We all remember our first dialysis session. I certainly do. At the Central Dialysis Unit, just down the stairs from Ward 4, the kidney ward. It was a super emotional time. Julie walked with me into the unit, my heart thumping, my mind racing, looking everywhere, taking in everything. I kept my face blank, hiding both fear of the unknown and anger that it was really about to happen. Everything was new and unfamiliar. Nurses moving briskly about. Patients on dialysis machines in all directions. And there, across the room, an empty chair next to a humming and flashing machine, just waiting for me.
Luckily, the Unit Manager was an experienced and sensitive soul. She knew it was my first session and made sure I knew she knew. “I know you’re not too happy about being here, but we’ll do our best to make today a gentle start to your time on dialysis. *Heather will be putting you on today. She is one of our best cannulators, and you’ll just have a short run today – a couple of hours.”
My mind went blank: what’s a cannulator? And relief washed over me at the same time: I wouldn’t have to sit there for four hours – this time.
Heather arrived. Hi (nice smile, didn’t look too fierce or incompetent). “Please wash your arm at the basin, then have a seat.” I washed, sat in the chair and waited.
Heather began examining my fistula “good size, nice and soft, with a good pulse and thrill” (I knew about the thrill – in bed, when my forearm was on the pillow next to my head, the roaring, pulsing sound had woken me up more than once). More pressing and examining, all the while explaining what she was doing. Would you like local? It stings a little, but it helps with any cannulation pain.”
Ah, cannulation is needles! Yes please.
Everything lined up on the table: two very large needles with tubing attached, a very small hypodermic needle with local anaesthetic, tourniquet, strips of tape. Ready. She fits the tourniquet, wipes my arm with disinfectant. OOWH! The unexpected sting of the local.
Heather picks up the first needle. In it goes, smooth as you like, into my virgin fistula. No pain to speak of, but a little uncomfortable. She tapes and flushes. We both smile. A minute later she has the other needle in. Intrigued, with two needles sitting quietly in my new fistula, and relieved that all went well, I relax for the first time: it’s awful, but not so bad as I imagined.
Heather connects me to the machine (with a fairly gentle blood flow of around 200ml/min) and I watch my blood snake out of me, through the filter and a few little holding tubes then back into me. I look around: I’m just one of the crowd now.
I look around: I’m just one of the crowd now.
I don’t know if I was lucky because I went to a unit with great management and experienced staff, or if the unit had systems in place to ensure great service, but that was my experience, 21 years ago.
And it should be every new dialysis patient’s first time experience.
Not the worst time
Unfortunately, based on a new patient in our unit’s first encounter in a Melbourne hospital, it is not. No need to go into detail beyond that whoever put her first needles in made a botch of it., *Kate’s first two runs resulted in blows that rendered her soft, young fistula virtually unusable. She was traumatised and terrified of trying again. Her husband took weeks off work to support her and their young children.
Luckily, Kate is now in our unit and on the mend, though at present her fistula is still only able to handle single needle dialysis.
How this could have happened is beyond me. First-time (and any-time) dialysis patients struggle enough without poor training and slipshod procedures further endangering their lives. Quality procedures and systems should be part of the DNA – fundamental building blocks – of each dialysis organisation, and each clinic.
For example, my unit has several detailed cannulation procedures, including one for mature fistulas and one for new fistulas. All are reviewed and renewed regularly to keep them effective.
Another way to keep them current is to track and respond to incidents like Kate’s, so changes can be made to minimise the chances of it happening again.
For example, a couple of years ago after a transplant, I was given the wrong dose of a very expensive and powerful antirejection drug (all at once rather than in 10 doses over 10 days). I became quite unwell and Julie rightly complained, loudly. As a result, several people apologised (including the hospital in writing), but more importantly, procedures were changed and additional training given to staff.
I will certainly urge Kate to provide feedback on her incidents, for her peace of mind, and so that other first times at that hospital are like my dream run, and not like her nightmare. The unit should have a written incident report for each blowout. Once she is up to it, she should follow up and find out what, why and what they are doing about it.
Suffering in silence helps no-one