? Question about fistula/graft

Quote from: noahvale on July 19, 2014, 07:41:57 AM

Quote from: gothiclovemonkey on July 18, 2014, 06:21:42 PM
To get to my question let me take you through this past few weeks.
I had a graft put in my right arm, because my fistula skin was thinned to the point it kept popping open...

the new graft didnt take, due to my poor veins. so they are doing nothing with it, put in a permacath, and then put a new graft in my left arm, using the fistula to supply it.
they arent sure yet if this worked...

question 1-
Why dont they remove the non-working graft? the only thing i was told was "we dont do that unless it becomes infected"

question 2-
has anyone else here ever had a graft being fed by the fistula before?? i had no idea that was even an option... the spot they will be sticking is far enough away from the thin areas, but the thin skin is still there, they did however remove the giant lumps so it just looks all wrinkled and odd.

#1 - It's a major procedure to remove an AV graft, especially if it has been in for a long period of time. Better to leave it alone if not causing problems. I have 2 old non-working AV grafts from the 1980s still in my arms.

#2 - My current AV graft is connected to an old stented fistula (the reason my vascular surgeon was willing to try this) in my upper dominant arm. I've had it for going on 9 years now. The first 3 years I had to have a balloon angio every 5-6 months due to clotting and/or venous stenosis, despite being on daily 81 mg. aspirin and Plavix (don't remember the dose). However, after starting to run 4.5 hour dialysis treatments and turning the blood pump down to 340-350, averaged a procedure once a year. Plus, no longer had to take the Plavix. Since going on extended hours treatment (6-6.5 hours) in 2010 and turning the blood pump down to 300-315, I average a procedure about once every 1.5 years.

I only have about 5 inches of usuable space because the graft dips very deep and kind of curves in the middle. To compensate, I only use 16 gauge needles. These work just fine for blood pump speed <350. Also, I am extremely diligent in rotating sites so pseudo aneurysms do not develop.

My main problem is venous stenosis - the vein narrows a lot as it curves from past my arm pit to around my chest. It is so narrow near the chest that neither my surgeon nor the special procedures radiologist who "knows" my arm are willing to balloon the area anymore due to fear of tearing the vein. Fortunately, I've built up fantastic collaterals to handle the blood flow needed for good dialysis while not stealing the blood flow to my hand.

If my graft doesn't feel "right" or if my venous pressure runs 30+ points (15%) higher than normal for 4 straight treatments, I get in to see my vascular surgeon. Otherwise, I schedule an ultrasound every 3 months as a preventative measure.

For me, this is what has helped keep my graft going for so long:

Diligence in rotating sites when sticking.
Running enough time to receive more than just adequate treatment while using 16 gauge needles with blood pump speed 350 or less.
Taking baby aspirin daily.
Preventative ultrasounds.
Getting an angio within 36 hours if the graft has clotted.

To prevent infection:

I clean my graft well (using both betedine and alcohol preps) before sticking.
Once bleeding has stopped after needles are pulled I tape folded 3x3 gauzes with a drop of Mupirocin 2% ointment over the sites.

Again, this is my personal experience. I am not a physician. However, my vascular surgeon believes all that I do is the reason for graft longevity.

I agree with everything you are doing. We do a lot of the same things with our fistula. I find it interesting that you see the results of slowing down the blood pump . Dr. Agar writes about this as have I. I am a firm beleiver in keeping the speed as low as possible. We run at 340.