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.
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.