any suggestions for undue bleeding after the needles are pulled. my wife has been having real difficulty with this especailly the arterial site. today it took her about 1 hour before the bleeding stopped. a friend was assisting with the dailysis. tom daggett
Perhaps too much heparin? Maybe she needs her heparin adjusted…talk to her Doctor about it…
Hi Daggett dad,
Too much heparin can be the problem.
Is the access a fistula or a graft? In a graft, especially, if it has been overused in one spot and the previous needle holes are too close together, you can get bleeding after treatment that is hard to stop. In some cases, the graft can rupture, which can lead to severe bleeding. So, if the access is a graft and it’s more than a few years old, it may need to be replaced.
thanks for your reply. she has a fistula, not a graft. would think it is not the heparin as her venous site clots off quickly unlike her arterial. keep your thoughts coming though. overall, we are very happy with the NX machine.
I found out, after several post-txs which took a long time to stop the arterial bleeding (not an hour, however), that putting too much pressure on the site while trying to get it to clot could have the reverse effect. This only happened on my arterial site.
I don’t know why this is true - it seems counterintuitive to me - but it was true. As soon as I stopped applying so much pressure on the site while I was waiting for it to clot off, the excess bleeding time stopped dramatically.
It’s my understanding that aside from Heparin it can be due to a problem with the access itself and so I recommend mentioning the problem to the neph… It may have to be evaluated at an access center. Lin.
Are you using buttonhole method or still using sharp needles? Is the arterial side more tender, or perhaps is shiny and very bumpy? If so, it could that the surface has gotten thin from too many needle sticks on the same spot. so its harder for it to clot correctly…just assuming.
P.S. Glad your enjoying your NxStage machine… 
I wouldnt be asking about these sort of problems here. Why didnt you ask one of the nurses while it was happening? The best time to be asking questions, is when the problem is in their face so to speak.
You need to take this up with your dialysis nurse. Whether one site stops bleeding fine and another doesn’t is not necessarily relevant in terms whether she needs her heparin dose adjusted and/or stopped earlier before the end of treatment. I had this problem early on when I started home hemo. It took a few weeks of trial and error with heparin adjustments. My arterial site was the bleeder, not the venous. For me, it was because the arterial one pulses a lot more due to being closer to where the arterial-venous connection is.
Pierre
I think that asking questions such as this here is a very good idea. Because once other patients have told of their experience and solution you can then discuss this with the nurse or staff. It can just happen that what a patient has mentioned here is something the nurse or nephrologist hasn’t thought of when thinking about a solution to the problem. By bringing it up it can trigger their memory. So I would definitely ask the question here but get confirmation on what to do from the nurse or nephrologist.
Marty, I’m sure you didn’t mean to make me laugh but you sure did, when you said “it may spur their memory”. Time and time again I would ask staff about things I was sure they knew about but they would play dumb, unless and until I repeated the question using specific jargon I learned from the internet and other pts… when they realized they couldn’t play dumb had to help solve a problem. Recently I had this experience again, being told that if I was getting sick after going home from tx. it must be me. I’ve been told this so many times in the five years I’ve been in center I can’t count them all. Apparently I can now make myself sick, but only on tx. days hmmmmm! Good advice Marty! Lin.
LOL, Yes the word is pro-active. Dear Lord, If I didn’t ask questions, compare notes on this site and others I would be dead by now :shock: Our nurses and nephs need more e.d.u.c.a.t.i.o.n.!!! We wouldn’t be here searching for info. if dialysis staff were fully competent.
I dont discourage these questions here. I just think it should be taken up with the doctor or nurse first. We are not doctors. We do have alot of experience, but we are not qualified. Some people may post the wrong information, which could lead to trouble for that patient asking the question. Sure we can advise, but I wouldnt want people using this forum as a substitute for seeking professional advice.
Remember, your fistula is your lifeline!
Jane if you feel the staff to be incompetent then ask to talk to someone else. Or are they all dumb? :roll: Surely if they were that uneducated then they shouldnt be employed. Just because you are a nurse or doctor doesnt mean you know everything about anything. Medical staff are continually learning throughout their entire career. If you dont get an answer about something, then keep asking until you do.
The nurses who work where I trained for Dx are fantastic and very knowledgable, but obviously there are things they may not know. If something only happens to a handful of patients, then not everyone is going to know this. Not every doctor or nurse has come across every single renal related problem. I am finding this out more and more over time. A couple of times Ive been in hospital and I have overheard doctors talking about this. What one may have come across, others havent.
Amba_79,
I don’t know how it is in your country, but in the U.S. most dialysis staff are trained in a very brief time, as little as 2-6 weeks. There are no standards which require dialysis staff to have an indepth understanding of how to deliver a dialysis tx. nor to understand the theory behind it. Someone with only a high school diploma or G.E.D can become a dialysis tech. No college courses are required. The focus of their training is to simply teach them how to get patients on and off as efficiently as possible. We also have nurses in dialysis, but they, too, get the same brief training.
I am not saying that dialysis staff are incompetent. Almost every single dialysis staff I have known was a hard working person. The problem is, in many cases, they don’t know that their training was incomplete. The brighter ones have told me they do know their training was incomplete. It is not their fault that there are no standards for more indepth training.
The nephs generally don’t understand how the machine settings affect the patients. They come in the unit for rounds and if a patient says he is being hurt by the txs. the neph orders the dw up. This may not be the problem, but seems to be the only thing some nephs adjust. In the first place, even if that was the problem, the neph is not there for an entire month or more in many units and the patient is hurt repeatedly. The patient may need an adjustment every tx., but the neph is out of sight out of mind. It is of no consequence to him if his patients are being hurt. This is the way a lot of nephs handle things. Even if they round once a week, the same situation occurs as it takes knowing the machine to be able to make appropriate adjustments.
Nurses and techs either keep patients fluid overloaded, not knowing how to properly assess their dry weight and goal, or patients cramp. The neph has assigned a dw and they think that the patient is supposed to come back to that dw every time. If this wasn’t so sad it would be funny. They act like they will get in trouble if they don’t land the patient directly on his assigned dw.
Educated patients don’t ask questions on net groups in place of speaking with their neph and staff. When we see that our neph and staff don’t know something, we search further for the answers. And just because someone says something on the net it doesn’t mean that we blindly believe them without checking things out. Nephs and nurses say inaccurate things sometimes. Educated patients must double check what they say, too.
Educated patients do not look only to this board or the net to give them their answers. Like Marty said, we share our experiences and this often gives us something to approach our neph and staff about.
I wasnt aware that the training over there was so poor. I wouldnt want them going near me. Glad I can do it myself.
Jane, what do you mean by “a patient is hurt by the treatment”???
They are right in thinking you should be reaching your dry weight each treatment, as long as your actual body weight hasnt changed. If its only 100ml over or under then thats no big drama. If you arent acheiving close to your dry weight then either their machines need cleaning (this is the case for mine anyway), or their calculations are wrong.
Amba, I am taking it for granted that everyone who does their own dialysis has brains enough to talk with the Nephrologist or Nurse before following the advice of patients on this forum. It is good to have the advice though as I said there maybe a solution here they forgot about.
A:
I wasnt aware that the training over there was so poor. I wouldnt want them going near me. Glad I can do it myself.
Jane, what do you mean by “a patient is hurt by the treatment”???
They are right in thinking you should be reaching your dry weight each treatment, as long as your actual body weight hasnt changed. If its only 100ml over or under then thats no big drama. If you arent acheiving close to your dry weight then either their machines need cleaning (this is the case for mine anyway), or their calculations are wrong
Yes, training here is very minimal. They train em real fast and throw em right out on the floor. Some techs are not suited for the job at all and we don’t want em coming near us. My current unit is such a relief as most everyone does a good job…just one or two that aren’t dialysis material. Nevertheless, home care is always the best option as even the good techs/nurses have bad days and get distracted.
One has to always protect his access, double check the set-up and monitor the tx the entire time in-center. Patients get hurt because staff don’t have sufficient training on assessment for dw and goal, or they rush and make tx errors in setting up the tx and maintaining it. They do not have an indepth knowledge of how to deliver txs so patients are put on a one size fits all type tx which can not be comfortable. As you know, if the tx is inaccurate in any of these areas, patients cramp and get sick.
Yes, we want to come to our dw each tx, but dw is ever changing and proper assessments must be done on a tx by tx basis, not a whenver the neph shows up schedule. Most techs have very poor assessment skills, really they just skip it, patients are not educated to particapte in their assessments and the nephs are absentee and could care less. This is not professional and I know because I see it every tx. Instead of FRIENDSHIP DIALYSIS or other of the names they are called, they ought to name units SREAMERS AND CRAMPERS DIALYSIS lol or TWILIGHT ZONE DIALYSIS. Of course, then they wouldn’t get too much business lol.
Re assessments- at a recent tx my tech asked me the usual, “Do you have diarhea or constipation?..I bet you get tired of hearing that?” Me-“Yeah I’ve heard it 3x a week every tx for 8 yrs” Tech, “We get tired of asking it”. And the thing is, if we told them we had a pile of diarhea out the door it wouldn’t matter as they just record it and don’t know how to assess what to do about it anyway lol. Dialysis- it’s a trip :roll:
Jane, If I understand right it’s called “putting two and two together” and I think sometimes that is something that perhaps can’t be taught, as it relates to common sense. Example: I don’t have a need for any fluid removal yet, and my weight fluctuates as much as two or three kilos, always has. The neph. is aware but is not concerned so my dry weight stays the same on my chart. The other day a tech. I have at least half the time asked me how much I wanted taken off and I said the usuall which is 500cc. She turned to me and said “but you’re over your dry weight”. I’ve been under and over so many times I can’t count but she still had to point it out and look puzzled when I told her it didn’t matter. She had recently passed a certification exam but still didn’t understand why a person who has effectively no dry weight was allowed to go over it.
When you are your own pt. you must be better at it because you are the only pt. you have to learn about, stick, ect… Even with all the training in the world there are things that staff can’t be expected to know; no one knows how you feel! CNN’s know the most and even so I’ve had to explain a few things about myself, in particular pkd because it’s so different. The best nurses I’ve had take the time to ask telling me if they get another pt. with pkd they will know more. My favorite nurse is the best; she was an aide before going to nursing school and is now a CNN. I hope I do as well as her taking care of myself. Lin.
This is sad to say, but honestly - after diayzing for a couple of years at my home clinic as well as dialyzing as a transient patient in about 5 or 6 different clinics - not one nurse or tech that ever worked with me blinked an eye based on how I repsonded to their pre-tx questions. Sure, they made a note of it on their flowsheet for that tx, but whatever I said elicited no response from them. Taking off a lot of fluid that tx? OK. Want the temp set to a certain degree? OK. Had problems with my bowels since last tx? OK.
I have heard other people mention how their tech would try really hard to make sure they reached their dry weight. The only response I ever got related to how much fluid I wanted to take off was whenever I asked for a lot in one tx (like 6kg or something). If they made any comments about it at all, they would ask me if I my body can handle that much. I knew it could. so I told them it could and they were fine with it. It didn’t really matter where the amount I took off was going to leave me in relation to my dry weight. I felt like, to them, my dry weight didn’t even exist.
When was in-center for awhile and I was learning more and more about the tx variables, I found what worked best for me. I would almost always have to walk my tech/nurse step-by-step through everything I wanted set for my particular tx (goal, UF profile, sodium profile, etc…). Some of them didn’t like the fact that I was asking them to set the machine up a certain way for my tx. Some of them, in fact, argued with me about my wanting things a particular way. It made me sad because after a while, most of the techs at my home clinic didn’t really want work with me anymore because they felt like I was telling them how to do their jobs. But I wasn’t. I just knew how I liked the machine set-up for me to get the best tx that I could, and since they would never ask me how to set the variables - I usually had to tell them that I wanted things set this way.
It wasn’t like I went around bossing around anyone who worked with me, I just had to take some of the specifics of the tx into my own hands because most of them either didn’t know enough to ask me what I would like things set at, or they just didn’t care enough to ask.
It really did upset for awhile. Eventually, though, I got over the fact that there were quite a few techs that didn’t like working with me. You know - it is my life they are screwing with when they are the person responsible for my getting that tx.