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. (more…)

Dialysis Buttonholing that Works

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…)

Holiday Dialysis – across the world

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…)

Dialysis: overcoming Buttonholing’s obstacles

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…)

Improving Dialysis Quality by Greater Separation of Fistula Needles

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…)

Dialysis Buttons for your Buttonholes

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…)

Dialysis is Like Life, Only More So

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…)

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). (more…)

Getting the Needles In – Part 2

Your first few Big D sessions will probably be like mine: a gentle and experienced nurse will put in the needles (called cannulating) and you will have a have short runs, so that your body gets used to the whole deal.  I had my first runs at the Central Dialysis Unit at the Austin Hospital. (more…)