The fistula works

[jambo101]

Been using a catheter connection for the past 5 months and yesterday we tried the fistula connection with the outflow but used the cathetrer for the return, it went very well but  holding the arm imobile for 4 hours was rather inconvenient and having to do everything with one hand was frustrating,but im happy we are on the way to getting rid of this catheter and all its problems.

[iolaire]

That's good news, with time you might find that you can move your arm a bit.

[GA_DAWG]

Congrats. In time you will find that small movements are possible with your arm, but depending on placement, bending your elbow cn be a no-no. You also will likely find it takes a bit less of a drag on your body using the fistula. Be sure and ask them for ways to avoid clotting.

[Michelle2016]

One lesson I learned from the fistula:

After the dialysis, the nurse put the bandage before it fully stopped bleeding. I found out the the blood was pouring out while I was in the middle of driving. I was panic. I  stopped at the gas station and called 911.

Now I learned. I just need to put pressure on the site and it will stop bleeding.

Wish you the best.

[Michelle2016]

Also remember to bring your winter jacket with you while on dialysis to keep you warm.

Wish you the best.

[iolaire]

Along the lines of lesions learned. I liked to take the huge bandages off after 2/3 hours and put a good quality band aid on instead. It helps with sweating and helps to keep the bandages from sticking to the scab.

[Michael Murphy]

The first 6 months of a new fistula the bloody thing has yet to expand, the ugly bumps make it easier to place a needle with out infiltration. When I started dialysis my fistula was already 2 years old.  During the first year I infiltrated about once a month I learned to keep my fistula arm still by the end of that year I as a habit did not move that arm, several years later one of the techs told me that my fistula was so big I can move my arm carefully.

[Alexysis]

One lesson I learned from the fistula:

After the dialysis, the nurse put the bandage before it fully stopped bleeding. I found out the the blood was pouring out while I was in the middle of driving. I was panic. I  stopped at the gas station and called 911.

Now I learned. I just need to put pressure on the site and it will stop bleeding.

Wish you the best.

That's why I always keep a hand towel rolled up in the glove box....and why I bought a car with a black interior!

As for the "keeping the arm immobile for 4 hours", all you need to do is ask them to tape the lines down to your arm, as well as to your shoulder. I often reach over to my satchel to get my laptop, and at the end of treatment I reach for my shoes, put them on, then stuff my pillows and blanket into my dialysis bag, all while still connected.

[Charlie B53]

I make sure I have my laptop, glasses and headphones all plugged in and ready BEFORE the needles go in.  Snacks all laid out on the side table.

Afterwards nothing gets put away until all bandaged and taped off done.

I've bled easy for years so now on the needle I always leave the pads taped on almost 24 hours, just to be sure.

I would have a tough time stopping a bleed one handed.

I'll never understand how anyone could pull their own needles one handed.  That has to be a trick that I do not want to have to learn.

[GA_DAWG]

Oe of our nurses had a transplant many years back. He says he stuck himself and pulled his own needles at home. I don't think I could manage either. Heck, sometimes it even squirts before the techs can get pressure on it. I usually take off all but one piece of tape on each stick when I get home, and the last two a few hours later. They pull the tape really tight and I am afraid of it causing a clot if I leave it too long. I have a graft, not a fistula, but I don't see there would be a lot of difference. I do worry about it starting to bleed as I drive myself home, so I give it a few extra minutes before I leave. With my graft in the right arm and the machines on the left,they have to stretch the lines across my chest. On the right shoulder they tape it, and on the left they use a clamp to give it a little play when I move.

[Riki]

Along the lines of lesions learned. I liked to take the huge bandages off after 2/3 hours and put a good quality band aid on instead. It helps with sweating and helps to keep the bandages from sticking to the scab.

I don't really understand this.  I've always had a sure seal bandage and a piece of gelfoam on each site, and sometimes an extra sure seal is used if there is a leak, to make it look pretty.. *L*

I leave these on until sometime the next day.  Rarely, I need to put another on because a site is still bleeding.  I keep a couple of them, plus some gauze in my dialysis bag, in case of any emergencies.

[iolaire]

Along the lines of lesions learned. I liked to take the huge bandages off after 2/3 hours and put a good quality band aid on instead. It helps with sweating and helps to keep the bandages from sticking to the scab.

I don't really understand this.  I've always had a sure seal bandage and a piece of gelfoam on each site, and sometimes an extra sure seal is used if there is a leak, to make it look pretty.. *L*

I leave these on until sometime the next day.  Rarely, I need to put another on because a site is still bleeding.  I keep a couple of them, plus some gauze in my dialysis bag, in case of any emergencies.

Yes we don’t get good bandages like other parts of the world. We get a few 1x1 bandages folded up, usually not tight, taped down with many strips of tape. It’s a huge mass, uncomfortable, plus you can sweat under it.  And since the wad of bandages is not tight the scab can grow into the first layer of bandages. 

[Riki]

Along the lines of lesions learned. I liked to take the huge bandages off after 2/3 hours and put a good quality band aid on instead. It helps with sweating and helps to keep the bandages from sticking to the scab.

I don't really understand this.  I've always had a sure seal bandage and a piece of gelfoam on each site, and sometimes an extra sure seal is used if there is a leak, to make it look pretty.. *L*

I leave these on until sometime the next day.  Rarely, I need to put another on because a site is still bleeding.  I keep a couple of them, plus some gauze in my dialysis bag, in case of any emergencies.

Yes we don’t get good bandages like other parts of the world. We get a few 1x1 bandages folded up, usually not tight, taped down with many strips of tape. It’s a huge mass, uncomfortable, plus you can sweat under it.  And since the wad of bandages is not tight the scab can grow into the first layer of bandages.

One of the first time I was to NYC with my fistula, the tech there tried to do the gauze and tape thing on me.  I stopped him before he could get too far and gave him the sure seals that I had in my bag.  I took gelfoam with me to Atlanta.  They refused to use it.

[rcjordan]

>gelfoam

I'm still having trouble with nuisance bleeding after the session, even the next day.  I'm using Telfa gauze, which helps keep the scab, but I'll still get slow leaks. We're having to resort to styptic pencils to help seal the site.  Does gelfoam just absorb better than gauze, or does it increase clotting?

[Michael Murphy]

I hold gauze on the sites for about 15 minutes, then switch to sure seals( gel foam on bandaids) then put new gauze on top of the sureseals. Finally I have the gauze and sure seals wrapped with a piece of vet tape that is 4 inches wide and keeps a constant pressure on the gauze so it’s like I am holding them.  Since I started this no bleeding episodes on the way home.

[rcjordan]

Thanks! I'll try the sure seals first.

[jambo101]

ftp://When im done and the needles come out the nurse applies a fistula clamp for 15 minutes. [urlhttps://moldedproducts.com/products/fistula-pressure-clamps?variant=16932258414651][/url]

[rcjordan]

For some reason, my Fresenius clinic discourages the use of the clamps.

[iolaire]

For some reason, my Fresenius clinic discourages the use of the clamps.

It’s bad for the life of the fistula. From what I’ve read it’s much better to hold the bandages but it seems like in the US if the patient can not hold the bandages then the clamps are used. Other places I traveled to had the nurses or techs holding.

[GA_DAWG]

My neph, who is also the clinic medical director, will not allow the use of clamps for the very reason iolaire mentioned. I take off all but one piece of tape on each site when I get home, then leave the gauze in place a few more hours. There usually is only a little seepage whn I pull the gauze of before showering, thugh if it stuck to the site, there can be a little more. Holding a piece of gauze on it for a few minutes usually stops it though. I have to be careful when drying the arm after a shower not to remove the clot, more just patting it dry than toweling in a normal way. Also, I remember that when they first started using it, and any time they went into a new area, so to speak, it took a little longer to stop bleeding and the sticks hurt a little more, though with the lidocaine/prilocaine cream, it was not too bad.

[rcjordan]

> in the US if the patient can not hold the bandages then the clamps are used.

Yes, I see them used on the elderly or disabled patients.  I have one in my home HD kit, just in case we need a 3rd hand in an emergency.  I guess people tend to leave them clamped too long. The pressure they exert is less than when I press the gauze with my fingers.

[PrimeTimer]

And even if you use the two finger method not much pressure is needed. Over time you will learn and "get the touch". 

[GA_DAWG]

At our clinic, if the patient cannot hold their own sites, the techs hold it for them.

[rcjordan]

>I'll try the sure seals first.

With a small piece of telfa gauze first to prevent pulling off the scab, sureseals are working great.  I hold the site for 3-4 minutes, then the tefla-sureseal bandage.  BIG nuisance-saver!  Thanks for the tip!