Fistula clotted

[Charlie B53]

One Nurse has already told me that I 'push' too hard.  Her opinion was the lowered pressure within the vein and a fast release lifting off, the sudden 'pressure shock' could blow out the newly formed clot and cause bleeding from the needle hole. 

I never thought about the tourniquet effect of pressing too hard and forming a clot INSIDE the vein.

I am going to have to re-learn just how much LESS pressure to hold it.

GREAT point about knowing where any stent is!

[kitkatz]

Update:  My surgeon did not realize the fistula is working but slowly, so he wants it mapped and ballooned on the 6th of February.  Hopefuly they will use the real drugs this time.

[cassandra]

That's good news!!! We're all hoping they'll get it going ánd figure out which drugs to give you.


Good luck honey.


   


Love, luck and strength, Cas

[Charlie B53]

Tues the 6th is my appt for the same thing!

Ditto on the fentenyal.  The other opiate based pain meds don't relieve my pain, they mwere make me feel like I've been drinking and getting drunk.  There is no fun in being drunk and in pain.

[PrimeTimer]

Good luck on the 6th. Glad your fistula is being given another looksy. Hopefully a good balloon job will put it back in business. I don't know if they will knock you out this next go around but maybe you can be given a sedative prior to the appt. I don't know if they can do a nerve block in the armpit and numb the entire arm. Hopefully it will be a relatively short procedure and just something localized will be all that is needed. My husband says that the angioplasties performed near his arterial don't hurt but the higher up they go near the venous hurts a bit. They usually take about 10 minutes with him so hopefully your procedure will be short too. Wish you all the best!

[GA_DAWG]

Hopefully they give you something before this time. I have a graft. They tried a fisula that did not take. After six weeks of waiting for it, they did a mapping and determined the veins were too narrow to form a fistula and put the graft in. Still seems to me maybe they should do the mapping before trying a fistula. Oh well.

[PrimeTimer]

Hopefully they give you something before this time. I have a graft. They tried a fisula that did not take. After six weeks of waiting for it, they did a mapping and determined the veins were too narrow to form a fistula and put the graft in. Still seems to me maybe they should do the mapping before trying a fistula. Oh well.

Vein mapping was the first thing they did before creating my husband's fistula. The vascular "fistula" surgeon had to see the results before doing surgery. Maybe they did yours early on before your actual fistula surgery. Sorry it didn't work out. Hope the graft has served you well.

[GA_DAWG]

Nope, after the fistula failed to develop, THEN they did vein mapping and decided on a graft. The graft has done well and I have no complaints, just seemed an odd sequence. I have seen others at our clinic do the same.

[kitkatz]

I went in today 6 am for 8 am procedure on the fistula.  They had to seriously balloon it under my arm.  They said it was working so off I go to D
tomorrow.  Thank goodness the doctor listened to me about pain meds and gave them to me.  It was not as bad as last time and was very quick.
I was out of there by 10am.  A burrito and fries for lunch and then a power nap.

[cassandra]

Fantastic news! Good luck for tomorrow!!


I'm sending positive vibes to you, your fistula, and whoever is putting your needles in.


Love, luck and strength, Cas




   

[iolaire]

Thank goodness the doctor listened to me about pain meds and gave them to me.  It was not as bad as last time and was very quick.

Glad it worked out well.  I really wonder why they would not have numbed the pain previously.  Each time I was in for angioplasty on the fistula it was numbed good.  But also each time I had serious staining in my arm from either blood or die, so my arm would have huge dark splotches that took about a week to dissipate.

[Charlie B53]

The staining I notice is bruising, everywhere the balloon was used.  I suspect stretching the vessel walls cause some small external bleeding, almost immediate bruising.  I also had mine done yesterday.  For some reason Dr made TWO different entries.  Prior to beginning Dr told me that I still have a measurable narrowing, reducing flow, proven by the obvious visible pulse in the first two inches which initially grew after creation of the fistula.

It's not pulsing visibly now.  And I swear I can also see further 'growth',, maturation,

Todays treatment was still a chore getting the upper needle to flow properly, but it did.  Afterwards I 'gushed'.  That lower site shot a stream out from under the gauze up and over my shoulder.  Tech says bleeding the day after can be common.  Here again, I suspect the stretched walls of the vessel stretch thinner, less able to seal well.  And may remain like this until they 'grow' and recover from the trauma.

Yea us!

I did call the clinic a short time after I got home.  This is my first time seeing blood under all the tape.  It doesn't look like the gauze is soaked, just a bit has oozed out from under and getting under the tape.  None outside anywhere making a mess.  I ain't touching it.  If it ain't broke, I ain't fixing it.  Wife can't see and I don't want to risk trying to stop a bleed one-handed.  I'll leave well enough alone.  Clinic agreed.

[PrimeTimer]

kitkatz: That is verrry good news! Whew! Glad they can still suck blood out of you. Oh wait. Maybe that didn't sound right....well, you know what I mean. 

Charlie B53: When we were still doing home hemo I remember my husband's bleed times were a little longer for a few sessions after an angioplasty. At the moment I can't think of why but the bleeding was never major. One time had the dreaded spurt event happen. We "peaked" under the gauze too soon. Never did that again. Better to hold pressure and not mess with it than to try to take a peak at it.

[Jean]

Gosh Kit, thru the years you have had so many procedures and you have never complained. Must have been a real doozy. Happy to hear this one was easier. Keep on keeping on.

[GA_DAWG]

I remember having the spurt thing after one declot. Wife wanted to call 911, SMH. They do my graft about every four months as a precaution. Much rather have it planned than an emergency declot. There is a LOT less bruising, and they anesthesia is much more gentle because they can give it through the graft after they get inside. Still seems I average about one clot a year.

[Charlie B53]

Curious how fat are these fistula's that clot?

Physics taught me that the larger the diameter of the vessel the slower the speed of the fluid passing through that vessel.  So it would seem to me that a very fat fistula the blood entering slows until it gets to a more 'normal' exiting where it speeds up to a more normal flow rate.  Within that fattened section it could be moving slow enough to clot.

I think I've stated this earlier about this very similar problem occurring in our very old Cat.  A large clot formed within her very slow heart.

So while my fistula has barely enlarged it isn't nearly as large as some of the sausages I've seen in some arms.

The graft using a cow vein sounds like a great alternative, possibly could be used to replace an overly enlarged fistula reducing the possibility of clotting?

[GA_DAWG]

It is hard to get the folks at vascular to say anything definitive, ut when they do, they usually seem to point to mishandling at the dialysis center. As I said earlier, they are insistent it is better to use two fingers across the fistula or graft, not one and never in-line with the graft. This of course would eliinate being able to hold both sites at the same time and increase the amount of time people are in the chairs, so the folks at the centers are not fans. They have also mentioned tightly folded gauze that is too small then taped tight enough to depress the flow rate through the graft or fistula. There is also the natural tendency of veins to narrow over time necessitating stents or angioplasty.

[Charlie B53]

Which is exactly what we are doing wrong most every treatment, holding too tight for fear of bleeding.  AND taping a small tight wad of gauge down depressing the site and reducing flow.

I can understand why we shouldn't be taking any blood thinners, but then again maybe a thinner should be used.  Tough debate.  Anti-clotting agents like Plavix I've taken for a couple of years after placement of stents, I have a BUNCH, all in the branches immediately after the 'Y' in the lower ab/groin feeding the legs.  None in my heart, yet.

An anti-clotting agent could be the solution however it would definitely increase our 'hold time' when pulling needles.  Further extending our chair time.

I haven't tried any of the clamps, yet.  I'm told my fistula is still too new and could easily be 'damaged' using a clamp.  Still being new I would take this to mean the stretched out walls of the vein needs more time to heal, that stretching damages it somewhat and only after it heals to normal will regain the resilience needed for a clamp.

[cassandra]

I can understand why we shouldn't be taking any blood thinners, but then again maybe a thinner should be used.  Tough debate.  Anti-clotting agents like Plavix I've taken for a couple of years after placement of stents, I have a BUNCH, all in the branches immediately after the 'Y' in the lower ab/groin feeding the legs.  None in my heart, yet.

An anti-clotting agent could be the solution however it would definitely increase our 'hold time' when pulling needles.  Further extending our chair time.

I haven't tried any of the clamps, yet.  I'm told my fistula is still too new and could easily be 'damaged' using a clamp.  Still being new I would take this to mean the stretched out walls of the vein needs more time to heal, that stretching damages it somewhat and only after it heals to normal will regain the resilience needed for a clamp.

I use Tinzaparin to stop clotting. It doesn't make much difference in chair time (haven't used Tinzap since stomachs bleed)
Moving the needle can cause clots as well.


Clamps are not used in my clinic, nor any clinic I've been.

[Charlie B53]

Tech or Nurse seem to be near constantly adjusting one or both of my needles.  So maybe this is irratating the hole and making it more difficult to clot.  Especially with a freshly ballooned fistula not having but a few days, barely beginning to heal and thicken the walls.


This makes a lot of sense.   Maybe I should ask them if they would just leave the fistula alone for a few weeks to let it really heal undisturbed.  They could very easily use my chest cath, just not run the pump speed near as high.


Nah!   That would be far to easy.  They ain't about to let me off that easy.

[kitkatz]

Letting the fistula rest may be a good idea.  After being worked on areas can be swollen and need time to heal.  It would not hurt to ask.

[PattyTricia]

I just had my graft clot and I was sent to the local hospital. When they started the procedure to declot it was so painful. They stopped and gave me some more medicine and when they asked if I was ready to start again I was shocked to hear myself say yes. From that point on during the 45 minute procedure whenever I felt something pulling I would laugh not cry. As soon as I was out of recovery I was at my dialysis center. I know my pain threshold and I told them to drug me up. I have learned to be very vocal about what works for me (most of the time anyway).

[kitkatz]

I have an appointment to see people for the catheter pull next Thursday.  They want an ultrasound then a vascular surgeon look see then pull it.  I cannot wait.  I was forceful with the dialysis clinic to get with Kaiser and get me an appointment asap.  They did.

[GA_DAWG]

When they took my catheter out, I had an apointment with the vascular surgeon, just a follow up. As I got up to leave, he said we should decide when to take out the catheter. I told him I had thought we were goingto take it out that day. He said good idea, called a resident who took me into a surgical room at his office. About 15 minutes later, after a local, it was out. No ultrasound or anything else. Two little tools that looked kind of like what the dentists sticks in your tooth when you have a cavity and makes your rear end grab hold of the seat. No pain with getting the catherter out though. I had it about 7 or 8 months.

[Charlie B53]

makes your rear end grab hold of the seat.

I hate it when that happens!

Being a lifelong motorcycle rider you would think I  would be used to that by now.

Nope!   Unexpected things still happen.

every M - W - F still as Needle-Phobic as I am I am very near this at both needle sticks.  Even using the Lidocaine, some sticks are far better than others.  I swear, some of the nerves in my arm are soo large that needle pokes straight through them!

I laugh a very stupid laugh and hold VERY still.  Gotta remember to breath once in a while.  Once the tape is on I'm fine.