Getting the Needles In – Part 3

Regardless of the siting method you use, the fewer people who cannulate your fistula, the longer it is likely to last, and the less dramas you will have.

Dramas include pushing the needle in so that it scrapes along the fistula wall (painful); taping the needle in place so that it constantly scrapes on one spot the wall (painful and often slows down the flow so the machine alarms constantly); and pushing the needle right through the fistula wall so that the blood pumps directly into the flesh and muscle around the fistula (called “blowing” the fistula).  Blow outs can be painful, they require re-siting away from that area, so you’ll need another cannulation, and the extensive bruising lasts a few weeks until your body dissipates the blood (and mental anguish and irritation).

The best person to cannulate you is a permanently available friend with a steady hand that goes to your every session, that knows you and your fistula back to front, and who cares deeply about your well-being.  We all know a person like that: it’s us! It is you for you and me for me.

Needling yourself is easier than you think, and once you get used to it, it brings an enormous sense of satisfaction and independence.  Putting in your own needles in also hurts less (or not at all if you buttonhole), because you are distracted by what you’re doing. And, since you can feel both ends of the needles, you have the best chance of getting it just right.

You can get ready to needle yourself in three steps:

  1. Stop using local anaesthetic. Usually, you are offered local for your first few sessions to limit the overall trauma of the occasion, which is absolutely right.  However, once you are in the production line, stop using it.  It is no great pain saver, since it hurts at least as much as the dialysis needle, and the routine itself is a psychological barrier to DIY.How did I get off local?  I cheated.  During my early days, several BigD nurses suggested I stop using local, mainly because it was unnecessary.  My head said yes, but… I just needed that little push.  After about a year Julie and I went overseas to the UK and Europe.  It took a bit to organise (the web and email were in their infancy then) but it was great, and for me it was like a reverse pub crawl, dialysing at a new centre in a new city each time.  I soon found that many countries and centres don’t offer local at all. One nurse at a centre in France brushed aside my request for local with a pitying “Don’t be ridiculous” and stomped off to help more robust French patients for a while.  That told me.  No more local for me!
  2. Get some training. Ask an experienced BigD nurse to go through the needling process with you.  Watch maybe three times, taking notice of everything the nurse does before the needles go in (disinfectant, tapes, gauze), and everything after (flushing, taping them at the right angles).  Get to know your fistula, find a good spot for each needle.  Feel the vein layout with your other hand to get a good mental picture of the lay of the land to understand where the veins flow.  Visualise yourself putting them in.
  3. Take the plunge! On day four, get the nurse to do everything else (preparation, taping, etc.) but YOU put the needles in.  Don’t just look and hope for the best, visualise where the tip of the needle is going when you put it in, position it right in the middle of the vein, clear of walls, dips, etc.  Do this for a week or so, and then do both the preparation and the needles.  Once you are comfortable with this, do the flushing and taping as well.

Welcome to minimal stress dialysis!  You can now go to any centre, deal with the newest or most distracted or heavy-handed dialysis nurse with confidence, and no about dramas.

There’s only one more step to stress-free, easy flow dialysis: buttonholing.  I’ll cover this in the next post.

9 thoughts on “Getting the Needles In – Part 3

  1. My Mom currently has the chest catheter. We just finished the vein mapping and are supposed to go for the fistula or graffe (sp?) consultation.

    With all of this talk about the pain etc… and my Mom having notoriously bad luck with this, can you tell me if one can stick with the chest catheter and what you need to look out for? When to change etc?

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    • Hi iambernardo. First, I am prefacing my reply by saying that my responses are my opinions; I have no medical training, except that gained by being on the receiving end for 14-plus years.

      In my opinion. there is no contest between having a permacath (chest catheter) and a fistula, the fistula wins hands down. Less chance of infection, easier to access, easier to live with. Permacaths are usually put in as temporary measures until the fistula is ready. Actually, in this case, it’s not just my opinion. The argument is well put at :Fistulas are Best. “Fistulas are the “gold standard” for dialysis access.”

      With regard to pain, to put it in perspective, if the staff are good operators, a scrape or a blow may only happen once a year, when someone loses concentration or is very new. The early stages are the most difficult, until the fistula matures. Depending on her age, your mom can minimize the chance of any dramas by simply staying alert and getting involved with each cannulation as much as possible. (Like my friend Max, the more anal, the better.)

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  2. Hi iambernardo,

    When looking at a permacath it’s easy to think “well that looks neat and uncomplicated, can’t we stay with this?” No! Inside the tip of the catheter sits in a large vein just above your mom’s heart which means any damage to the permacath or infection is very, very serous. Another complication can be the permacath becoming blocked or partly occluded by clotted blood or fibrin which reduces the flow and therefore less blood gets cleaned during dialysis.

    It’s often those un-expectantly new to dialyses that have a permacath while arrangements are made to create a fistula. Your mom’s dialysis centre should have guidelines on when the permacath be replaced as well as a dressing regime, they may have a fact sheet for you and your mom.

    The permacath is not often taken out when a new fistula is created and so if the new fistula becomes sore or tender your mom should let dialysis staff know the permacath can then be used and the fistula rested. The permacath is often taken out once the fistula is able to achieve the desired blood flow without complication or pain.

    Hope this helps

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  3. Pingback: What does a Healthy Dialysis Fistula Look Like? « Big D and Me

  4. thanks for your answer,another question i have is I am 39 years old so i want to get a transplant and have family members willling to donate but iwas wondering should i do dialysis for awhile first. The doctor told me to set up with a hospital to get the process started cause he says it takes awhile but what test do i have to have? I do not enjoy going to the doctor even more!

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    • Hi Belinda. Happy New Year! Who knows what it will bring, but hopefully a new life.

      Regarding waiting or starting the transplant process now, I’d plumb for starting pretty soon.

      While you never know how long you have to wait for a kidney from a deceased donor (but usually several years), a live donor transplant can take some time to organise. My wife donated one of her kidneys to me. We started the process three months after I started the BigD, and we were wheeled in to theatre nearly a year later.

      There are all kinds of tests, from blood and tissue matching to physical fitness, psychological interviews (making sure the donation is genuine) and what-to-expect briefings. They take time and they are numerous.

      Now that you are on the BigD, you should be starting to feel well again. This is the time to get as fit as you can before the transplant. It is a big operation, and can take a lot out of you. The fitter you are, the better you will handle it. Check out the post about exercise, here for more.

      Regards,
      Greg

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  5. Going for my 5th session tomorrow – had a lhs nephrectomy, 3,6kg 30cm polycystic kidney out ten days ago. Already found out that the needler plays a big role in pain levels – will go for DIY later. Thanks for your post.

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  6. My mom finally started the BigD last week…..at 9 percent GFR…they put her on.
    Now her fistula was done 2 years ago….and every doc said how strong it was, great, etc etc…..

    First day….it was painful for her , etc…and the first night…or middle of night…I look at her arm….and the whole thing was black and blue and purple and I thought GOODGAW….what the heck happened? we called the clinic….they said if its not swollen not to worry.

    Day 2….3 nurses later….they couldnt get a flow this time (i guess…they said it wasnt working)…a nurse practitioner tells me i have to drive mom to some place miles away for a catheter….this is DAY TWO….my mom freaking out…..going “say what?”….she doesnt want to …cant understand it….

    we go to THIS guy….he says….the fistula sounds good to him….he will just write on paper work….patient refuses…but he thinks we should try again…

    call the kidney doc…he says try again in a few days…..that was today…..it worked apparently….but took awhile……
    me talking to other people…..it was suggested to me that maybe first tech (a huge guy) jammed my moms new fistula and maybe it was exactly as you say…it punctured something? or went through something?

    my mom doesnt want this guy again, but he is always there…..she wants the girl she had today…lol.

    Have we damaged the fistula though with that first horrible situation? do you think they will still send us for the cath? Mom was just in shock that the first time it seemed it was destroyed….and all for nothing…..

    what a disaster. we are still not sure how this ends….that other nurse practitioner will think we did the cath when she sees us on tuesday prob.
    And does it depend on how rough the tech is? wow.

    Her arm STILL looks like a boxing match…..its been 4 days since the first session that happened on tuesday…it was thursday they couldnt get it….and today we tried again.

    mom was also wondering….why everyone in the clinic looks like they have a lower arm one than her (are those grafts?)……why….are they better? easier for the techs? (they seem to be)…..hers is the only one I saw at the elbow or slightly above (upper and middle arm….not lower).

    Hers always seems to be a struggle versus others……..shouldnt it be mature after 2 years?

    I ask a lot of questions…..thanks for listening….

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