Haemodialysis Risk, AVF and Needle Size

Thursday   2014-07-24  

Last Thursday, 17^th 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.