Well Damn it! Fistula is clotted again!

[kitkatz]

Oh drat Jean! I would loved to have seen you and the dark chocolate!
I run 7 hours due to my request for nocturnal dialysis around 8 years ago.  I feel better on the longer hours and my blood work is bang on pretty much despite my eating crap sometimes.
I think it is the only reason I have made it 18 years on dialysis.

My fistula is banging along, every now and then it aches, I did a good run on Monday. 

Friday sucked though.  The radiologist did not give me enough pain meds in my opinion and I hurt when I left and could take nothing for four hours.
The dialysis center of 2 Tylenol 250mg did not touch my pain. To even touch a headache for me it takes 2 500 mg Tylenols.
Friday night I was in tears when I got off the machine.
I do not think anyone in the medical field realizes that a procedure, then dialysis tends to hurt like hell for the patient.
I came home and knocked Norco down and had some dinner, then off to bed to recover a little bit.
I was such a grump at the nurse at Kaiser so I could get out of there and get some lunch and get to dialysis on time at my clinic.
She knew I wanted out of there by noon, we made it to the car by 12:30pm.  Not bad for Kaiser timing.

[Riki]

TO: KickingandScreaming and Rikki - did either of you at least read the article in the first link? 

In all honesty, I didn't read it, at least not lately. i'm sure I've read it or others like it which say the same thing. It's not something I didn't already know. I was just pointing out that there is a difference between 7 hours on hemo and 10 hours on PD, at least where comfort is concerned. I wouldn't be able to handle it, not being able to move.  4 hours is bad enough.  I'm not saying that it wouldn't work for others, just not me. It seems to work fine for Kitz, and she's been at this dialysis thing a bit longer than I have.

[cassandra]

Hi Kitkatz how are you doing?

TO: KickingandScreaming and Rikki - did either of you at least read the article in the first link? 

In all honesty, I didn't read it, at least not lately. i'm sure I've read it or others like it which say the same thing. It's not something I didn't already know. I was just pointing out that there is a difference between 7 hours on hemo and 10 hours on PD, at least where comfort is concerned. I wouldn't be able to handle it, not being able to move.  4 hours is bad enough.  I'm not saying that it wouldn't work for others, just not me. It seems to work fine for Kitz, and she's been at this dialysis thing a bit longer than I have.

And Riki there is a huge difference between hanging on the machine for 7 hrs with sharps or with blunts. With blunts you can do nearly every thing. Sleep a bit, walk, pick up things, open de door, knit, write, sleep a bit. It's in the middle of APD and HD with sharps I'd say.

[Charlie B53]

That's something I NEVER would have thought about.  The slighest wiggle of the sharps cutting into the walls of the vessel and causing an infiltration.   Great point (no pun intended) to remember.  While on this cath I can easily one day end up with an access site.

[Simon Dog]

Blunts/buttonhole can be made available if you are an in-center patient, willing to self canulate, and have a cooperative MD.   It's not the easiest path for the center since you have to be trained, but if you are an alert and oriented x4, and willing to take on the responsibility, it could be better on your fistula in the long term.

[cassandra]

TTL times have moved on, My centre did not have to put itself out at all. I had a technician stand by at the next chair (preparing another machine) while I stuck the first needle in. Learned everything from YouTube and other info from the worldwideweb and my own mistakes. Not only better for my fistula, better for me as a person.


   

[Simon Dog]

Congratulations Cassandra.    Hopefully others will follow your example.

I just finished up a week of in-center while traveling, and doing my own rather than having people I don't know, puncturing made the process much less stressful.  It also saved the tech lament of "crap, a visitor....another person to put on".

[Riki]

And Riki there is a huge difference between hanging on the machine for 7 hrs with sharps or with blunts. With blunts you can do nearly every thing. Sleep a bit, walk, pick up things, open de door, knit, write, sleep a bit. It's in the middle of APD and HD with sharps I'd say.

That's cool.  I've never used blunts, because I don't have buttonholes.  I've watched others in my unit use them, though, putting their own needles in.  I found it fascinating.  I didn't know about buttonholes when I started, or I might have mentioned it, but I also have an upper arm fistula, which would make it difficult.  I also don't think my eyesight is good enough to put my own needles in.






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[Blake nighsonger]

Been sticking my self awhile in center ,thought it would take 2 or three weeks to learn how to do it as home hemo" classes" nurse said I'd or we would be "up and running" ......well ,its been three months now in center still learning ( plan A ,give it a year ,then make decision as have caretaker issues ) then reevaluate ..... I'm on third button hole second one on upper arm was not" getting it" so this one ,the new upper hole one in upper arm is a interesting one too. the bottom hole I am sliding in or "sucking in" pretty good most allways now(knock on wood) even after two day lay over. That upper hole is a bitch. yesterday I had it lined out perfect and boom right in , so learning in center with access in upper arm is tougher doc. said because scar tissue is tougher he said. Coming back after 2 days the approach in has to be followed up with a umffff that I'm hesitant to administer, it is a skill that takes alot of practice , when i have trouble, the hardest part, but that's getting easier, is to ask for help. i never get a break. hello






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[cassandra]

I have my buttonholes in my upper arm too. Very mature fistula, so it's never too late to try. My eyesight isn't too hot, so I'm glad it's an upper arm one.

Blake ns how long do you 'soak' your buttonholes for? I soak mine for at least 3 hrs, sometimes a day (if I had too much to drink, and I deem it unsafe to get myself on, or I've got a spontaneous cold or something)

Love, Cas

[kickingandscreaming]

how long do you 'soak' your buttonholes for?

What does it mean, to "soak" a buttonhole?  I assume to soften the "scar tissue," but how do your soak it?

[Blake nighsonger]

Hi cas, just an hour,.. the drive to center is 40 min. so then scrub down good at center wish soap and hot water . that soaks the scabs pretty good , new one kinda smears off with pick i use about 8- or so alcohol packs then go at it ,clove, masked whole gambit. I try holding on behind flaps on needles but i have to go near vertical and deep'  so to get better grip i feel it better holding on to wings( (flaps) especially the top one as after said 2 days its a.... that's where i have the problem exacting correct angle each time and knowing its on spot before i punch it through. .....i feel the tunnel but knowing the amount of pressure to exert as not to feel a  crunch or-  tear?' ....  hard to describe it. ....... Following through. ? Should i concentrate on that ? Thank you. This is quite the time appreciate your help. ,Did it take you awhile to" get it"?.  Why do you soak yours for 3 hours . Do you do top or bottom first ? thanks.            Best to you. Blake ns.

[cassandra]

What does it mean, to "soak" a buttonhole?  I assume to soften the "scar tissue," but how do your soak it?

Yes KaS it's to soften the scar tissue, and the skin around it, and the opening of the hole. I soak it by cutting 2 pieces of gauze. Soaking them with saline, placing them on top of the holes, I stick a Tegaderm film (big seethrough plaster) on, so no air can get to it, and no water out.

Blake ns by accident I 'discovered' that the needle goes in much easier the longer I soak. When the scab (and dead skin etc) is removed (with a blunt fill needle) the 'hole' is there to see. I hold the tube (I use a wet needle (so the needle and tube are filled with saline)) and squeeze so some saline comes nearly out. If I than come with that 'near drop' to the hole, it 'finds' its way in. Still pulling back a few times when going in. Mine is also 90 degrees down. I found that if I relax and bend my arm and rest my elbow on a pillow, it goes easier. I didn't created the hole like that, but it's as if a muscle is in the way when I stretch my arm like when I created the hole. I mainly hold the tube about 1 or 2 Cm's behind the flaps.

I gather you D in-centre, and I would soak longer especially after your 'weekend'.
I do bottom first as that's my arterial, so if a clot forms because I'm taking longer to stick the venous (top) it doesn't matter.

Love and luck, Cas

[Simon Dog]

I tape 3 2x2 gauzes folder into quarters over each buttonhole, and soak eack with 5ml of saline I draw from the back when I set up my NxStage about 2 hours before the start of treatment.  It makes insertion easier since the skin around the annulus is softer and more pliable and also makes scab removal much easier.

I dry canulate (no saline in the needle/tube when I puncture), and then draw blood into the line, and flush with saline.   I only fill a 10cc syringe with 7cc saline to allow volume to draw back the blood if I need to get air bubbles are out of the line before I flush with saline.






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[Blake nighsonger]

Hi cas, thank you , for the tips i will see if i can try ,the saline in needle tube sounds a type of syphon affect plus lubrication that helps draw or suck needle in?. i do in center will give this a go, thank you. much love and luck right back. Blake

[Blake nighsonger]

I tape 3 2x2 gauzes folder into quarters over each buttonhole, and soak eack with 5ml of saline I draw from the back when I set up my NxStage about 2 hours before the start of treatment.  It makes insertion easier since the skin around the annulus is softer and more pliable and also makes scab removal much easier.

I dry canulate (no saline in the needle/tube when I puncture), and then draw blood into the line, and flush with saline.   I only fill a 10cc syringe with 7cc saline to allow volume to draw back the blood if I need to get air bubbles are out of the line before I flush with saline.

attention: Cassandra , SimonDog, Thank you , the soaking has made world of difference. Having "2 days off". My next question is; will putting lanicane Hurt anything to cut down on needle sting going in or will a wet needle drip allow less drag going in tunnel hole to slid in,commence pain free? , concern also being  Bactria . ===    can i soak 2 hs. saline then 2hr. numbing cream? what do you advise.                                                                                                                                                         ***********Asking  nurse,they pass my questions to next hire up .  ," who told you that? nurse ask (told her a friend that's been doing this most her life,...went from Rn to Manger of clinic to nurse practitioner and i am guess doctor now. Haven't ask or told  N.P. yet and probably will just drop it and tell doctor what i discovered when i see him. He told me 90% of home hemo is learning ...or hardest part is the sticking , said humane body was not made to stick is-self, the rest is tought spisificlly for you, to take it home .....  But at any rate i am just amazed how big a difference soaking made.                                                                                                       ^^^^^^^^^^^Also; wondering on policy and" historically the way we do things here due to staffing shortage" as head / manager RN told me when asked her if she would put me in a position as NOT to have specific tech. ^^^^^^^^^^^^ will i make history? how does that work" historically"? any thoughts .? thanks. ......can you see the flash in tube when you wet needle Cas? thank you so much.


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[Blake nighsonger]

sorry still learning how to catorigize my point of question with blue ...

[Charlie B53]

Y'all talking like this makes my needle-paranoid bones chill.  Shivers running up and down my spine.

Y'all are tough #$%^&'s.

I can't even force myself to Dream os needling myself.   

This is going to be a serious challenge.   I would sooner sign up to go through Escape and Evasion, again, than have to do this.  Physically, I don't think I could do it again.  But if you were standing behind me with a couple of those 15's, my motivation would be greatly increased

[Blake nighsonger]

Surly if i can do it you can do it . i never watched  for 8 months no frigging way  , i still am so on edge. but the soak, O the soak.Here my friends told me about the sweet soak. The soak.  i like saying it.! Once i was committed south bound  with a following sea and i had just what you are talking about (master- RN  ,she  infiltrated me  the first day i did hemo. she was so sorry genuienlly. How so kind the techs and nurses were my first day, still are. Hello .. She Trained me , once i cleared the bridge.( Morgan city r.r. bridge  in highwater in comparason  on how fear riden i was to me.).                         ------------------Anyway, saying this for prosparity reasons ,--- after having her in my dialysis  life for 10 months she left .... i welled up like a baby ' s,o.b.   what was that .?  Just loved her. thanks

[Riki]

I have my buttonholes in my upper arm too. Very mature fistula, so it's never too late to try. My eyesight isn't too hot, so I'm glad it's an upper arm one.

I'm actually legally blind, with no peripheral vision at all, so I don't think that putting needles in my upper arm is the best idea. *G*  Perhaps if I had the fistula in my upper legs, where I could see it and feel it with both hands, I might try it.  I have a hard time putting tegaderm on my sites after putting emla on them because I can't look directly at my upper arm.