left or right? Right or left?

[Charlie B53]

My first infection in 3 1/2 years on PD has been the cause of my cath coming out and now on Hemop using a Perma Cath.  The decision now is whether to have a real acces done as I know  this Perma Cath isn't forever.  I still don't know if I can go back on PD.   Most likely can, but even then, I know again one day PD will most likely fail and I will again need to go on Hemo.

So the question remains,  Do I have an access done NOW?   I use both hands almost equally well.  Right handed but for much fine work I use my left.  As a mechanic I have always had to use my left as many times, many places, it would be way too awkward to try to use my right hand.  Losing feeling, dexterity, or strength in either hand would be a MAJOR problem.

It's very hard to make any decision with risks.   I'm stuck on what to do.  Vein mapping is about to be scheduled, but that isn't invasive so that won't be any problem.  I will have to see how that goes.  Learn exactly what veins the Surgeon is looking at, and what nerve paths are, where they are, and have a very long talk with him about the possibilities.   No doubt I am worried.






split topic mod Cas

[kickingandscreaming]

If you're sure you want to go on living, then it's probably a good idea to get a fistula so it has time to "mature" before you need it. Even if you can go back on PD, 5 years is the average time that PD can continue before being replaced with something else: hemo, tx, death.

[Shaks24]

Been on PD for a bit over 3 years now. When I went in for catheter consultation the surgeon recommended getting a fistula for back up as he felt inevitably there will be issues with PD. I went for it and had a fistula placed in my upper left arm (after vein mapping) at the same time my PD catheter was placed. To this point I get a little bit of numbness in my left hand and it always feels cold. The color of my left hand is also a little redder than my right hand. Over all no big deal and if something happens I can go right to hemo with a fistula. The surgeons office schedules me once a year to do a sonogram on the fistula to make sure all is working as it should. Had one close call with a leak at my PD exit site but it seemed to resolve itself after doing a month of lower volume exchanges. Good luck to you on whatever you decide to do.

[iolaire]

I have virtually no impairment from my left arm forearm fistula (non dominate hand).  But I guess the risk is that they might hit something and impact the motor control system.  Also wonder if an upper arm fistula is any safer for hand control, I feel like a majority of the people in my center are using their upper arm (closer to the heart)?

[Shaks24]

Mine was placed in the upper arm because the vein mapping indicated the best veins to use were there. I guess the ones in the forearm were too small.

[Michael Murphy]

Mines on the lower left arm, but I think upper arm placement allows for more freedom to move arm.  My honest option is yo let the Vasular surgeon pick the best site you  got.  I had mine installed 2 years before I needed it. It was fully matured prior to starting dialysis which helped.  I visit the surgeon once a year to have it checked even though it has never given me any trouble. 

[Simon Dog]

Thought I posted this before but I don't see it, so maybe I didn't hit save.

The lower arm (radio cephallic) is generally used when possible since it is then possible to move to an upper arm (brachial cephallic) if the lower arm fails, plus the veins will already be well on their way to being developed if the lower arm one had time to mature.  I have left lower arm, 3.5 years, no problems except an initial tweak to tie off some small veins so it could develop and a fistulagram later to check make sure it was all open (it was).   No impairment in my arm, though I try to avoid lifting heavy weights or using it as a blocking arm in knife fights.

Things rarely work out as planned.    I planned on PD for a few years; lasted 6 months, then went to hemo.

[KatieV]

All veins being equal, they usually prefer to install fistulas on the non-dominant arm.  Both mine and my brother's were upper arm fistulas (opposite arms - he's a leftie) and they both grew quite large.  His fistula ended up being removed as the doctors were concerned it was putting too much stress on his heart.  I have to be careful not to sleep on my left side or I'll lose feeling in my fingers, but otherwise don't have any issues with my left arm with motor skills or nerve pain.

My sister has the tiniest little fistula at her wrist.   It's maybe 2 or 3 inches long and not very raised, but worked well for the months she used it.  My wrists were ultrasounded too, but my veins were too small for a good fistula there.

[Riki]

I had a fistula put in in the left wrist when I was 12 as a backup to PD.  That was before the days of the lovely chest caths that they use now.  It was never used and was tied off when I was 15, about a year after my first transplant.  When it came time for me to have the one I use now, it was put in my upper left arm.  I'm right handed, but I can use my left arm for everything I used it for before I had the fistula.  The hand gets cold during treatments, but that's the only problem with it that I have.  My mom had some lovely fingerless gloves made for me for Christmas that go right up the arm, almost to the elbow, to keep my hands and arms warm during while in dialysis.  Being a mechanic, I would think that you would be afraid of scratching the fistula, or getting it caught on something if it were in the wrist.  It might be better to wait and see what it said after the mapping.  I think having the fistula in my wrist as a child made it easier for the surgeon to make the one in my upper arm, as the fistula was well developed, and caused the veins in my arm to get bigger.  I got a lot of good blood draws from that arm after the fistula was removed.

[iolaire]

I think having the fistula in my wrist as a child made it easier for the surgeon to make the one in my upper arm, as the fistula was well developed, and caused the veins in my arm to get bigger.  I got a lot of good blood draws from that arm after the fistula was removed.

I like that idea, my veins are larger above my elbow coming from the fistula below.

[PrimeTimer]

Seems I remember the surgeon asking my husband which was his dominant arm/hand so to create the fistula on the opposite side. But I also think they use whichever side or area is best according to what the vein mapping reveals. They may not always have a choice. One thing to keep in mind if given a choice, is try to avoid having a fistula placed on the side you sleep on most. Hubby has an upper left arm fistula and he had to learn to not sleep on that side anymore.   

[Charlie B53]

All good information.

High on my left may be the most logical position.  I am primarily right handed but being a Mechanic I use both hands almost equally.  I sleep on my right and once asleep roll onto my back.  So high on the left may be the best choice.

Now just to wait for the vein mapping to see what it tells us.

Thanks for all the responses.  It may be a month or more before mapping so I don't think I will know much of anything until then.

Take Care All,

Charlie B53