Getting the Needles In – Part 2

Your first few Big D sessions will probably be like mine: a gentle and experienced nurse will put in the needles (called cannulating) and you will have a have short runs, so that your body gets used to the whole deal.  I had my first runs at the Central Dialysis Unit at the Austin Hospital.

While I appreciated the gradual introduction, don’t think I didn’t resent being there.  I was cranky with my body, the situation and anyone who tried to “jolly” me along.  However, as with most unpleasant situations, not venting these feelings tends to lessen their effect, so I just went quiet.  With Julie, my wife sitting with me, supporting me all the way, the sessions were mostly painless, easy and successful, and I was really grateful for that.

After this short honeymoon, you move to the production line.  I went to the newly established Gambro Unit at Diamond Valley, run by the quite amazing Anna Catterall (more about Anna later).  In those early stages, there’s often a strong urge to not want to know anything, and to just hold out your arm for your dialysis nurse to cannulate while you stoically look away.  That’s OK for a little while; it takes a few weeks to come to terms with having to be there, getting to know your fellow dialysers and the general lay of the land.

But you become far happier once you start to take notice.

First and most obvious, you need two needles, one for the tube taking your blood from your body to the machine (called the Arterial line), the other for the tube returning your blood to your body (called the Venous line).  The Arterial needle is inserted pointing towards your hand, so that your blood flows directly into the mouth of needle.  The Venous needle can be placed almost any distance from the Arterial, and usually points in the opposite direction, so that the returning blood goes with the flow.

There are two options for siting the needles:

Site Rotation – At each session the needles are inserted a few cms away from the last sites, in a sequence that goes up and down the length of the fistula. This keeps any one place from being weakened by too many needles, and should help prevent aneurysms (ballooning out of a weak spot in the fistula wall).  I used this technique for about eight years, as you can see from the white scar tissue along the length of my fistula.

My 14 year-old Fistula

My 14 Year-Old Fistula

Buttonholing – At each treatment, as much as possible, the same person puts the needles in the same holes, at the same angle. After about seven treatments, a track forms in the fistula (like in a pierced ear). You can then insert special blunt needles into the tracks.  This approach is nearly painless, and is said to reduce infection and aneurysms.  I have used the buttonhole technique for about ten years, since it was first developed.  I found it counterintuitive, so I first did it as an experiment (suggested by my Renal Specialist, John Dawborn at the Austin Hospital, who was a pioneer in many dialysis advances).  However, once I began, I found that the benefits were real (including less dramas and faster clotting after treatment, so I could leave quicker) and now I would never consider any other method.

However, to do buttonholing right, you really need to have the same person (or people) cannulate at the same angle every time, otherwise the track is constantly damaged by needles going in at the wrong angle and without the track you lose all the buttonholing benefits.

Of course, the very best way to get the benefits of buttonholing is to cannulate yourself.  It’s actually pretty easy, once you get through the mental barrier.  I’ll cover self-cannulation and how to get there in the next post.

3 thoughts on “Getting the Needles In – Part 2

  1. Hi Greg
    Sorry for the belated comment but I have only today come across your blog. Boy, does it take me back to my time on haemodialysis before I received the lifesaving phone call and kidney graft in November 2000. I can relate to so many of your experiences in those early days.
    All my life I had a phobic terror of needles so facing haemodialysis with no family support in Australia was a million times more challenging than emigrating to a new country on my own over a decade earlier. I was diagnosed in 1982 with polycystic kidneys passed on from my maternal parent, with two brothers having had kidney transplants so had some idea of what to expect … or so I thought.
    My first six weeks of BigD sessions were done via chest vascath at RPA’s Dialysis Unit (as a day patient) while waiting until my newly created righthand fistula was ready. Can you believe the first cannulation on my fistula was carried out by a nurse with first day nerves returning to duty after years of raising a family in New Zealand. Her hands were shaking so much that she could not hold the cannula steady and it went straight through the soft vein tissue and out the other side ie she BLEW IT. She then panicked, dropped everything and ran off to fetch the renal unit manager who calmly came over, reassured me and got me up and running on the dialysis machine. My entire arm below the elbow was black from bruising which made it difficult to locate the cannula on subsequent dialysis treatments for a couple of weeks. Thankfully that was a one-off experience as the staff were caring, patient and extremely competent. I quickly learned what questions to ask instead of waiting to be told what to expect.
    I saw some funny sights, for example when a group of student nurses visit to the dialysis unit for the first time one young woman took a look and fainted right in front of me. RPA is a teaching hospital and I had great fun on several occasions on the wards as a test case with fresh intakes of medical students trying to guess the cause of the lopsided hump in my periteneum (enormously enlarged kidney) or being amazed while listening or feeling the ‘whoosh’ of my fistula.
    A natural optimist who needed to continue working full-time, I decided early on that I was going to control the dialysis rather than the dialysis control me so I underwent 5 weeks of training for home haemodialysis at Dame Edith Walker Satellite Centre in Concord West before being sent home with my smart new computerised blue Gambro. For your first home session you were required to set up and get up and running on the machine then call the dialysis nurse who came over to check that all was well. I was so nervous when it came to cannulate that first time at home that my hand was shaking worse than a lettuce leaf but I knew I could not quit – and I did it!
    I continued my love/hate relationship with my Gambro for 4 years 3x a week 5 hrs per session. I loved that it efficiently cleansed the impurities from my blood but I hated the relentlessness of the dialysis treatment necessary to keep me alive. I also used the buttonhole method and had excellent arterial flow, no clotting or other problems with good dialysis almost every session. Towards the end of my 4 year stint, I experimented with sleeping in bed for around 4 hrs rather than staying awake in a recliner chair for the entire session, and I never had any problems with arterial or venous pressure or the needles coming loose.
    All that took place almost 10 years ago and I now live in rural NSW, deeply grateful to my donor family for my second chance.
    To all of you on the BigD journey – your inner strength will enable you to hang in there for the long or short haul. Take care and best wishes.


  2. Why is it that the staff does not introduce this method to the patients when it appears to be more efficient and less painful. If this method helps to preserve the fistuala I would think it would be used more frequently.



    • Hi Sharon, thanks for your comment. The buttonhole technique is best introduced after you have settled in to dialysis, perhaps after three months. By then, you will be used to the routine and be feeling the good effects of dialysis. The next steps are to try to eliminate local, then start buttonholing, first sharp, then blunt needles. If the staff in your unit don’t talk about it, ask them. It doesn’t hurt to be a little pushy!
      Regards, Greg


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