They can see how it works, but, they are concerned about the risk of contamination. While I was on dialysis today, I tried to see just how possible it would be to do this. With my upper arm fistula, I would not have enough arterial needle line length to be able to do this. It’s too short to comfortably reach my hand. Because of that, I remove my own needles by attaching a scissor clamp near the end of the needle line, so I can grasp one of the hole with my thumb and like that, pull the needle out.
Pierre I am a self dialyzer also with upper arm needles. My needles have at least 12" of tubing attached so there is no problem doing this with them. I even have a longer venous needle which is a real special order, (I would think you would have more trouble with venous since it should be above the arterial). I believe they are experimenting with manufacturing them, but I’ve had them for 5 months. My fistula is in my left arm, I hold the site with my right hand and remove the needles by pulling on the tubing with my left hand. FWIW I can get both sharp and dull/buttonhole needles with the long and longer tubing.
I leave both needles in and taped until all blood is returned, then I reconnect the dialysate lines and start the acid rinse. While the acid rinse is going I take my needles out and then by the time it is done (I clot quickly in spite of using 7.8cc of heparin in 4 hours), the acid rinse is finishing up and I reconnect for the heat disinfect and do the clean up.
Finally, I am sure if they consult with Fresenius they would be happy to train them in this method. It sure works well for me as a self dialyzer and someone who thinks the risk of contamination is much less than the risk of getting air.
My nurse said they would figure something out. It’s not really a priority at the moment. I’ve got all I can handle learning and practicing responding to alarms and emergencies
One nice thing is I’m off BP meds already! I was only actually on one, but it sure is nice being off it.
Pierre – maybe you could change tubing to solve this problem. We have just started home hemo on the 2008 K – but started training on the H machine. The tubing is different. On rinse back, we are currently discarding the arterial blood in the needle tubing. We connect the arterial blood tube to the saline line and it rinses back the arterial and venous all at once through the pump, etc. I do want to check with the nurse on getting even that needle tube blood returned via the syringe method Cathy described. Guess really we are doing the same as Cathy except using the syringe to get the needle arterial blood.
In case it wasn’t clear I store the “filled” syringe on the IV tubing line where I fill it to one keep it where I can’t lose it and two to reduce chances of contamination.
I’ve only been on dialysis 6 months, but so far haven’t suffered from any contamination. (knocking on wood).
Well, this week, week 3 of my training, we tried applying pressure on the saline bag by means of a pressure cuff. That didn’t work at all. Both times we tried it, I pretty much ended up having to discard the blood in my arterial bloodline. My blood backflows by shooting right up into the saline bag the second the clamp is moved on the saline T.
Next, we will be looking at a solution along the lines of what has been suggested here. My only problem with that, personally, is that my needle sites are way up on my upper arm, and they just aren’t long enough that I can manipulate the connectors very easily. It might take me so long that I might loose my extracorporal blood anyway.
Well, the nurses at my training centre are finally going to try your method of returning all the blood at once. Anyway, we will see how it works tomorrow. Thanks for the tip - it made me look pretty smart
They are also sending me for a fistulagram, just to be sure there’s no stenosis there causing a higher pressure at the arterial needle site.
Pierre – in-center training, we used tubing just like they always had there for the H machine. But once our supplies were shipped to our home, the proper tubing came in that is designed to work with the 2008K just as Cathy and I are talking about. It is called a “combi-home hemo – 8mm pump segment, supply # seems to be #03-2962-3.” It is exactly what the instruction manuals for the 2008K go by – (instructions don’t exactly match the in-center supplies). Also, we have found a few glitches in the instruction book – the most important being that the machine will not pass it’s tests if you go ahead and connect the transducer protectors and put the tubing through the optical detector. You just have to remember to do these before hooking to patient. We are definitely still learning and working through the transition to home. Hoping the stress will ease soon and everything will fall into routine. With the proper tubing and perhaps the longer needle tubing as someone suggested, hopefully your probs will be solved.
Thanks for that Joanne. I’ll watch for tubing when I start at home. I’m in week 3 of trg, so, it should be at least another 3 weeks. However, today, we did try the method of rinsing back all lines at once by connecting the arterial blood directly to the saline line, and, it worked great! It’s a piece of cake, really. My nurse did the procedure today herself to see how well it would work. Another older nurse there watched, and she said that’s how they used to do it anyway. Now, tomorrow, we’ll see if I can do it fast enough myself - the needle lines aren’t easy to disconnect from the bloodline because they are so short. It has to be done like that, because there’s no way I can rinse back my arterial bloodline via gravity without someone applying a lot of pressure on the saline bag.
For now, the problem seems to be solved thanks to the fine people on this forum.
I use Medisystems needles that are 300mm (12") by 3.3 mm LD. Code BH-7005 for the buttonhole. They make the same length tubing needle in sharp Code D-9 7005. From needle base to connection it is 12". I also use Code 04-009D (buttonhole) and 04-009-8 (sharp) that are an additional probably 4" longer. With these needles you will have no problem doing your connections, as I can do both my arterial and venous with the shorter ones (both upper arm with the venous maybe 3-4" from my shoulder. The longer venous helps but isn’t necessary.
Glad I was able to help. If you have any questions, please feel free to ask, we can all learn from each other!!
I was glad I could help Pierre, people here were so helpful to me when I first started and as I have had some minor problems. This is a very helpful place!!
Here’s an update on my situation (see the original post in this thread).
The method of rinseback which Cathy suggested works great. The only downside I see is the extra manipulation and disconnection of lines with blood in them - and hence the possibility of mishandling and eventual infection. But it does rinse back the blood very easily. Yesterday, I did mishandle it badly when I disconnected the arterial bloodline from the needle line while the needle line was still unclampled. I was sure I had clamped it, but obviously I must have forgotten it. Blood started gushing out as soon as I disconnected, of course. Luckily, I realized my mistake quickly and I didn’t lose much blood. I still feel pretty stupid this morning though!
Yesterday, I had a fistulagram (my first one, after 2-1/2 years using my fistula). It appears the reason I can’t rinse back the arterial blood line via gravity only is because I have a fairly severe stenosis a little above the area where my needles go in (on my upper arm fistula). This is exactly what my training nurse thought in the first place. It’s something they will have to fix. By the way, those fistulagrams are quite painful when they inflate the cuff above the fistula.
Did I hear gushing, oh no! That’s my net nickname, Gusher…hehe, anyway, when I first started Home hemo way back with the older machines one of the biggest mistakes I did was inject myself with Lidocane (numbing medicine)…heck, my face turned white… :o …my whole body felt WEIRD and seemed like passing out…anyhow, as soon as that happened I reacted quickly by infusing saline to dilute the strength I had…well, glad it worked and was relieved…learned my lesson there…never think about anything else other than your therapy… :roll: …
Speaking about those fistulagrams, it’s a nightmare!! :shock:
