Firstly, many thanks to our intrepid BigD-ers, especially Carl, Cath, Henning, Debra and Adam for their needling stories, advice and suggestions.
This Briefing is a How To for putting in your own hemodialysis needles. It covers five parts: Theory, Practice and Visualization, to help you understand the mechanics of needling, Know Your Fistula, so that you know and understand the lay of your particular territory; and eventually, charged with the skill and insight you need, it will be time for The Real Thing.
More power to your arm! (more…)
Josie (not her real name) emailed me recently about a problem she had getting one of her needles in:
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. (more…)
Buttonholing seems to come in and out of favour. It has many boosters; I am one. Why? The fistula lasts longer, less pain, easy insertion, less chance of a blowout, less time holding the needles after removal – what’s not to like?
According to Roger (not his real name) and several dialysis units, one thing: infection.
Roger emailed me last week:
I’ve been meaning to send you a query about buttonholing for a while now. (more…)
Manny (not his real name) started BigD about two months ago. And contrary to common experience, he feels just as lousy as when he started: weak, tired, generally unwell and incapable of doing much at all. These are classic symptoms of insufficient dialysis, where not enough toxins are being removed by the membrane filter.
Why? Like all new BigD members, his fistula was soft and fragile and initially couldn’t handle blood pump speeds higher than about 200 milliLitres per minute (mL/min). But rather than his fistula gradually maturing over time to become capable of faster blood flows, it had some kind of blockage (maybe it was clotted or had a narrowing that impeded the blood flow). So staff couldn’t get the blood pump speed past the 200 mL/min mark, which is not really enough dialysis to make a difference. (more…)
Julie and I flew from Melbourne on 6 May at midnight and after a three-hour break in Hong Kong we landed in London on 7 May at 4pm. Allowing for the time zone jumps, that’s about 24 hours in the air.
A few weeks earlier I spent three weeks in hospital with some bug and my haemoglobin had dropped to 7. It was around 9 when I got onto the plane. We debated whether I (we) should go at all, but my health was improving and frankly it is always easy to find an excuse not to travel. If you give in, you will never go anywhere, so we decided to push on. (more…)
Buttonholing is great: less pain, easy insertion, less chance of a blowout, less time holding the needles after removal – what’s not to like about it?
Well, there are a couple of obstacles, at least for me. Both can slow you down, but both can be overcome.
First, the scab plays hard to get. If I push the needle all the way in, so that the hole is sealed by the barrel of the needle (which is the intuitive thing to do) the hole eventually forms an indentation. (more…)
For the last 6 months or so, I have been placing my needles on the two crests of my fistula, for ease of access and to help keep my fistula arm relatively unencumbered (so I could type and generally do things with both hands). The total distance between the two points was a little over 6cm (2.5 in).
In the back of my mind, I wondered if this was a little too close and that maybe there was some recycling going on in the space between the needles. That is, clean blood from the machine entering by body via the venous needle was being sucked back to the machine by the arterial needle, rather than being circulated to the rest of my body. (more…)
In my last post, I mentioned that it is becoming more common for units to get people started with buttonholing by inserting a plug into each needle hole for a couple of weeks so that buttonhole and tunnel formation are accelerated. I met with Anna Flynn, a very experienced practitioner of this technique last week to get the whole story. As you know, I am a big proponent of buttonholing (using the same needle holes for each dialysis session) for several reasons. (more…)
The BigD is the original moving feast. One month life is sweet: my brain functions Ok; puncturing is easy, with both buttonholes working; I feel fit and well; my blood pressure is like an athlete’s; my blood work is mostly within the zone; I am sleeping well; I can get out of bed, jog and exercise like I did way back when. On these days I think: “This dialysis is a soda – can I handle it or what?”
Then the next month arrives. Suddenly (more…)
Now, for the last, and probably the most useful step towards stress-free BigD: buttonholing. As I wrote in Part 2, the technique involves putting the needles into the same holes at the same angle every time you dialyse. (more…)