Fistula Placement

[Tkski]

I had my mapping done on Tuesday and will follow up with vas surg on Jan 4th. I didn't realize, from my consult, that the fistula could be placed in the forearm. 3rd generation PKD patient and all relatives previous to me had it located in upper arm.

For those of you that do home dialysis and you had the choice, forearm or upper arm? Any advantages to either? Thanks.

[Michael Murphy]

I don't do home dialysis but there are advantages to  both I think inserting needles would be easier with a forearm placement, I have a forearm fistula and arm movements appear to cause a infiltration with movement, from what I have observed up arm placements have more freedom of arm movement.

[Simon Dog]

The general trend is to start in the forearm and work up.      If you choose to start in the upper arm, ask your vascular surgeon if the forearm will remain possible for a future fistua.

As to movement and infiltration, consider button holes and blunt needles.    Done properly, with self canulation, you should be able to avoid all infiltrations (I've been on home hemo about 2 years and have never infiltrated with blunts).   Even if you don't opt for home treatment, you may be able to convince your doc into having you trained on self canulation with buttonholes.  Or, you can continue to let genuine high school graduates at the clinic puncture you 6 times a week 

Moderate arm movement is not a problem with forearm and blunts.   I am on the hose as I type this.

[iolaire]

I have the forearm fistula and had big veins to begin with.  I'm able to move my arm a good bit (in center) but am very careful and have never had a problem.   I use my fistula had to open packages and hold things well I'm doing something (like a phone) well under treatment. I agree that you probably would have a lot more movement in the upper arm but I'd think it would be much harder to reach.  You would end up spending a lot of time looking down and to the far side (at your shoulder) rather than more in front of you as you place the needles..

[Vt Big Rig]

As mentioned, foreman placement seems to be preferred because if it fails you maybe able to use the upper arm.

I have mine in my lower right arm and it has had many issues. The surgeon does not like how it is going; so he put another in my upper left arm. Since the day he told me I needed a second one (KNOCK ON WOOD) the first one has been working fine. It has been the longest I have gone without a fistula gram.

He told me he was going left because someday I might be able to use upper right.

Mine is sensitive to movement but many are not after maturation.

Best of Luck to you.

[cassandra]

I have button holes in upper arm and do home hemo. I think I am less 'hyper careful ' with my upper arm than I was with my lower arm ones. But like Simon says, you can work up the arm, not down, so better to start in lower arm if poss. Maybe you can try self cannulating with buttonholes?

Good luck and love, Cas

[Simon Dog]

Cas - are you able to self canulate and hookup with the upper arm fistula.    With a lower arm one, I can hold my lines with the left hand while connecting with the right ... not sure I could do that with an upper arm.    Just wondering in case I ever have to go that route.  Thanks.

[Michael Murphy]

Vt Big Rig, maybe the lower fistula was afraid it would be laid off, glad both are working, I wish I had a spare.

[Vt Big Rig]

Vt Big Rig, maybe the lower fistula was afraid it would be laid off, glad both are working, I wish I had a spare.

"A spare" .... LOL.

Never thought of it that way but I see your point. The only problem is having weight restrictions on BOTH arms now. My wife (GOD BLESS HER) is constantly "reminding" (read as yelling) as me about using it for things I should not use them for. It is frustrating watching her trying to lift things that I would used to do easily.

[cassandra]

Cas - are you able to self canulate and hookup with the upper arm fistula.    With a lower arm one, I can hold my lines with the left hand while connecting with the right ... not sure I could do that with an upper arm.    Just wondering in case I ever have to go that route.  Thanks.

Yes Simon the needle lines are long enough to hold with the fistula arm itself (and I use tape and my teeth too. Also when making the BHs I made sure they are not in the elbow pleat itself so I can bend my arm to reduce the distance

[Jean]

Ya know, the thing around here seems to be putting the fistula in the crease where your elbow is. My dear friend got one last week and she likes the placement a lot. Of course, she still has the neck catheter too.

[cassandra]

Ya know, the thing around here seems to be putting the fistula in the crease where your elbow is. My dear friend got one last week and she likes the placement a lot. Of course, she still has the neck catheter too.

I think that the vein develops 'by itself' further and higher up the arm if you keep needling that direction. My fistula was 14 yrs old when I made the BHs, and had 'laddered' before that.