Haemodialysis Risk -- Fistula Needle Shortage

Tuesday 2014-9-23  

Fresenius 17G, 20mm or 15mm fistula needle is a phantom rather than a description of a needle. It is unbelievable that I am the only person in whole Australia who requests such a needle. Months passed the official word is I am discouraged to have hopes ever using such a needle. I think I am being fed fibs. I am really puzzled by this situation.

The force of high blood flow velocity produced a wave of Ws on my arm with enough Ws to open a web site. By the way it is still developing the surgeon might even add the detail of the site name. Sadly with the straight section between each bend is all less than 20mm, I am still waiting for the needle which opens the web site. 

Currently I am using 25mm length needle (another puzzle for me instead of Fresenius’ which is our supplier it is from Nipro), half of which must be left outside, once it is taped and secured arterial pressure could drop from 0mmhg dramatically, the same goes with venous to the other extreme, very often this would render the machine unworkable. Not to mention the fact that when it does work I must sit hours still and endure constant pricking pain.

The surgeon said my fistula has good flow, which is quite true, but where on earth can I find the right needle for the bizarre shape. Last time he saw me, he suggested using my upper arm, the access nurse on his behalf called my training nurse and passed the surgeon’s message right in front of my face. On surface everybody is in unison.

Back at the training centre, the upper arm conversation seemed never took place, I was still taught using my lower arm. The fistula is bad, but it is the only vein I began to know. Perhaps the nurse shared the same thought not mentioning the upper arm. The irony is the one who prescribe where and how to put the needle does not do the needling.

For now my fistula is serving as a supplement to my catheter (perma-cath) than a life line on its own.

I hear there is still hope.  A plastic needle of some sort is under talks of being imported. I was told

that this is the needle for me.  Patience…

   - Haemodialysis Access Risk—AVF Creation and Accessibility
   - Haemodialysis Risk, AVF and Needle Size
   - Haemodialysis Fistula Repair – Branch Ligations and Effects of Anaesthesia
   - Haemodialysis Access Conundrum - Fistula Turndown and Ligation of Branch

A Dialysis Patient’s Daily body weight and Daily urine chart

One year since I started my dialysis life, some things changed and some did not. 

Note: Haemodialysis UF goal mostly  0,  before 14 Feb 14, since I was downgraded to use Fresenius 4008B machine,  UF goal setting is 20ml per session ( UF rate is 6ml/hour ), most of my dialysis sessions are  is about 3 hours.

The accuracy of the scale I used to weight myself is 50g (by the way, this scale is a gift from dialysis unit D),  24 Hours urine count after morning BW taken till next morning before taking Morning BW, Evening BW taken before sleep, my urine at night makes up about half of the total 24 hours urine.

7-day average daily body weight ( morning and evening ) and 7-day average daily urine chart

Daily body weight and urine chart

    

Note:  Dialysis Daily Body Weight and Urine Chart
           Dialysis Daily Body Weight and Urine Chart (Note) 
           Dialysis Daily Body Weight and Urine Chart ( 2 )

Heamodialysis Risk --- Catheter (perma-cath) & Blood Clot

Friday  2014-9-19

Heamodialysis access -- the shape of a catheter and the formation of blood clot

After dialysis if one smashes the caps on both end of a used dialyser, at the arterial side one very often will find a blood clot about 2cm in length half clear whitish and half dark blood red whose shape fits exactly the inside of the catheter that goes inside the patient’s body with the whitish part fits the tip end; at the venous end of the dialyser a clot is rarely found and if there were any, the clot is generally small which doesn’t resemble any particular thing or shape.

The part of the catheter that goes inside a dialysis patient’s body is a plastic tube, within which a plastic wall divide the round lumen into 2 semi-circular shaped tunnels with the partition wall in the middle extending all the way out of the lumen at the tip by about 3mm. At the end bit, the 2 semi-circular tunnel walls are cut diagonally making two 1cm slant openings, another centimetre down there are 2 diamond shaped small holes appear 180 degree apart, one at one corner of the 2 tunnels.

Whether the catheters are locked with 5000 unit in 5ml strength Heparin or 25000 unit in 5ml, in fast or slow push make no difference to the clot formed or not. The difference of fluid movement at the tip of the tube inside a patient’s body, the area around the 4 openings of the end bit of the catheter made by human speed in pushing in saline and heparin is negligible.

The heparin inside the lumens beyond the diamond holes downward is relatively stable, unless the patient moves vehemently and vigorously with force or bend downward which may lead to blood being filled into the entire lumen even tint the out of body catheter pink or dark red. For safety reason, when the catheter is dark, better relock again immediately.

How does the fluid inter-react with one another at the area around the tip end where the 4 openings are, is beyond me. One thing is clear with these many holes fluid at this segment is murky, heparin if there were any would be diluted. As it is mostly are blood which surround the 4 holes, I would say 

heparin has no chance at this last 2 centimetres of the tube where riddled with holes. Most of the time, the clot will always occur at this end of the catheter beyond the diamond hole.

With unlock the clot can be drawn out some times, other times the clot when not drawn out will simply end up at the arterial side of the dialyser. If the clot can be drawn out, I would use this side as venous, this way, I am sure the other clot if there were any would be caught eventually by the dialyser.

             

If both catheters are smooth and without sucking I would be worried as I have seen a clot in almost every dialyser. However the fact that I am still here today after a year on catheter it is more of a puzzle for me rather than a risk.

The nurses’ standard practice is if a clot is drawn out, they would further draw out another 3ml of blood which I fail to see the reason in doing so.