Cannulation problems resolved, or Stuart Mott: Fistula Whisperer Redux

TL:DR

Stuart Mott: (573) 826-8237

If you’re having problems cannulating, CALL STUART. If you are wondering if you should contact Stuart, and how, stop wondering and CALL STUART. Now. No, Really! Call him: (573) 826-8237


I started training for home hemo in January. From the start, we had issues with my buttonholes, even my nurse in the training center. The blunt needles just didn’t want to go in, so I ended up using sharps for about a month. My training nurse was able to bring in another tech that had many more years’ experience and she was able to get the blunt needles to go in, but it was like putting a screwdriver into a garden hose. When I tried it, it required so much pressure that when it finally went, the needle went clear through and I infiltrated.

A typical dialysis session would begin with 30-50 minutes of trying to get the blunt needles in. Sometimes (rarely), they would go in like a toothpick into a warm stick of butter – this is how it’s supposed to be all the time. Most times it would be like putting a toothpick in a water balloon. A little more pressure, but it would go. The problem is, it would take forever and a day to find the “right spot.” Something had to change.

I had stumbled across this forum early on in January, but could not find any contact information for Stuart, despite seeing posts saying “call Stuart”. Also, I was reluctant to go outside my medical team. However, in in late June I finally got fed up with the lack of answers from my medical team, found Stuart’s e-mail address and sent a plea for help. “Call me” was his almost immediate reply, with a phone number. I called and now wish I had sooner.

Stuart explained that 1) the Nipro blunt needles I was using are too blunt and that there is a company that started making sharper blunt needles at his request 2) that my buttonholes are probably stretched and deformed from poking around so much, 3) the walls of my veins could just be too thick to use standard buttonhole blunt needles.

Stuart got me in touch with the new needle company and they sent me a week’s supply to try out. Unfortunately, the new JMS Harmony needles did not work any better than the Nipro needles I had been using. The needles just slid across the top of my vein, even using a 45% angle of attack. This led Stuart to believe the problem probably lie in #2; my buttonholes were stretched out of shape. So, for the next two weeks, we used sharps in the buttonholes, using Touch Cannulation to allow the buttonholes to heal.

At the end of the two weeks, we gave the JMS Harmony needles another try. In the meantime, Stuart suggested getting another ultrasound of my fistula, which I did. He wanted measurements of the vessel wall thickness, but whenever I mentioned this to my nephrologist and the ultrasound tech, they just stared at me like a deer in the headlights. My nephrologist didn’t really think it necessary and the tech had never heard of it. In the end, the vascular Dr that reviewed the results with me said my veins did look very thick.

When trying the JMS Harmony needles after the 2 weeks with sharps, I still had the same issue: the needles would not go in the veins and would just slide over the top.

So, it turns out that I am in “the 5%” of people with super thick veins that cannot use blunt needles and that need to use sharps in the buttonholes. Stuart kept asking whether I’m a construction worker or if I work out. No, I’ve been in IT for more than 20 years and I do not work out if I can help it. I guess I’m just blessed with thick vein walls.

I have been using sharps in the buttonholes now, using Touch Cannulation, for about a month and cannulating now takes me about 5 minutes compared to the 30-50 minutes it took previously. I’m also now using the scrubby pads for cleaning my access, only, I need to soak the buttonholes for about 40 minutes prior and still need to scrub 30-40 times to remove the scab. Still better than using the worthless plastic forceps and scab pickers supplied with the needles.

After all the time he spent and all the help he gave me, the only thing Stuart asked for in return was for me to spread the word, give out his contact info and to keep track of the number of times I cleaned my access with the scrubby pads so he can keep a record.

I cannot thank Stuart enough for saving my sanity…and my arm. He really is a Fistula Whisperer.