I got a bad stick at my art. site. The RN failed to notice that my art. pressures were sky high. What must be done to deal with the situation when the needle must be pulled and a new needle started at the site? Another RN said if the needle was pulled and a new one started, I'd have to hold the first site the entire tx. I know this is not true as this happened to me once before and I didn't have to do that. I think I recall that the site was held and tapped off and a new stick was started below the original one. Is this correct?

Casey,

I was on hemo for nearly three years and had to be re-stuck many times. I never had to hold the site for the remainder of the treatment. It sounds to me like maybe you had a lazy nurse or tech and they just did not want to re-stick you.

My recommendation has always been that if you have a situation where you must restick a patient, to leave the first needle in place and then remove all needles at the end of treatment. This eliminates any potential for bleeding to resume at this site after treatment has been reinitiated, and helps to eliminate blood loss in the beginning. (You would expect that this site is going to bleed slightly longer than after treatment sites simply because of the heparin use.)

Carol

Can a bad art. stick affect the way fluid is pulled off? Because my bp's were nicely up, but I had symptoms of feeling a little clogged in my head, and my hand felt slightly crampy. My foot went into a cramp at the last 2 min. of my tx.

I cut the UF off and received 100cc's of saline. The tx was on a Mon. and I've read that it is sometimes harder to release fluid after a two day weekend. I have never had a tx where I was close to cramping and then finally did at the end when my bps were up, so I am wondering if the high art. pressures affected the fluid pull?

Also, is there a way to know just what kind of damage occured with the high art. pressures? Is a one time occurence something to be concerned about? My pressures were in the -290's at one point. I usally monitor my art. pressures every tx by asking the tech to read them off to me, but could not do so this time as we are now short staffed due to company cutbacks and there was no one free to give patient care. It left me unprotected.

When I noticed that I had symptoms of feeling slightly crampy, eventhough my bps were up, should I have gotten some saline early on or done something else? And with my earlier question, what should of been done with the needle when it was obvious it was a bad stick? I had felt soreness with my ven. site at initiation and the tech said the venous presures were good, but when I got my tx sheet I found out it was my art. site that was the problem. The tx sheet also showed the art. pressures were ok at put on, but went up sharply when the tech raised the blood pump speed, which she failed to notice.

Something else I thought to add. We were so short staffed at the tx I spoke of that the RN could not get around to give me my IV meds until the last 5 min. of the tx. Are the meds absorbed just as well at the last second of tx, and could that of had anything to do with the cramp I got in my foot moments after it was given?

Certainly, bad sticks can certainly affect the way your treatment proceeds. Most commonly, you would expect to see poorer clearances of solutes (for example, your urea nitrogen). Although not as common, I have heard individuals state that they have had fluid removal problems when the access was not functioning optimally.

Without knowing everything that happened on this treatment you are referring to, I hesitate to say what else could or should have been done. It is very common and accepted practice to reduce the UF goal and / or give normal saline if a patient is cramping. Since it was so near to the end of treatment you could not give any concentrate sodium chloride at that point.

I am concerned, however, that your BP remained elevated. How is it now?

Finally, elevated arterial pressures can and do cause hemolysis. I can not begin to tell you if - on you - that arterial pressure was or is safe. I would not recommend having a pressure in that range again.

Best wishes,
Carol