Bad Fistula what next?

[boxman55]

My fistula operation did not work I had it done on my left wrist. I am using a chest cath but I've read you don't get the best dialysis through that. I have an appt. with the surgeon on the 13th of Feb. trying to guess what he is going to tell me will be next, any ideas?
Boxman55

[Rerun]

Have you considered Peritoneal Dialysis?  He may suggest that.  They can put fistulas in you leg.  There was a guy at my other center that had one.  He did fine. 

Dialysis is only as good as the access.  So, you do the math.   

[jbeany]

My left wrist fistula didn't work.  My left lower arm graft didn't work.  My upper left arm graft works, for now.  The next one is my choice - right arm or left leg.  I'm thinking leg, because I sleep on my side, and if I use my arm, I'll never get comfortable - I already can't sleep on the left side.

[Zach]

Try exercising the arm before the next surgery.  Start doing curls as far in advance of the next fistula surgery as you can.  It may help.

[angieskidney]

My first one failed because it was too small and clotted off. They dried me out at dialysis. Usually you want to make your target but for the 2nd fistula I left .5 on me so I wouldn't be too dry like last time and it has worked for 18 months now! 

[renal30yrs]

I have been very fortunate so far regarding fistula.  I'm still using the same fistula created in April 80'.  I think the key to maintain your fistula is 1) never let them use tourniquet and 2) always insist on doing he needle removal on your own.

[angieskidney]

I have been very fortunate so far regarding fistula.  I'm still using the same fistula created in April 80'.  I think the key to maintain your fistula is 1) never let them use tourniquet and 2) always insist on doing the needle removal on your own.

Really? How come?

I know they ALWAYS use a tourniquet on me which I thought they had to (especially if someone has a deep fistula but mine is just so snakey they use it to not have to do any guessing because it is not that visable) but I don't feel comfortable when they flush the line with saline with the tourniquet still on my arm. As for the needle removal .. I don't get why.

[Epoman]

I have been very fortunate so far regarding fistula.  I'm still using the same fistula created in April 80'.  I think the key to maintain your fistula is 1) never let them use tourniquet and 2) always insist on doing the needle removal on your own.

Really? How come?

I know they ALWAYS use a tourniquet on me which I thought they had to (especially if someone has a deep fistula but mine is just so snakey they use it to not have to do any guessing because it is not that visable) but I don't feel comfortable when they flush the line with saline with the tourniquet still on my arm. As for the needle removal .. I don't get why.

Removing your own needles is a VERY good thing to do. Either that or make sure the Tech does NOT apply pressure until the needle is TOTALLY out. Let me repeat TOTALLY out, it takes timing but it is ideal. Simple place the gauze over the site and do not apply pressure until the needle is OUT. Some techs will apply pressure and pull the needle, doing so is not only painful but can cause scar tissue and that is bad for the fistula. As for the tourniquet is should ONLY be used when the fistula is first being developed and removed as soon as the needles are in place.

- Epoman

[angieskidney]

I have been very fortunate so far regarding fistula.  I'm still using the same fistula created in April 80'.  I think the key to maintain your fistula is 1) never let them use tourniquet and 2) always insist on doing the needle removal on your own.

Really? How come?

I know they ALWAYS use a tourniquet on me which I thought they had to (especially if someone has a deep fistula but mine is just so snakey they use it to not have to do any guessing because it is not that visable) but I don't feel comfortable when they flush the line with saline with the tourniquet still on my arm. As for the needle removal .. I don't get why.

Removing your own needles is a VERY good thing to do. Either that or make sure the Tech does NOT apply pressure until the needle is TOTALLY out. Let me repeat TOTALLY out, it takes timing but it is ideal. Simple place the gauze over the site and do not apply pressure until the needle is OUT. Some techs will apply pressure and pull the needle, doing so is not only painful but can cause scar tissue and that is bad for the fistula. As for the tourniquet is should ONLY be used when the fistula is first being developed and removed as soon as the needles are in place.

- Epoman

Ah okay! Yeah that much I know and they do it correct. I am always like a hawk with them but I am still learning! Thanks for teaching me Epoman! 

As for the tourniquet, thanks to your teaching, I will be telling them I want it off when they flush my line when the needle is in. I think they are just lazy and don't want to put it on again for the 2nd line.

[Epoman]

I have been very fortunate so far regarding fistula.  I'm still using the same fistula created in April 80'.  I think the key to maintain your fistula is 1) never let them use tourniquet and 2) always insist on doing the needle removal on your own.

Really? How come?

I know they ALWAYS use a tourniquet on me which I thought they had to (especially if someone has a deep fistula but mine is just so snakey they use it to not have to do any guessing because it is not that visable) but I don't feel comfortable when they flush the line with saline with the tourniquet still on my arm. As for the needle removal .. I don't get why.

Removing your own needles is a VERY good thing to do. Either that or make sure the Tech does NOT apply pressure until the needle is TOTALLY out. Let me repeat TOTALLY out, it takes timing but it is ideal. Simple place the gauze over the site and do not apply pressure until the needle is OUT. Some techs will apply pressure and pull the needle, doing so is not only painful but can cause scar tissue and that is bad for the fistula. As for the tourniquet is should ONLY be used when the fistula is first being developed and removed as soon as the needles are in place.

- Epoman

Ah okay! Yeah that much I know and they do it correct. I am always like a hawk with them but I am still learning! Thanks for teaching me Epoman! 

As for the tourniquet, thanks to your teaching, I will be telling them I want it off when they flush my line when the needle is in. I think they are just lazy and don't want to put it on again for the 2nd line.

It's ok to leave it on while they are placing both needles as long as they are quick about it and not leave it on for more that a minute or two. What about having them flush the lines with saline after BOTH lines are in? If they are flushing the lines I assume they are doing a "wet" stick?

- Epoman

[BigSky]

My fistula operation did not work I had it done on my left wrist. I am using a chest cath but I've read you don't get the best dialysis through that. I have an appt. with the surgeon on the 13th of Feb. trying to guess what he is going to tell me will be next, any ideas?
Boxman55

Did they do a study of the veins in the area they wanted to put the fistula in?  Here before they put fistulas in now they do a study to make sure its the best area for a fistula to try and avoid them not working after being put in.

[angieskidney]

It's ok to leave it on while they are placing both needles as long as they are quick about it and not leave it on for more that a minute or two. What about having them flush the lines with saline after BOTH lines are in? If they are flushing the lines I assume they are doing a "wet" stick?

- Epoman

I wanted to thank you Epoman. I just got back from dialysis just now. When I last posted in this thread it was right before my cab got here. So I went to dialysis. I told my nurse how I wanted the tourniquet, and she agreed with me and said she sticks both in and then takes the tourniquet off and then puts in the saline. I asked her why the other nurses usually put the saline in for each one as soon as they cannulate me? Why don't they do it like she does (the way you posted to do Epoman). She doesn't know but agreed that the way to do it is the way I was telling her to do it today.

So thank you Epoman for guiding me. I take your 13 years experience very seriously and am learning that I have the right to demand my care be a certain way.  I also told the nurse who cannulated me today exactly the angle and how I want it because since I have a different nurse all the time I realize I have to be on top of things! I can't wait til my buttonholes are finally ready for blunts so I can just cannulate myself.

Um... Actually I am going to make a new thread and add the link to this post because I have more questions. Thanks.

Sorry for taking this off topic (even though it isn't I have made this about my fistula), I just wanted to thank Epoman in the thread where advice was given.
Anyone going to reply to me wait for the new link  

*edit: Link = http://ihatedialysis.com/forum/index.php?topic=2499.msg34943#msg34943

My fistula operation did not work I had it done on my left wrist. I am using a chest cath but I've read you don't get the best dialysis through that. I have an appt. with the surgeon on the 13th of Feb. trying to guess what he is going to tell me will be next, any ideas?
Boxman55

Did they do a study of the veins in the area they wanted to put the fistula in? Here before they put fistulas in now they do a study to make sure its the best area for a fistula to try and avoid them not working after being put in.

I remember when I got my first one they didn't run any tests. Why? Oh because I am young so I *must* have good viens 

[boxman55]

No there was no study. All I got was some touchy feely by both the Nepth and the surgeon then off to have it done. at first you could really hear it then it died out. It was never used. What worries me is, does this guy know what he is doing and the other is once I do get one that works I am not thrilled about the needles. Hooking up to the cath is easy.  Boxman55

[jbeany]

I had studies done on mine, and they still failed - it's no guarantee.

[angieskidney]

No there was no study. All I got was some touchy feely by both the Nepth and the surgeon then off to have it done. at first you could really hear it then it died out. It was never used. What worries me is, does this guy know what he is doing and the other is once I do get one that works I am not thrilled about the needles. Hooking up to the cath is easy.  Boxman55

Oh I know what you mean! That is the same thing I thought but I guess he just underestimates some of us ... 

As for the needles oh I can relate to how you definately feel!! But really ... it comes down to this: The needles are the better of two evils. You can get an infection a lot easier through the chest perm cath and it goes directly to the heart (I know what you are probably thinking .. same thing I did which was, "Oh come on! I have had this in for over a year! I haven't got an infection YET!" but with the fistula you also get better kt/V and flow rates. I am sure there are a lot more people like Zach and Bigsky and BillP and Epoman!

I have been having the needles in my arm now for months (yes just months) and let me tell you I am the biggest chicken (I couldn't even stab myself with the subcutanious needles for Eprex (Canadian version of Epogen) when I was on PD!!!). But after time your arm gets used to it and it doesn't seem to be as bad. Plus you know you have to have it. But there is a great thing that helped me. Does your local drug store sell Emla cream? It is a combination of lidocaine and prilocaime in a tube of cream that numbs your arm where they stick you! It evaporates so I use it with cling wrap and it works for me! 

[boxman55]

But there is a great thing that helped me. Does your local drug store sell Emla cream?

There is also vicodin. Just kidding Thank you for your advice seeing how lately I have been living at the drug store I will look for it. As far as the needles I will just have to suck it up like we all have. Thanks again--Boxman55

[angieskidney]

But there is a great thing that helped me. Does your local drug store sell Emla cream?

There is also vicodin. Just kidding Thank you for your advice seeing how lately I have been living at the drug store I will look for it. As far as the needles I will just have to suck it up like we all have. Thanks again--Boxman55

The Emla cream wasn't covered where I live (Ya, I know .. isn't everything covered in Canada? Things they don't see as neccessary aren't ..) so I don't know if you can get it covered. It is usually expensive so use sparingly   That is another reason I use the wrap! So I can use very little without losing any

[del]

Hubby does not use tourniquet anymore he just holds his arm when I put the needle it.  But then again he has a fistula that looks like a gardenhose.  Has been working fine for almost 7 years now.

[livecam]

My original fistula was placed right at the boundary between the wrist and hand.  The area of the fistula and surgery was very small, about 3/4 of an inch.  That fistula failed on the first use, the vein blew with the entire arm swollen for 10-14 days.  After that a fistulagram (similiar to angioplasty) was done where it was found that it would not be usable.  The original surgeon went back in and created a new fistula about 6 inches further up the arm.  He extended the original incisiion so it looks like a single continuous one. This time I went through the ball and tourniquet excersizes for many months until it was ready.  That fistula worked perfectly from first use and never caused any problems.  If you are asking what he might do it might be to just go further up your arm.

[boxman55]

my initial incision was right above the hand also about an inch long. So you are probably right about just moving up the arm a little. It just pisses me off that I have to go through  it again

Boxman55

[charee]

I had mapping of my arm before they operated I was told i could only have a upper arm fistula as the veins in my lower are were to narrow. The day of the op i signed for a upper arm fistula I woke up in recovery with a bandage on my lower arm near my wrist asked why no one could tell me when the Dr came he said i thought I'd  try your lower arm first as its a better position than upper, but lt looks like is not working WTF you already told me that it wouldn't work so why do it? So long story ended back in hospital the next week and now have a working upper arm fistula still not real sure why they did it when i woke up from the first op i had a black drawing on my upper arm were they should have put .... maybe they were having a bad day at my expense 

[angieskidney]

I had mapping of my arm before they operated I was told i could only have a upper arm fistula as the veins in my lower are were to narrow. The day of the op i signed for a upper arm fistula I woke up in recovery with a bandage on my lower arm near my wrist asked why no one could tell me when the Dr came he said i thought I'd  try your lower arm first as its a better position than upper, but lt looks like is not working WTF you already told me that it wouldn't work so why do it? So long story ended back in hospital the next week and now have a working upper arm fistula still not real sure why they did it when i woke up from the first op i had a black drawing on my upper arm were they should have put .... maybe they were having a bad day at my expense 

For me they didn't even do the mapping as the surgeon looked at me as a kid figuring my arms would be perfect for anything. Needless to say my first one failed, but just like boxman said,

my initial incision was right above the hand also about an inch long. So you are probably right about just moving up the arm a little. It just pisses me off that I have to go through it again

Boxman55

mine was right at the wrist and then when it failed only days later they did the new one just a little further up the arm.

[Zach]

This small research project studied exercising the arm before the fistula surgery is performed:


http://journals.elsevierhealth.com/periodicals/yajkd/medline/record/MDLN.12640286

Just thought we need to read this.

[boxman55]

Angieskidney, my goodness my incision on the wrist is barely noticable they went to town on you. Zach, I will take your advice and start curling both arms. Thanks--Boxm55

[angieskidney]

Angieskidney, my goodness my incision on the wrist is barely noticable they went to town on you. Zach, I will take your advice and start curling both arms. Thanks--Boxm55

That is a picture taken in direct sunlight right after the stitches were taken out of the 2nd incision. Here is a pic of how it looks right now: