Growing fistula!

Hi Stuart,
I have been self cannulating for about a year now. I am on home haemo for about 8 months and it’s wonderful. My first lower arm fistula lasted approx 2.5 years (in centre 3 day week treatments), it clotted and I lost it. I am really afraid the same is going to happen again. However, I was not using any heparin whilst doing incentre dialysis, and now I am using inohep 2,500u daily. I am unsure of the correct medical terminology how to describe what the problem is, so bear with me please!! My arterial hole is 2 and a half fingers up from the crease of my elbow. An anuerysm has formed on the crease and is still getting bigger it seems. My arterial pressure started going uo, it usually was 160-165 and it went up to 180-190- over 200 which is too high on a pump speed of 420. I brought my pump speed down but a pump speed or 350 is obviously not going to give me as a good a dialysis as 420. I was using 2 short needles all the time. So I tried lots of different combinations of needles, and now I am using a long needle daily on my venous access, and alternating long and short needles on my venous access. This seems to be working. Unfortunately the nocturnal dialysis program which i have been pushing for is not going to happen until next Feb/March. I am afraid if the anuerysm continues to grow that the problem will reoccur. I know the problem is being caused by the changing angle of the needle, however small that is. When I suggested I create a new button hole in clinic last month, I was advised to leave it for now. I am very uneasy with that advice. So what would you suggest I do please?
This question might be for Dr Agar as well, not sure as this is you area of speciality. I suppose really I would value anyones input. Hope this is an understandable query! I can clarify if not.
I appreciate anyones time in replying,
Bye for now,

Sorry Stuart,
just to add I give my inohep 2,500 at the beginning of 3hr treatment into the arterial line. So it mainly primes the lines, not sure how much I absorb systemically.I never clot, and the fibres in the dialyzer are clear at the end of my treatment. The reason I didn’t have heparin before I started home haemo is I had a severe bleed as a result of high dose aspirin (300mg daily) in 1996, a few weeks post my first transplant.

"In my opinion you have a problem not with the needles but with the access. You need intervention has fast as possible let me know what the out come is. It is never to late to start a new buttonhole you may need it for back up.

I’m sorry but I don’t have any knowledge in this drug, please check with your doctor

hi Stuart,
firstly thank you for your reply. Will be seeing my doc.
And secondly ‘inohep’ is a low molecular weight heparin. There appears to be ‘some’ evidence of lower risk of bleeding, osteoporosis long term and thrombocytopenia. So I guess from a risk/benefit perspective the evidence isn’t great, but I am happier with any ‘positive potentials’ however small in my life!
Bye for now,
thanks again,
Sinead :slight_smile:

hi Stuart,
just to let you know the team are not worried about my fistula, they are going to keep a close eye on it for me and if my pressures go up, in the meantime, I just have to pick the phone up and go see them. I’m just letting you know I followed it up.


Here is some thing that is new to me in the cannulation world. Maybe some others are doing this, but it is called side cannulation. [Editor’s note] Here is a pdf of a presentation on side cannulation by Dr. Shenoy that was given at the Heartland Kidney Network’s educational conference in January:

hi Stusrt
thanks a mill. Much appreciated. Finally getting to look at this. Sometimes life gets far too busy!