Dialysis needling: if at first…




Josie (not her real name) emailed me recently about a problem she had getting one of her needles in:


Hi Greg

I hope you don’t mind me getting in touch. My name is Josie, I live in the UK and started home haemo a few months ago. I have had a problem with my fistula tonight and because it is Friday night here I can’t get hold of any of the nurses from my training unit, and having followed your blog I thought I could seek your advice… as I say, I hope you don’t mind me doing so.

My bottom needle went in fine, but I was unable to get a blunt needle into my top site (I use the buttonhole technique) so tried with a sharp. It slid in easily but I was unable to get a back flow. I took the needle out and tried again but I think it just followed the now incorrect path. It was getting very late so I simply gave up and scrapped the session.

It is a huge long shot that you will see this message and be able to reply before tomorrow morning (UK time) but just on the off chance, I was wondering if you could advise me on what to do. I thought I should probably try and needle a slightly different site but I have never done that before and would be quite nervous about doing so. The alternative is that I have another go in my regular site, but I don’t know whether it will have healed by then. It is not particularly painful now and does not appear to have swollen or bruised, so I don’t know whether I blew the fistula or simply put the needle in the wrong place.

If you are able to reply I would be incredibly grateful but I understand that may well not be possible. I hope you yourself are well – I actually write my own blog at (http://thelistlife.blogspot.co.uk). I suspect I know what my next article will be about…

Many thanks, Josie

My response.

Hi Josie.

Firstly, I am impressed that you are buttonholing after just a few months at home.  It says a lot for your skill and confidence.  And don’t worry.  I still have the odd problem with a needle site.  I know how frustrating and nerve-wracking it can be.

Since I know nothing about your fistula, it is difficult to say what last night’s problem was – maybe the needle was not actually in the fistula, or hard against the wall, or even right through both fistula walls.  However, I have found that it often takes more than one badly positioned sharp needle to completely destroy the buttonhole tunnel.  Given sufficient time, the tunnel recovers and is fine for next time.  I’m not sure if overnight is sufficient time, but it’s worth a try.

So today, try the same site again first and if possible, avoid the drama of a making new site.  Your overnight rest may just be enough for it to settle down and come back to the fold.

You can always move to a new site if it is still a problem. If this is the case, while it is a tough ask to needle a new site after only a few months, I think you will surprise yourself.  Stay calm. Take a deep breath and take it slowly.  The other site will recover, so choose the new site for ease of access.  You may only need it a couple of times until you can use the old site again.

Driving home from BigD this morning I thought of one further thing.   A couple of weeks ago a group of us had been discussing ways to recover from failing to get a needle in properly.  Cath, one of our very experienced dialysis nurses, reminded us that sometimes you just need to relax.  Her formula is to make the patient a cup of tea, make herself a cup of tea, and sit quietly drinking it.  Once both are finished, she tries again: invariably, the needle goes in without a problem.

I know this works, not because I have had the presence of mind to stop when I have a problem, but because the times I have a needling problem are when I’m stressed.  Either because I’m in a hurry, or because I’m needling myself at a different unit.  For example, when I went to Bali a few months ago, the nurses there had never seen buttonholing, or someone putting in their own needles.  As a result, I had an audience.  Talk about performance anxiety.   One of my sites is tricky and requires focus.  Of course, I couldn’t get it in. So, foolishly, I did exactly what you did: asked for a sharp needle, and ended up scoring the tunnel.  What I should have done was ask the audience to leave, taken a few deep breaths and a soothing drink, and start again.

So, next time you encounter a recalcitrant needle site, stop, have a cup of tea, then start again.

I hope all goes well today.  Please let me know how you go.

Regards, Greg

ps: Your blog is great!  I  have added it to my blogroll.


More Organ Donors

We all know that organ donations are hard to find, but there is some good news:

Opt-out organ donation system (July 2 2013).  In an effort to increase the number of donors for transplant, the Welsh assembly overwhelmingly voted through a change in the law to create an opt-out organ donation system.  Wales will become the first UK country to adopt a process where individuals will be presumed to have consented for their organs to be donated unless they opt out.

Currently, twenty-four countries in Europe use the opt-out system.  All tend to have very high levels of organ donation.

Read more:  http://www.bbc.co.uk/news/uk-wales-politics-23143236

Expenses paid for donating (April 7, 2013).  The Australian Federal Government will trial a scheme to pay employees wanting to donate an organ a six-week salary on the minimum wage.  Under the scheme, workers will be paid up to $606 per week for six weeks to help ease the burden of medical costs.

Read more:  http://www.abc.net.au/news/2013-04-07/organ-donors-to-be-paid-six-weeks-salary/4614278

Update on Artificial Kidneys

I first wrote about wearable and implantable artificial kidneys in September 2009.

Thanks to guest poster Robert Longstaff , the Economist tell us that now there’s iRAD – the implantable Renal Assist Device, which uses a filter made from natural kidney cells (taken from human kidneys deemed unsuitable for transplant) to clean blood and produce urine.  Human trials could begin in 2017.

Read more: http://www.economist.com/blogs/babbage/2013/04/bionic-kidneys

Progress is slow but worthwhile.  All we have to do is hang around long enough.

2 thoughts on “Dialysis needling: if at first…

  1. Hi I am Sazid from Bangladesh. My father is a CKD patient and recently started dialysis. But 2 weeks ago he was admitted to hospital due to difficulty of breathing and acute fever. Doctor diagnosed that he gained huge fluid in the chest cavity outside lung . They removed water 2 times from lung and it was about 2 liters. They have done several test including CT scan found literally nothing and prescribed for TB drugs. He takes dialysis 3 times a week and water intake is 1 liter/day. He is still hospitalized and need oxygen support for 2 hours each day. Will you please suggest anything I could or should do about this matter? Thanks in advance……


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