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  1. #1
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    why doesn't the fistula work???

    So husband goes for his first dialysis session and they couldn't get the needle in or get a blood return? They kept poking around and then called it a day becuase the fistula wasn't mature enough. He had it done about 8 months ago and last week needed a fistulagram and balloon procedure. Dr was able to get an 8mm widening and tied off some branches. The thing is really loud and thrumming well. His dr thought it would be good to go the next day with a "skilled technician". We waited (on nephrologist's orders) 4 days until we tried. No good. Can someone please give me some info on this? Very frustrating. Was it the center? The technician? The fistula? He sees his dr on THursday. Meanwhile, his legs are cramping. Ugh.

  2. #2
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    Hello magickgirl,

    I've had three fistulograms in the past two years, the first to resolve an 80% narrowing near the anastomosis that was restricting flow and leading to infiltrations on the venous portion, the second to remove a substantial clot in one of the vessels that developed as a result of the first fistulogram and most recently a third as a follow up to the second and to resolve a narrowing in the vessel that had previoulsly clotted.

    I've sought the advise of my original vascular surgeon as well as the doctor that performed all three fistulograms as guidance in what vessels to use and where to stick them. I've used much of their advice as well as that of my home hemo team, that consists of several expert cannulators. I have found that through my own experience of developing button hole access through repeated sticks with sharp dialysis needles, that no one knows my access (AV Fistula) as well as I.

    As a home hemo patient, I pretty much do it all, and if I fall short I only have myself to blame. Your husband has to rely on the capabilities of the technicians at the dialysis center. While those capabilities are limited, what is even more limited is the time they have to work with your husband's fistula.

    I received and continue to receive excellent guidance from my HHD clinic medical team. You will not only need to find someone with an adequate skill set, but they must also have the time and patience to work through your husband's fistula cannulation issues by finding the best spots for needle sticks. There is only so much of the fistula that one can see or feel to determine a good location to place a needle. Even these are not foolproof and can require some experimentation. I'm afraid that this is an issue that will take time to resolve through some experimentation.

    Think of the situation as taking your car to one mechanic who can't seem to figure out how to resolve the problem at which point you take the car to another mechanic. You continue this rather frustrating process until you find a mechanic who is skilled and experienced in the issue and he/she is able to resolve the problem.

    If you read enough Forum posts, you will find that your husband's situation is very common with a new fistula, and resolution can take several months along with fistulograms, surgical revisions of the fistula, or the trial and error of cannulating the fistula in different locations. Persistence is your only ally.
    Last edited by stumpr54; 06-27-2014 at 01:05 PM.

  3. #3
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    Thanks so much! You are an inspiration to us. Is it ok to ask for a different technician at a center?

  4. #4
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    Hello magickgirl,

    I don't see why not. After all, you and your husband are the "customers" and are entitled to the best care that the center can deliver. If there is a technician who is either better skilled and/or particularly skilled or familiar with your husband's fistula, it makes perfect sense to request that individual to work with your husband. The problem that you may run into is that individual's availability could be limited to days of the week or portions of those days - driven by the days and shifts worked. If none of the techs have any familiarity with your husband's fistula, you'll have to be willing to go through a trail and error process to find one who's got the skills to successfully cannulate your husband's fistula with regularity.

    When I began HHD, my prone to infiltration, but mature after 9 months fistula, was cannulated by no less then 4 different nurses, three of whom were very skilled cannulators. They were all smart enough to realize that the problem was not their technique but some physical constraint of the fistula itself. Yes, it took some 5 infiltrations in 14 needle sticks over the span of 10 days of HHD training to make the determination, but the determination was made. I was sent for a fistulogram, that successfully diagnosed the problem, (80% constriction/stenosis at the anastomosis) and corrected it. After the fistulogram, I was back on track and had no further infiltration issues.

    There are plenty of contributors to these Forums who began hemodialysis in center and when through months of fistula access (cannulation) issues, failed treatments, vascular surgeries, fistulograms, fistula revisions, etc. before hemodialysis treatments began to occur without issue.

    When I went through the experiences that I have detailed, I had no basis of comparison, and my expectations had not been managed as well as they could have been, e.g. "There may be complications with your visually wonderful "9 months mature" yet untested fistula". When it became clear that the infiltrations were chronic and not isoloated incidents, that it was clear that my situation was exceptional and exceptional steps needed to be taken. At the time, I was incensed, but in retrospect, the actions of my HHD team were appropriate and taken in an appropriate time frame.

    I was misinformed by my nephrologist before starting training. He told me that the process would take some two to three weeks. I had set up partial days of vacation to support the five day per week afternoon training schedule for two weeks. At the start of training I was told my my trainer to expect three to five weeks, and the figure would not acount for the two to three weeks of training that were lost because of time taken off for infiltrations.

    We were all quite fortunate in that I was not sick and did not require hemodialysis to live. I started the training not in response to my health, but because my kidney function was getting close (months) to that point, and I had committed to a training slot back in May, some 6 weeks before the actual start of training.

    When I begain the training regimen again at the beginning of August, I had effectively lost between two and three weeks of training time. The training process and the development of two button hole sites in my fistula, which I was able to self cannulate, were complete just after Labor Day 2012, and I was able to go home and begin home hemodialysis.

    My HHD training was a long 7 week journey. In retrospect, those 7 weeks, and roughly 30 treatments, are a blink of the eye in contrast to the time I've been treating at home, and a thimble's full of knowledge compared to the bucket full of insight and experience my care partner and I have gained during the 450+ HHD treatments we've conducted since.
    Last edited by stumpr54; 07-03-2014 at 11:30 AM.

  5. #5
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    Jul 2012
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    Not only do I pick who takes care of me, I had one tech place a button hole and I cannualte myself. The techs that help can be anyone now. When I had trouble with my upper access a few weeks ago and I did not like, nor trust the newbee, I told him to go get "my tech, the one who placed the buttonhole". He came right over, used a sharpy because a scap developed lower in the button hole. No big deal. Next time I went in, I had no problems and again it didn't atter who was handing me the swabs, needles to taping.

  6. #6
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    Dec 2013
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    Here we are a week later... neph wanted to have a chest catheter inserted so dialysis can start. Since husband is feeling much better (it was a cold that was causing his tiredness), he refused because he wants to talk with his vascular surgeon first. He has an appt with that dr this week. The vascular surgeon told us earlier that the fistula was doing well after the angioplasty. Iwas all set to go with the catheter, but husband researched it and wants to follow through with the fistula. The difficulty was not at the site of the fistula (lower wrist) but they couldn't get the artery? Does that make sense?? Thanks so much guys. BTW all of my testing is done and I can donate in a paired swap!!!! Also the recipes from Davita are incredible. I 've been picking a new one several times a week. Really helps keeping husband on track!

  7. #7
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    Yes! After the consult with the vascular surgeon who thought the fistula was good to go, and an initial rocky start as they tried to get dialysis going, husband was finally able to have treatment.The Davita staff was absolutely joyous! I have never met a more upbeat group of caregivers. It was not as bad as we feared, and I was able to sit with him the whole time. His first treatment was two hours. No bad effects except a little dizziness. For the last two days, husband has been feeling like his old self more. He cleaned the pool, went up stairs without getting out of breath, and even fixed the darn toilet that has been running. Better still, he's staying awake in the evening and sleeping through the night. We go back for treatment 2 today. I am so thankful for dialysis and the people at the clinic. Just hope this continues.

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