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:
- 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!
- 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.
- 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.