Monday
2014-08-11
I need a
fistula for haemodialysis access.
First they
said that my left arm was no good, too many branches, my right arm became the
chosen one in spite of my right-handedness. Operation day Oct 31st 2013
surgeon S was grinning seeing my fat and straight vein. After operation access
nurse M commented how beautiful my fistula was each time she saw me until an
ultrasound was done.
Then they
said the anastomosis suffer from severe stenosis and furthermore there were
branches siphoning off blood flow. I thought my left arm was the one pestered
with branches. A turndown which was to open up the narrow bit and, ligations
was arranged for me. The branches were duly nipped including a ECG shaped branch which was the product of the narrowed anastomosis, but the turndown never
happened.
After ultrasound this time access Dr. Y, when he saw me on April 30th dismissed my concern about the high velocity of blood flow saying, “Velocity, never mind velocity, the flow is good. The fistula is beautiful. Don’t worry about velocity”. Access nurse M chanted the word ‘beautiful’ with him repeatedly.
Ultrasound after second operation
After ultrasound this time access Dr. Y, when he saw me on April 30th dismissed my concern about the high velocity of blood flow saying, “Velocity, never mind velocity, the flow is good. The fistula is beautiful. Don’t worry about velocity”. Access nurse M chanted the word ‘beautiful’ with him repeatedly.
Ultrasound after second operation
Dr. Y
decided my upper-forearm was ready for action immediately, the lower-forearm
where 2 scars were, beneath which the vein felt taut and rolled under the
finger tip, could be needled in 2 weeks, even the upper arm one day could also
be used. Nurse M agreed with Y totally.
The
upper-forearm was needled first. However, my vein is very shallow, and this
segment is crooked nick-named by nurses as ‘dog leg’ and got punctured easily.
Nurses ventured downward which turned out to be even more difficult.
Beneath the
scars the vein not only still stay taut bouncy as the palm of a cat’s paw plus
a strong pulse, had also grew wavy like a zigzagged ECG chart (repeated dog-legs), however this
time the ups and downs are half as many as the branch which was ligated
previously. Before the ligation both veins shared the blood equally from the
anastomosis, after the creation of the fistula, one of them turned crooked
first and got nipped. Beneath the scars the vein used be very straight which
turned crooked only after the ligation. The high pressure unchecked will have to go somewhere and do something anyway.
Finding a
suitable needle became a problem, the needle which is good for me short and
thin was not available, as the nurses put it ‘there was no such demand’. See: "Haemodialysis Risk, AVF and Needle Size" . What are
available are the ones either too long, puncture my vein easily or; too fat, making a
large hole causing blood gushing out and running down my arm, not to mention
longer holding and healing time. Catch 22. When the nurses see me their blood
pressure rises.
15G Needle, blood gashed out
long Needle 25mm, punched through.
Remember
‘operation turndown’ which never took place, the anastomosis remain severely
stenosis, pressure inevitably building up at the narrow bit, when blood unleashed
through the bottle neck, it was with power and force, thus created a
treacherous torrent with twists and turns and also made the vein taut and hard
with tension trapping every scared person who does the needling.When you
Cut off one
crooked vein another will popped up.
To reduce
the pressure of blood off the anastomosis and return the vein its softness and
straightness and prolong the life of fistula, at the same time make it easier for a needle person such as myself who is
right-handed trying to learn needling with a clumsy left hand,the narrow bit must be opened up. Anyway this
is only my uninformed opinion, what do I know being a small patient. As I’m no
surgeon, the decision is not mine to make.
On Aug. 6th,
I went to see access Dr. W carrying nurses’ message that there were limited
space in my arm. Solution was easily found, the forearm was too dangerous and
space too limited, just forget about the forearm, we still have upper arm. If
it is not broken why fix it. Dr. W, the surgeon who decided on the operation
table that the turndown was not necessary, kicked the ball from his court to me
and the nurses offered my upper arm to us and chanted along with access nurse M
just as Dr. Y did previously that my fistula was beautiful and my blood flow
was good while both ignored my concern about the high blood velocity, the potential
shortened fistula life and the difficulty of a wrong handed needler.
I wonder as
this is the pathetic fate of my right arm fistula, why the left arm was not
used. That way at least I would have a usable right hand. Now I’m doomed with a
troubled fistula and a wrong hand need to learn doing things from scratch.
I remember
on March 24th for transplant reason I saw associate professor J, the
number 2 boss of nephrology department, when he learned as a right-handed person
my fistula is on my right arm, he blurred out “They didn’t even try the left
arm”? Obviously his foot surgeons have much catching up to do technically,
ethically and morally.
- Haemodialysis Access Conundrum - Fistula Turndown and Ligation of Branch- Haemodialysis Fistula Repair – Branch Ligations and Effects of Anaesthesia
