I come from a family of natural redheads, even though I myself do not have natural red hair; I still have the typical redhead’s complexion, and my vascular surgeon knew what he was in for when he got a look at me. He was not at all surprised to find out that my veins are small and spastic, as is apparently typical of redheads, and that they’d collapse and hide as soon as he tried to do anything to them. I had an AV fistula put into my left forearm (I am right handed) two years ago last month and it’s taken the entire two years to mature to near-usable status. I’ve been on PD the entire time so I had the time to let it mature. Now it’s time to cut over to home hemo, but before I can, I have to get my fistula developed fully and in use, so I’ve been on PD four nights a week and going in center for hemodialysis three days a week for almost a month now to get my fistula in use and to develop buttonholes.
In addition to being small and spastic, my veins roll dramatically, and my fistula is only near the surface for a short length, diving pretty deeply after that to deeper than they can reach with a standard needle. So far, only one tech has been able to put me on at all, and even she’s infiltrated me twice. She showed someone else how to put me on and when he tried, he infiltrated me promptly. On all of these occasions, I went home and just did PD that night. Because there’s only the one person who can put me on, and because I’ve been asking to learn to self-cannulate, so although my buttonholes are not at all established yet, I took a gander at it on Friday with her hand guiding me. I promptly infiltrated myself and could not run at all on Friday, having to spend the night on PD again instead.
What is the best way to learn to self-cannulate when we are not to the point of being able to use blunt needles yet? I was supposed to start learning when we went to blunts but my buttonhole channels are not nearly developed yet. How long does it take to get them developed? What do you do when your veins roll and literally hide if poked? How do you overcome the psychological effect of knowing what’s coming if you’re self-cannulating and you suspect that that effect is causing your veins to collapse, roll, or hide? What do you do about an unusually-deep fistula that’s still in a new state, having only been used for a month or less and never at a flow rate of greater than 350? I am anxious to get into home hemo training and then back home dialyzing where I should be, but I am concerned that I may not be able to self-cannulate with any great degree of confidence with my veins being how they are.
I should add that even to a professional tech, cannulating me cannot be done with just a tourniquet. It’s not adequate to the task. Instead, she uses a manual blood pressure cuff on my access arm, just above my elbow, and inflates it to about 90. That stabilizes the access enough for it to be cannulated. She has recommended that I purchase one for my use at home.