Friday, 25 July 2014

Haemodialysis Risk, AVF and Needle Size

Thursday   2014-07-24  

Last Thursday, 17th July nurse J blew the arterial point of my vein, a bump the size of cherry grew under our noses. The venous point was not spared either though not as bad as the arterial. When dialysis started the venous pressure which climbed to 180-200mmhg positive refused to come down, alarm continuously broke out however much the pump rate reduced.

The problem was identified later that nurse J misconnected the 2 lumens. Arterial became venous, as the entry point already swollen, it had trouble receiving blood. Even after swapping the lumens back correctly, the vessel and its vicinity were too damaged by pushing blood back forcibly through the already swollen arterial. The machine refused to work properly. Eventually dialysis was aborted.

On my way out manager L complained about the waste of about 200 dollars caused by the failed session as if it were my fault.

That morning I got up at 5am, got 2 bruises, took on one litre of saline getting on and off the machine and also included were numerous ampoules keeping blood from curdling while making many adjustment in order to make the needle sit properly in place, and wasted much blood in doing all these. Not to mention the biting hospital parting fee I dished out. In spite of all this they managed giving me zero dialysis. By the end of the day, they even tele-passed me more worry by still seeping blood when I pealed the arterial pressure pad off, redressing was obligatory.

One week’s rest is not enough to heal my bruises which still look grey. The flesh around last week’s venous point felt sore the whole week, mere touching made me cringe. I was told after more drama today that perhaps a nerve was touched.

Today arterial took 2 entries to render it usable. The needle set near last week’s venous point which is still sore, with the needle in the pain worsened and didn’t cease. I kept my fist tightened, teeth clenched and brow knitted for 2 and half hours and got just enough dialysis to sustain me another day and asked to be taken off. Nothing could distract me from my pain. Even with the needle out the flesh continue refused to be touched.

Once again today I asked for a thinner and shorter needle which would be better suited, safer and kinder to my shallow and crooked vein. “We don’t have any.” Nurse S said, “There’s no demand for such needles, we only have longer needle in thinner size”. Could they be in a milk bar business or something that she kept on mentioning the phrase ‘supply and demand’?

Perhaps if my request were not suppressed and snuffed there would be such demand. After all I can’t be that unique.

Nurse J on the other hand cited me all the negative effects of the thinner needle, talking about blood volume and so on, totally oblivious of the size 17, a thinner but longer needle they used on me at the beginning accompanied by a pump rate of 200ml/p/m which remained as such even when later they changed to use size 15, a shorter but fatter needle due to size 17 blew my vein too often for comfort.

One other thing J had short memory of is only last week she managed giving me no dialysis by recirculating my blood within just 3cm length of my fistula through wrongly connected lumens. What volume did I get then? Blood volume is important to me indeed, my life depend on it. I might even game enough taking on a needle the size of a garden hose if necessary. However, so far since I started dialysis last September the highest pump rate I used is 250ml/p/m. I fail to grasp the difficulty in getting and using a properly sized needle. The chance of me drop dead tomorrow is quite slim.

Since May as I started using fistula I had 3 successful runs apart from 2 good single needle entries. In all I received 19 needles among which 11 good ones and 8 bad ones including one done by myself. The success rate is roughly 60%. Both technique and the needle size including length and width contribute to this figure. Applying this figure to 100 patients that would mean 40 of them would go home without dialysis on the day. And further, if the saying that ‘a student is only as good as his teacher’ as something to go by, my future is looking rather far from promising.





During the past months my arm stay bruised most of the time. The only thing I noticed was that if it were a bad bruise, a longer recovery was needed and I may have a chance seeing a reasonably good arm or if it were a minor bruise, a shorter recovery necessary but I would be called back before recovery took place and thus the bruise would be piled on layer upon layer until I forgot which is which.

Secretly I fear for my poor fistula. I’ve heard too many stories and seen too many grotesque arms sported by haemodialysis patients.

Today I met patient C who share similar conditions which is very rare as mine, also battle high blood pressure, and complications caused by residual urine function, etc. Our difference is my kidneys are diminishing while his expanding. He already had his right one, a 45cm football sized kidney taken out. His left one is now 47cm and still growing, both fill his body up and squash his intestine one way or the other.

Within the past 3 years his arm were operated on 5 times and had almost as many fistulas which started from his wrist and today he is dialysing through the top of his arm. His lower arm is damaged suffers from numbness and pain.


The good news is that his cancer (his other problem) is now dealt with and he is on the list of kidney transplant, and he has a large supports , a troupe of contingent bulls 400 strong who love him dearly, C, the beef farmer.



Tuesday, 8 July 2014

Haemodialysis Risks – Fluid Removal Method

Tuesday 2014-07-08

The pace and amount of fluid removed from a patient is simple and yet risky.

On Thursday, July 3th I went to the training centre and R was the only patient there. The nurses had forgotten that it was my day of the week and were surprised seeing me. As I only made the room half full, I was settled-in in no time.

R (see myblog Monday, 2014-06-16  DialysisRisk—Fresenius 5008 ) told me he spent the last 10 days in hospital. It seems that after months coming here strapped up with the flashy Fresenius 5008 to reduce his weight, and after numerous times of fainting here and in the clinic on and after dialysis, and a few times of strapping with oxygen masks, his formerly by-passed heart could take it no more. One day while on dialysis here in this centre his heart finally gave in and he was sent by ambulance to the mother hospital M where he stayed for 10 days allegedly for heart trouble.

When asked about his 12kg + excess weight he replied that it was all gone. He did dialysis everyday for 5 hours for 10 day while in hospital.

Hospital M doesn’t have F5008S, what they do have are the regular F4008S (BVM-lie detector) which is just one scale better than the F4008B I have in my home. What they did there was very simple. Some doctor ordered 2.6 litres was to be taken off from him each day. My interpretation is this, R was allowed 800ml of fluid each day, on dialysis he would take on 500ml which include 200ml drink, 300ml saline going on and off the machine, together that make up to 1.3 litre, double that to 2.6 litres which is the amount doctor prescribed.

10 days later, bang, his fluid was all gone. R was a happy man again and out of the hospital. The benefit of removing 2.6 litres a day is obvious, the speed of fluid removal allowed ample time for the excess fluid to move from extracellular into blood vessel without dehydrating the patient which causes unnecessary fainting spells thus endangering the patient’s life. Gradually in a steady pace the weight came down.

Everything was so surgical, mathematical and yet so simple. Another contributor is that in hospital a renal patient’s fluid movement is closely monitored, anyone who has been to the renal ward knows how strict the nurses can be in handing out drinks and recording the urine output, they follow instructions to the letter.

Now that R  is back, I saw on the F5008 the UF was 3.9 litres (RISKY) for 5 hours and he was due back again the next day on Friday, Saturday and Sunday the centre closes, and his machine at home is been checked out by our technician. R is back to his old routine including the help he gets from the nurses at the training centre.

Again the nurse was preaching to him about the benefit of longer hour dialysis and enquired about the length of R’s sessions at home. His answer was evasive.


By the way, R’s diet is mainly fruit than anything else except some noodle soup and ice. I wonder how he can survive with such a diet, after all R is a guy of 88 kilos. If both he and the nurses at the centre were back to their old way, I remember at one cession that R wanted taking off 4 litre at one go and the nurse chose 3 litre over him, provided these continued I would imagine that his next tune-up is either 6 months or 10kg whichever comes first. For now things are looking up, I heard there’s a baby on the way. Until next service, so long R.