're in the middle or at the side of the vein. That's because you not only sense the needle sliding into the vein, but you can usually feel it with the fingers holding the needle you're inserting.

– Those who self cannulate have a greater sense of independence and relief that comes with controlling this important aspect of treatment. 

–  It takes away the anxiety of vacation travel knowing you will be in a different clinic and not having to worry about the qualifications of that facility's floor staff.

More on this topic:

http://ihatedialysis.com/forum/index.php?PHPSESSID=11692e3d31daf673e873adfa84131cd3&topic=19555.0

[lmunchkin]

I agree, Pat, cause when I first stuck my husband, looking back, I was worried about how it may hurt him.  But now it is a breeze!!  MooseMom will do very well with this whether she goes incenter or home! You have your ducks in line alot more than I do, so you will be great!  I don't worry for or about YOU at all, unless, you are not posting!!!!! That did worry me and others on this site.

Is your fistula big & thick now, MM? 

lmunchkin     

[MooseMom]

Is your fistula big & thick now, MM? 

As far as I can tell, I think it is as big and thick as it can be without having actually been used yet.  I am always aware of it.  I can feel the thrill in my neck.  If you run your hand over the surface of my left arm from halfway up my forearm all the way up to my shoulder, you can feel the "ropey-ness" of the blood vessels.  And you can easily see the veins all the way into the left part of my chest.

[lmunchkin]

Oh yea, MM, Id say it will serve you well!  I do believe you may be at an advantage having one now even though you are not dialysising.  Like I say, you have your ducks in a roll!  That is what is going to make your transition somewhat easier, (If that is possible with this disease)than most!

Got to get to bed!  Church comes early in the AM. Thank God for it!!!

lmunchkin        

[tyefly]

my understanding about a mature fistula is that its healed up from the surgery..... they say that take several weeks..... I do mot believe that the exercises have much to do with the healing process.....   but exercise is always good..... I believe that your fistula will be soft....that is the vein inself will be soft and it will infiltrate easy because the needle will pass thru it really easy when use the first few time.... after they have stuck you a few times there will be scare tissue build up and that part of the vein will become callused.... so as the vein becomes callused and thicken up because of the scare tissue development thur cannulation there will be less likely that when someone cannulates you then will not go in very fast ...that is  they will not go in and out the vein because it is tough now.... kind of like your hands when you work.....  blisters at the beginning and then they get tough....I feel for the people who have to go thru this process with newly used fistula..... I dont think it matters how long its been in your arm  it only when its cannulated can it get toughen up..... so new fistulas do infiltrate and some people have more problems than others.....  and its really dependent on the cannulator....

MM   when You do start..... I am sure you will probably infiltrate... dont worry.... it heals up and then after a few times you are good to go like we all did..... I infiltrated many times at first.....  but it gets better .....

[Jean]

I realize it is your fistula and you know when it was put in, but, WOW, a year already. Hard to believe.

[MooseMom]

Jean, I was diagnosed with fsgs 20 years ago.  The first time I saw my current neph, it was 7 years ago, and he said, (Eeyore) "I don't have much hope for these kidneys." (/Eeyore)  Again, that was 7 years ago.  Then in Nov 2009, my egfr finally went down to about 15-16, and he said I had about 6 months before I would have to start D, so it was time to get my fistula created.  That was almost 2 years ago, so he has been wrong (thankfully) about the rate of my decline.  So, it really is all a mystery.  The docs don't know everything.  All I can do is be as prepared as possible, and as difficult as it was to have to think about getting my fistula done, now that it IS done, that's one huge worry I don't have anymore.

tyefly, thanks for your response as that was the type of information I was looking for.  I know there is a difference between a year old fistula that hasn't been used and an eight month old fistula that HAS been used, that the latter is tougher and more "mature".  And I am fully prepared for the probability of being infiltrated at first (before I get the self-cannulation technique down pat); that's just part of it.  (I already have ice packs on hand!)

[rsudock]

I know many folks say that infiltration is more then likely but I don't think it has to be. I was only infiltrated twice....just have to be very vigil and what your arm as the machine starts up. If your arm starts to swell then stop the machine and readjust the needle or stick the fistula else where. I guess prepare for the worse but hope for the best.

xo,
R