Hi I am new to this site. I am trying to find info about fistula's. I do not have kidney problems but have MS and will need fistula for access for plasmapheresis which basically needs the same access. I do not know what a fistula does or is other then website pics-my main question is can I still use my arm the same after they create the fistula? I have read you can't lay on it or wear a watch, lift anything with it etc.... I am 37 yr old Female and just need to know if this is something I should wait to do. Can it ever be reversed? How noticible is it?? I have had several treatments using thru temporary access port in chest which helped tremendously but am very nervous about whether I should proceed or not. Please help!!!

I know my fistula they taught me that it can't be reversed but some time down the road it may stop on its own. Also you can't lift more than 10 lbs with it and can't have blood tests done in that arm .. can't have IV in that arm and can't be used for anything other than dialysis and can;t have blood pressure taken on that arm.

I too want to know more however because this is my 2nd one and even though this time it is working (not like the first one that failed after 10 days) it is blocked by scar tissue .. which I TOLD the surgeon that might happen but he didnt listen to me cuz I am so young. Now he is admitting I am right. And has to take a vien from my leg cuz my arms have too much scar tissue. He wanted to try my other arm but I said no. I live alone and I don't have anyone to do things around the home for me. I need at least one arm that isn't limited.

So he will put dye into my arm to get a better look.

I am interested in the button hole technique but my unit has not talked about anything with me. It is another patient who I saw was doing this technique and I asked him about it. He says I should do it especially since I have all this scar tissue from years of blood work (since I was 9). I find sometimes other patients give the best advice.

- Angie

Hi mk4dream,
I am a dialysis nurse and know that the fistula is usually the best way that the blood stream can be entered (via two needles) for dialysis. This procedure is done either under a local block type of anesthesia or may be done under conscious sedation (twilight sleep).
The surgeon or nephrologist will usually do some testing first which looks at your vascular system to see if you would be a good candidate for this and where the best placement of the fistula would be. It is usually placed in the lower or upper arm.
The fistula is a created by a vein and an artery being sutured together (called anastamosed). After a few weeks, the doctor will suggest that you start some exercises that will increase the size of the fistula. (The fistula needs to be at least 7 mm in order to have needles inserted successfully). These exercises are simply to have a light tournique applied above (closer to the shoulder) the fistula and you will squeeze on one of those squeezy balls (for lack of a better name). This will be done multiple times a day and will make more blood be "held" in that area for short periods of time, which will increase the size of the fistula.
Yes, I have seen some fistulas that are not particularly cosmetically attractive to the non-dialysis eye, but, believe me, if you have a nice, large, well developed fistula, this is a positive thing! The staff doesn't have as much difficulty cannulating, you will have less problems (with possible infiltrations), and will have less mechanical problems.
If you are a candidate for a fistula, I say, run to have it done! If you need to have a cathether for your treatments, the rate of potential for infection goes up tremendously!
It usually takes between 2-4 months for fistulas to even be able to be used. My suggestion is that you learn to cannulate yourself (from day one- you will be your best cannulator!). Hope this helps. Dialysis Deb, RN

Dialysis Deb, it's good to know that nurses read these forums. You brought-up some great points regarding this issue. One thing you did not address, the lifting of 10lbs. or less, ever. Correct me if I'm wrong, picking up heavy objects is ill-advised the same day of cannulation, however, not prohibited the day after? The reason I ask, I have dialyzed friends that are body builders, I'm talking bench-pressing 300lbs or more. Also, there was an issue of Dialysis Transplantation years ago that followed a dialysis patient through one day of his body building training, and there were photos of this patient competing in body building contests. Furthermore, the frinds that I dialyzed, cannulated with 15g fistula needles. I'm not sure if plasmapheresis requires a larger guage cannulation device, this could be the reason for the lifting restrictions, Angie is referring to. Please do not take this literal, the physician's word is the way to go. I only bring this up, due to what I have seen and read.
Good luck with all your endeavors.

Ya things might be slightly different with plasmapheresis.

Since you are a nurse I want to know something. My fistula is very "snakey" and rolls a LOT. The nurses have a troublesome time cannulating my fistula. I figured this would happen as both my arms have scar tissue in them from having blood work since I was a little girl (9 years old) and even my hands prove difficult for the many IV teams who have had to pick me. The surgeon seemed to feel that with a fistula I would not have these problems but it is looking like I was right. They want to take the catheter out of my chest but I am worried and wonder if it should not be left in sooner. I do the "shower technique" since it is a deep catheter with a cuff that prevents anything from getting inside the skin. I still have to use Chlorhexidine on it daily. But I have had it over a year now with no infections but already had to have 2 fistulograms on a fistula that I have only had since May of this year. It to me would only make sense to leave the catheter in a little longer. The Nephrologist tells me that 2 weeks since the last fistulogram is long enough to see and that I have had it now for 3 weeks. It was not "blowing up" anymore but the last dialysis it did. She tried higher up and still it "blew" again (goose egg/swelling/bruising).

Also since I have trouble with scar tissue I have asked to be put on the buttonhole shift but they don't take me seriously. I think they judge me for being so young (32) and assume I would have no trouble. They don't seem to realize that I was born sick and that I have already had a transplant and it failed and then I had to go back on dialysis (before my transplant I was on PD instead of HD because I was in a children's hospital).

What advice would you give to me? What can I do to improve my arm? How can I improve things so that the nurses have better success at cannulating my arm?

Thanks.

- Angie
angieskidney.com

This message has been edited. Last edited by: Michael Williams,

Angie, I hope this finds you well. Regarding cannulating and upkeep of that run away fistula, pardon the pun. Refer to the excellent instructions dialysis deb advised, I'm pretty sure that your physician has provided similiar instruction. As for cannulation of an ever elusive fistula, what I found (worked for me), by applying a light tournique on the upper arm (above the fistula) then holding the fistula in place with my thumb and forefinger (free hand), thus cannulating between my fingers (quickly, however, carefully, making sure not to traspass the fistula). I hope all goes well, and remember, your nursing staff and physician are an excellent means of information; don't hesitate to ask them questions, or provide them with any of your concerns.

Goodluck with all your endeavors.

Free hand? The fistula is on my lower arm near the wrist so I don't know how I can do that

They are finally going to teach me right after the Canadian Thanksgiving!

This message has been edited. Last edited by: Michael Williams,

Angie,
Pardon me, I was under the impression that you were being cannulated by the staff. As for personnal cannulation, you've got me. I would not know were to begin, therefore, I can only wish you the best. Also, kudos, for I have seen only two clients whom performed such tasks (in 16 years). Again, regretably, I can not offer words of wisdom, rather, my best wishes to you. Please let us know how it goes, your wisdom and perseverance is greatly appreciated.

Goodluck with all your endeavors.

Well I have a nurse cannulate me but I have had other dialysis patients (not in my unit but on the net) really try to push me just to take the innitiative on just self-cannulating. I didn't want to because I feel I need to be taught first. I really wouldn't want to screw up my fistula!! Anyway, the nurse I have is finally going to teach me buttonhole and she said that if I am too scared to learn to self-cannulate that she would just keep on doing it. I can't afford to travel anyway so I am not worried about not having the same nurse. I will always be at my dialysis unit.

This message has been edited. Last edited by: Michael Williams,

Hey Angie,

Please keep in mind that people, namely your dialysis nurse, will take vacations and sick leave. Therefore, it would behoove you to allow other staff personal to cannulate you. I understand that not everyone has the skills. However, I can almost bet that there are several staff personal that can complete the task safe and timely.

Goodluck with all your endeavors

Update: They have started button hole on me 3 weeks ago (finally) but you are right. My buttonhole nurse is gone EVERY Friday! So at first they would not touch the button holes and do the ladder technique but then she gave them permission to do buttonhole on me. This made me VERY nervous as they are NOT established yet (well the arterial was but last time they had to go back to sharps on it).

- Angie

This message has been edited. Last edited by: Gary Peterson,

I can't log in but wanted to point out that both people in this thread by this name are me. I couldn't find where to post this. Please email me at angieskidney at gmail.com and then delete this post, thanks!

Figured out my log in. Wanted to post that the nurses finally gave up on my buttonholes and I am back to rope ladder technique. I still feel that different cannulators during the establishing of my buttonholes made them not work out. But they told me it is because my fistula rolls too much and that they don't think I would have been able to start cannulating neither. I believe them since they are more experienced at this than I will ever be and all my life nurses have even had a hard time with my arms even with simple IV's ..

Does this mean a patient with rolling fistula like mine should never attempt to make buttonholes? The staff is having a lot easier time with the sharps and rope ladder.

This message has been edited. Last edited by: Michael Williams,

Hi:

An interesting exchange on fistulas. Mk4dream`s original message regarding a fistula for plasmaphereisis certainly got things rolling.

As I understand it, plasmapheresis - the drawing of blood, removal of unnescessary liquids and return of pure blood - is, indeed, a lot like dialysis.

The fistula is usually created in a person`s non-dominant arm. There was a mix-up with mine, however, and it was created around the wrist area of my dominant arm.

Except for the period immediately after the creation of the fistula, there were no restrictions like wearing a watch or not lifting anything more than 10 pounds. Exercising the arm was encouraged and eventually I found I could lift anything I could before the surgery.

Taking bloodwork from an arm with a working fistula is avoided.

The button-hole method has gained a lot of popularity over the years and is a better route than chest catheters, which still pose a risk of infection.

I say this even though I used a chest catheter for almost two years during dialysis after the veins in both arms became too weak for dialysis.

Rolling fistulas are not uncommon, but do become more stable after long periods of use. Such movement would not preclude the use of the button-hold technique, which also takes time to build up enough scar tissue to make access easier as time goes by.

I`m looking forward to getting more involved in these discussions once again.


Good luck all.

Michael

Well hopefully I can try buttonhole again one day. I am just worried about the scar tissue developing now with ladder technique as they admit there are not a lot of spots for the arterial so they do it in the same 1 inch area.
- Angie

Quote:
Rolling fistulas are not uncommon, but do become more stable after long periods of use. Such movement would not preclude the use of the button-hold technique, which also takes time to build up enough scar tissue to make access easier as time goes by.

This message has been edited. Last edited by: Michael Williams,