Once you are all taped up with the needles and fall asleep are you able to go from side to side or on your back without causing alarms. I know with dad’s catheter he can move anyway he wants to and we don’t get alarms. Are needles more restrictive in movement?
Hi Marty
This is a question I get asked a lot by people I talk to about nocturnal hemo.
I have never dialyzed with a catheter, so I can’t compare personally, but the answer is no, it’s not a problem dialyzing with a fistula.
My needles are in my left arm (upper arm in my case). I can sleep on my back, of course. I can sleep lying on my right side, with my arm either lying on top or crossing over. I can lie on my right side more on my stomach, with the bloodlines crossing above my body. I can also lie on my left side. However, when I do lie on my left side (the side with the fistula), after about 30 minutes, my hand gets numb. Oddly enough, needle pressures remain unaffected even when that happens.
Unless I place my needles carelessly or tape them down too tight, I have no alarms at all during the night. Movement during the night is not enough to trigger any pressure alarms. Once I’m on and I’m done with logging, etc., I press override as I lie down. This overrides the pressure alarms and TMP as the pressures settle down, and then they remain pretty much stable like that all night. Sometimes I might get one alarm after the first 10-20 minutes as the pressures stabilize, and then no more. With my blood pump running at 300, my arterial pressure is usually about 100-110, and my venous pressure is about 110-120. This compares to pressures around 180-190 when I do short daily and run at a blood pump speed of 400.
People always find it hard to believe a person can sleep while connected like this to a hemodialysis machine, but, as I’ve said before, you quickly get used to it.
Pierre
everytime i flip the arterial but never the venus
Terry, have you tried a “pillow” for your needle? Sounds as if it might be close to the top of the vessel. Take a gauze and fold it in thirds and put it under the tabs prior to taping down and see if this helps. I have one buttonhole (out of 4) that needs a “pillow”. I now make them and tape them up so they are reuseable.
Cathy
self home hemo 9/04
You mean the tiny pillow, or 2x2 gauze folded twice…its something I use and need to use or else the needle just tends to stick to the wall causing high pressures…very common…
Same here. The nurse used one or two 2x2’s under each needle right from day one when I first started dialysis, and it’s been the same with buttonholes. I sure wouldn’t re-use them though! They go into the garbage. Besides, they are well stuck under the Tegaderm after use.
Pierre
I have trouble removing the tapes and thus getting my needles out if I don’t wrap the pillow in tape. The tape sticks to the pillow making it nearly impossible to free the needle with one hand. Works for me,
Cathy
Hi All,
The only time that my husband had a paroblem was just before Thanksgiving. Thought his Fistula had Stenosis and went for a fistulagram. They ballooned the venus buttonhole area. Thought that would take care of it. But 2 weeks later his arterial just bottomed out. I was on the phone with the nurse til 11:00pm. We than just bagged the night. Ralph went into center the following morning at 7:00 am. They were able to dialyse him fot 4 hours. They also took a test with blood being drawn from both the arterial and the venus at the same time.
The results were that he was only being dialized at 51% NOt A GOOD THING. Thank GOD for the nurse I was on the phone with the night before because she insisted that an other fistula gram be done. (Radiologiest was giving her a hard time and said we needed to sere the surgen.) Well we went to the sister hospital and the radiologist there was wonderful. They fistulagramed the WHOLE arem. (Hubbies fistual is in his upper left non dominate arm.) He found that Ralph had a very very narrow area (stenosis) in the elbow area causing the arterial to not work properly. He was just recirculating tlhe toxins. He was feelin pretty awful for about 2 weeks but once the balloon was done at the elbow and he hot the right diallysis. Things improved 100%. However the second day of dialysis after the elbow balloon catherization his BP bottomed out and I had to work fast to get his feet above his heart and get the saline in. It was a pretty scary time. We learned a lot!.
But he is now back to his old self. We thank GOD for every dsy. LIFE IS GREAT!!! :lol:
Pat
Just an after thought— If you have a fistula in your arm-- make sure they fistulagram the WHOLE arm not just the fistula!!!
Have a great day
Ralph
Dialysis 5/03
Nocturnal 6/04 and doing GREAT!!!
Cathy,
I’m always interested in learning about the little variations we all have in how we do things 
I learned my current method of rinseback from you! My nurses approved of it, but I would never have even thought of it if you hadn’t suggested it.
Pierre
Yep, this board has been a lifesaver more than once for me. I am glad to help out when I can!!
Cathy
Don’t you thinkl they learn from us more than we learn from them?..har har…jokingly 
Do most patients use Tegaderm to tape the needles?
Pat glad to hear you and hubby are back on track. Have you heard anything on how the Fresenius RO worked out?
Plain old tape and a gauze stocking for nocturnal down under. 8)
I use only tape, no stocking, no tegaderm and that would be the same if I did nocturnal.
Cathy
If you’ve ever done dialysis at a dialysis centre for any length of time, where they only use tape (partly because it’s cheaper, but also because it’s easier to reposition needles once taped), and if you’ve seen what can happen when a needle pulls out, well, let’s just say that there’s no way I would sleep through a treatment using only tape. It might be secure enough for a normal observed daytime treatment, but what happens with tape is that even if it doesn’t come off the skin during the treatment (and remember that a nocturnal treatment is 6 to 8 hours long - that’s a lot of time for moisture buildup on the skin under the tapes), edges of it catch on clothing, blankets, sheets, etc., and then when you move your arm, it rips the needle right out. This can happen even if the needle line is also secured. Sometimes, the machine might not alarm if it’s the venous needle (most likely to pull out, by the way), because the needle might remain pressing against the skin or something else, which might result in the machine not alarming immediately. In the meantime, a person could lose a heck of a lot of blood, and when you add being asleep to the mix, I don’t have to explain what the consequences could be.
I guess tape might be more secure if the whole thing is covered with a burn mesh sleeve, but for many people if not most, this would definitely interfere with the functioning of the needles.
In my experience talking with dialysis nurses over the past 3 and half years, most would prefer to use a Tegaderm on everyone even in-centre, but they can’t because of policy (higher cost if everyone used them). It’s so much easier and so much more secure.
Pierre
Pat C. writes:
He was feelin pretty awful for about 2 weeks but once the balloon was done at the elbow and he hot the right diallysis. Things improved 100%. However the second day of dialysis after the elbow balloon catherization his BP bottomed out and I had to work fast to get his feet above his heart and get the saline in. It was a pretty scary time. We learned a lot!.
But he is now back to his old self. We thank GOD for every dsy. LIFE IS GREAT!!!
Pat
Just an after thought— If you have a fistula in your arm-- make sure they fistulagram the WHOLE arm not just the fistula!!!
Thanks for sharing this experience and how you dealt with it. I would like to know re: patients who dialyze alone, if your bp should begin to bottom out, how are you trained to deal with it? Because as the patient, alone, are you always able to administer emergency measures in time? Can this happen when you are asleep on a nocturnal tx?
Hi Jane,
Generally they do not like to have you dialyise alone. What happened to my hubby was pretty unusal. When you train for nocturnal you are also trained for emergency situations. We did an inservice with the EMS that would handle us in an emergency situation. Thank GOD I have not had to call them. We are also observed at night by a group on the internet. Every thing is and can be monitored except the heprin. If something happens-they either call you or the EMT’S.
Nocturnal patients generally do not have BP issues. You need to keep a real close eye on the Dry weight and actual weight.
In Ralph’s case it was like he just started dialysis for the first time because the toxins had built up again. BUT we are back to normal again.
You know the old saying! Experience is the best teacher!
Pat
PS for Marty- have not heard about the Fres. RO. I will call and see what is up with that.
Pat
Pat, I know you have mentioned your husband is to heavy to go NxStage but I am curious what you think about this. If you were only going to use it on vacation wouldn’t it be just as good as going in-center 3x a week someplace. I’d like to see the Rubin have one to lend traveling patients.
This varies, but in my program, home hemo patients can train to do it alone, as I have. No helper is needed. I’m not necessarily alone, but nobody else there is trained to help me, and even if they were, they are sleeping through the nocturnal treatment too. I am not monitored remotely at all. This has been tried, but they decided it wasn’t worth the trouble. There’s a nurse on call and I know when I need to call her - and it’s hard to imagine any reason to do so after starting the treatment. If there was an emergency during treatment, I would simply call 911 directly, or press my Lifeline button. Lifeline knows I’m on hemodialysis at home, even if I pass out after pressing the button (Touch wood!)
Yes, those of us who do it are trained not only to respond to an emergency situation in a timely manner, but much more importantly, to prevent it happening in the first place.
First of all, we’re not talking about dialysis patients whose blood pressure tends to crash spontaneously. No such patients are accepted for home hemo, for obvious reasons.
On short daily, you are presumably awake, and the machine is set to check BP every 30 minutes (and you can check it any time if you want to). The rule is that if systolic reaches down to 110, you have to infuse saline to get it back up. So, if you follow the rules, you never get low enough to crash. You infuse 200ml saline, recheck BP. If it’s still too low, you infuse another 200ml. If BP is still below 110, you take yourself off treatment. If you don’t follow that rule, well then yes, you could crash alone and be unable to call for help.
On nocturnal, you’re sleeping. BP in only checked prior to treatment and immediately after starting the run. The BP monitor is turned off, and you don’t even wear the cuff during the night. Similarly, you have to take measures if BP approaches 110. You either resolve it, or if you can’t, you take yourself off. Nobody will “crash” with a BP of 110. For the rest of the night, there is no danger, simply because BP is very stable on nocturnal, given that it’s very slow dialysis and low UF rate. It’s not going to crash if it’s over 110 at the start. But again, we’re talking about stable patients here.
With nocturnal, it’s easy to gain real weight, and, if you don’t raise your dry weight, you will end up with lower BP. You can see this happening gradually over time. As long as you pay attention to this, and raise dry weight appropriately in consultation with your nurse, you won’t have any problems with BP which is too low. As a nocturnal patient, you have to be more aware of these things.
Pierre
gus writes:
Worsest scenario is when the needle clots needing to reinsert a new needle quickly…
When the needle clots is it usually a one time thing or can it indicate a more serious problem? Do most have 2 sets of buttonholes so the alternate can be used in a case like this?