Fistula use

[horsie63]

I go back to the surgeon for my second checkup on the 15th. It might be ready but I am not. Can I wait until I feel ready or is there a risk of it closing up?

[Bassetmommer]

The surgeon is not really the one to say it is ready. He is just checking on his work. They recommend at least 3 months, which in my opinion is too short a time. I had surgery on June 29th and poked for the first time on Oct 16th. There were issues and they infiltrated the fistula on the third day. YOU DON'T WANT THAT TO HAPPEN. I would never have thought it would be so painful. My upper arm from my elbow to over the fistula turn dark purple for weeks. So if you are on a catheter, let your fistula get strong. Now we are doing button holes and having issues with the venous hole. Not sure what is going to happen.

[horsie63 in reply to Bassetmommer]

Being infiltrated is my fear. I’ve seen pictures and they are awful. I had surgery Dec 22 and there’s no way it’s ready.

[Bassetmommer in reply to horsie63]

It happened only once and it was because the person doing it was tired and in a rush. Once they only let the head nurse do it, and then the head med tech, I never had anymore infiltrations. I am now learning to poke myself and the button holes will make that easy. Just have to figure out how far to push it in. The needle was resting on the wall and giving my machine all kinds of pressure issues. I cannot wait until this doesn't scare me. lolol

[horsie63 in reply to Bassetmommer]

Not sure if my arm is big enough for buttonholes but I’ll ask the surgeon.

[Bassetmommer in reply to horsie63]

you won't need them if you are going incenter. I will be doing my own cannulation.

[StillVertical in reply to Bassetmommer]

In the beginning, I was infiltrated about once a week, which gave me major anxiety lol. It's not fun, it truly is a weird pain that I've never felt before, and the swelling is enormous. Sometimes they drag it, sometimes the needle sucks up on the super vein artery, etc. After 6 months, the fistula is large and it's pretty hard to miss, but occasionally they do. If pain isn't your thing, they can spray a numbing agent on you, its a cold spray. Or there is a prescription they can give you for a balm, you lather on your arm an hour before, which numbs the area for quite a long time. Never tried those, but many swear by them.

I know it's a nuisance, but keep that ball working in your fist, the super vein will get larger, similar to body builders veins sticking out. Aim for 3 times a day, 5 mins straight.

[horsie63 in reply to StillVertical]

I might be overdoing the squeezing in as I do it pretty much all day for 5 squeezes at a time during commercials. I heard the cream/spray makes your skin f tougher and that makes sticking you more difficult. I fear the infiltration more than the actual sticking part. I've had plenty of IVs in the last few month and god help me 2 months in hospital and daily blood draws to not have needle phobia.

[StillVertical in reply to horsie63]

It's funny you mention tough skin. The night before, I always use a dove fragrance free lotion for dry skin on that part of my arm. One of my techs always comments. "like butter" when sticking me. lol. I guess it works.

If you can keep that ball up, you are in great shape. I really babied mine for a long time. I was paranoid about sleeping on the arm for fear of it closing or clotting. In the end, it's a crap shoot, just take care of the arm best you can. Don't be lifting 100 lb objects etc. Heck, I'm lucky if I can pull off 25 lbs up a flight of stairs.

[horsie63]

There will be no heavy lifting...even in my good days I couldn't lift 100 lbs...heck that's more than I weigh. I kept my arm on a pillow for several weeks...even slept like that. But I used the ball from day one.

I might get the Dove lotion...I've been washing it with antibiotic soap I had from when I had the PD catheter.

[Vius]

I was about a month for an elbow AVF. Infiltrated once but that was at three months and more a technician problem than an AVF issue. They started with a larger gauge needle but migrated within a week.

«Maturation mostly occurs 4 to 6 weeks after the initial fistula surgery but that timeframe can vary with the average time ranging from 1 to 4 months. » • ncbi.nlm.nih.gov/pmc/articl...

[horsie63 in reply to Vius]

I asked the nurse today who said the surgeon determines when the AVF is ready so I'll ask at my appt. How do they determine it's ready? Is it size or time or even feeling the "thrill"? The first couple of weeks I could not feel anything so I was kind of worried, now I can feel it even through my shirt.

[Vius in reply to horsie63]

I believe they did a second vein mapping (dynamic ultrasound of the blood flow) that needed to reach a particular flow rate and possibly diameter before approving use.

Something like «The Rules of 6 (flow volume >600 mL/min, vein diameter >6 mm, vein depth <6 mm) » • pubmed.ncbi.nlm.nih.gov/352...

Presumably if it failed to mature sufficiently they would follow up in another month or so.

[horsie63 in reply to Vius]

When I went to my 2 week check up they had a hard time feeling and hearing it (it was very weak) and did a vein mapping and we could see it so they have me coming in a month later on Feb 15. Now I can feel it, the nurses can feel and hear it so I'm thinking they will want to use it soon.

[StillVertical in reply to horsie63]

Yep. Yep. Just remember in the beginning that “super vein” isnt quite yet a super vein. It may take some time for techs to get to know your arm too. In the beginning I was infiltrated often, one time did it myself walking to bathroom. Came back hooked me up, wow massive pressure built. It’s not a fun ride getting your blood back after that the arm just disperses blood under skin not in super vein. Obviously end of session too.

Funny story, one time tech went in and down through vein. Tech calls nurse over, hmm, she’s like that needle will let stay, I’ll poke you 2 more times. 3 needles in arm that session.

Don’t expect miracles, tough it out a few months all will be well. I found more they use it the bigger it gets even more than fist pumping. Pretty soon you may not like the look of your arm with bulges. I get questioned often, I dont hide anything. I just merely say take care of your kidneys and walk off in grocery stores etc.

If that vein is still small in width dont be surprised they balloon it. Just get sedation, you’ll thank me later lol. Awake on that procedure is well not a walk in park unless they give you good stuff.