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Friday, 18 February 2011 00:08

Improving Dialysis Quality by Greater Separation of Fistula Needles

Written by  Greg Collette
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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.

If that was the case, my dialysis efficiency would not be as good as it appeared.  The volume of blood processed would be fine, but unbeknown to me, not all of the toxin-laden blood was being cleaned while cleaned blood was being re-cleaned. If this was the case, I would feel gradually less well as time progressed (because I was being underdialysed), even though I put in the time.

I don’t know if was my imagination, but over the last month I was feeling gradually less well.  Tired, aching bones: the usual when you don’t get enough (dialysis).


Good and bad needle spacing on the fistula

So about a week ago I decided to move the sites further apart – in fact as far apart as comfortable and possible, which ended up being 22cm (8.5in) – I wanted to be sure I was getting the best dialysis possible.  See the pic.


I still want to use buttonholes and blunt needles on these new sites, but for the first 10 days or so, I must use sharp needles, to start creating the “tunnel” at each site.  This is a bit of a pain initially: with new sites it takes a while to find the best spot and the new holes tend to bleed a little until the needle is fully in.  This is because both are old sites, with lots of scar tissue that I used a lot before I switched to buttonholing.  However, now after a week, the sites are becoming a little tougher and easier to use.  I will try blunt needles for the first time around the middle of next week.

I am still getting used to having less movement in my fistula arm.  Especially while I am using sharp needles, bending my elbow too far may result in a puncture at venous needle site, in the fistula wall and a Blowout”.  Not for me thank you.  I am perhaps a little over-protective, but things will change when I graduate to blunts next week.

But there is good news.  I am feeling fitter and healthier.  No so many aches and pains, and I have more energy.  As far as I am concerned, this is good enough evidence that the needles were a little too close.

With the BigD, it the same old story: don’t get complacent; keep looking for improvements; you are sure to find them.

By the way, my video series of the month is Lost.  I started Boston Legal, Series 1 in December, which I enjoyed immensely, but I decided to have a break and started Lost in January.  I’m now at Series 5 and soldiering on.  It is great as long as you can suspend any modicum of disbelief, which I can and do with pleasure. Especially during my not-bending-my-elbow period.

My all time favourites so far are Arrested Development, and Battlestar Gallactica for Sci Fi.  Fortunately, there are lots more to come so favourites may be a moving feast.

... http://bigdandme.wordpress.com/2011/02/18/improving-dialysis-quality-by-greater-separation-of-fistula-needles/

Greg Collette

Greg Collette

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