I am to begin nxstage training in two weeks. I have been on hemo at a clinic for almost 8 years. I am nervous but excited to start this new process.
I have a mature fistula that i have already begun to stick in my unit to “prepare” for home. I have two questions for anyone using nxstage. Although mu husband is going to train with me, I was wondering if anyone dialyzes on thier own? If so how do you take out your own needles? Is it hard? I know that you should always have someone there, but thought I’d ask see what you all think.
Also how is that buttonhole method? I was always told that you should rotate your sites.
hi Vanessa,
I dialyze alone, on the PHD by Aksys. The needles are not had to remove at all, just takes practice and a technique. I can tell you what mine is but you will want to find what works for you. You might want to practice and get your techinque down when you have some help to catch any leaks.
For me there is not a thing I can’t do by myself…have been dialyzing alone since I got on the PHD about 1 1/2 years ago and on a Fresenius for a couple years before that. I am not advocating just saying what I do.
Ok …the needles (by the way for a spare hand I always use my mouth, I especially get a kick out of doing it in-center and the staff goes quite bonkers… ah, it’s the little things that get you by.)
the needles…my taping set up is very secure it’s basically an ‘H’, the upper bars of the H go over the wings and back under so it’s sticky secure on top and under neath the wings…each wing gets it’s on separate piece of tape …I use 1/2 " paper tape so it is easy on my skin …when I’ve taped each wing …on the venous needle for instance which I do aimed up toward my arm pitt and bevel up also. when it is taped I place a ‘cross-bar’ piece of tape that holds the wing tape strips down …that makes the ‘H’
On the end of my Chair I have 2 10" pieces of 1" tape. I lay it out on my crossed leg sticky side up and fold a gauze 3x3 over about 4 times til it makes a 3" tight burrito which I then fold length wise one end down and the other over it…the fold ends go down on the tape which I roll up and down once on the tape so it will adhere to the sides of the burrito turned pad and prevent it from unraveling.
I drape one end of the tape over my arm with the pad over my needle site(I’ve removed the needle tape before rolling the burrito)pull the other end down and secure on this side of my arm…you need to get the tape moderately tight so it will hold while you retighten after the needle is pulled.
my thumb goes on the pad and I pull the needle out with my other fingers
…before I got good at this part I would hold the end of the needle line in my fistula-arm hand and slowly extend my arm til the needle came out…then I got good at it and it’s easier now. BTW I have a left upper arm fistula. Venous is lower bicep and Arteriole is 1/2" above the crease of my elbow. With my thumb holding the pad on the site, I then tighten each leg of the tape til it will then be equivilent to aprox my thumb pressure.
I let go watching for any telltale blood on the guaze to tell me if it isn’t tight enough. I roll another burrito on my crossed leg and apply it to the arteriole in a simular fashion pull the needle after securing the legs of the tape and hold both sites for a couple minutes and I’m done.
I use very minimal heparin so I clot quickly. I use as few drugs as I can get away with and always heprnize the lines and dialyzer before blood hits them and don’t heprinize myself. I’ve worked my program out over 25 years and it is customized to me.
The button hole is the best thing since sliced bread as my mother would say about anything she liked alot.
It is painless once it is established, it is the freedom from dependance on someone else’s skill, mood, errors, and any other unpleasant thing you could think of that happens in- center when you have done this long enough. I have used the button hole technique since 1998. It certainly changed EVERYTHING! Someone should write an “ODE to THE BUTTONHOLE”…maybe I will.
Anyway hope this is helpful, however you do any of this stuff, you gonna feel alot better at home whatever your treatment choices.
The good thing about home is that it allows you the freedom to dialyze your way once you know what your way is.
Regards, Guillaume
I’ve been doing self home hemo on the Fresenius for almost 10 months now, how time flies. Since I don’t have a partner I had no choice. I know plenty of people doing it without a partner, if you want to do it alone I’m sure you will have no problem.
I too am a firm believer in buttonholes. I have two sets now and rotate also. I use a lot of heparin, almost 9,000 units in 4 hours but bleeding stops almost always within 2-3 minutes. I simply hold the site for that time and then tape and remove the second needle, hold both, just in case, and then tape that one. I do this all alone with little difficulty, I have an upper arm fistula in my left arm. I can fold the guaze in quarters with one hand and use just a single piece as I don’t bleed much, then I fold another one and put it on the tape I pulled prior to getting off dialysis and put the guaze over the site after it has stopped bleeding and then push the tape down.
To remove the needles I first remove all the tape then put the line to the needle in my left hand, I partially remove the needle, cover the site with the guaze and then pull it the rest of the way out with my left hand with my right hand holding the site, works easily.
Good luck and feel free to ask any questions, people were such a big help to me when I was new.
Guillaume writes:
I dialyze alone, on the PHD by Aksys.
How do you like the PHD?
G writes:
Ok …the needles (by the way for a spare hand I always use my mouth, I especially get a kick out of doing it in-center and the staff goes quite bonkers… ah, it’s the little things that get you by.)
Lol, I would love to see this! Something I have wondered, do you think you would be just as resourceful if you had your access in your dominant arm and had to use your non-dominant hand to cannulate?
G writes:
I use as few drugs as I can get away with and always heprnize the lines and dialyzer before blood hits them and don’t heprinize myself.
How do you get away with not heparinizing yourself? I was taught to hemparnize myself for 5 minutes before beginning tx. I agree, the less drugs the better.
G writes:
I’ve worked my program out over 25 years and it is customized to me.
The button hole is the best thing since sliced bread as my mother would say about anything she liked alot.
It is painless once it is established, it is the freedom from dependance on someone else’s skill, mood, errors, and any other unpleasant thing you could think of that happens in- center when you have done this long enough.
I hear ya! Very inspiring story…we can learn a lot from your experience! Please share more of your tips when you have time, and if you run into a digital camera, would like to see a pic of your taping style.
I do my dialysis alone without any problem. It’s not on a NxStage, but needles are needles. It’s very simple to take out the needles. I do it one by one. I have a couple of lengths of tape already prepared from the night before, as well as 2 packs of 2x2 gauze already open. Once I’m off, I unstick the Tegaderm with which the needle is taped down. Then as I pull out the needle, I simply put a folded 2x2 gauze over the exit site, then I hold it on there for 10 minutes before doing the other needle. Because my fistula is in my upper arm, which makes it awkward to pull the needles out because the needle lines are fairly short, I simply clamp a scissor clamp near the end of each needle line after I disconnect them. When it’s time to pull the needle out, I grab the scissor clamp with my free hand (the one on the fistula arm, the other hand is holding the gauze) and pull. It’s very neat and quick. Taking out the needles is actually the simplest thing in the whole treatment.
The buttonholes work better and better as you go along. At first, it’s a learning experience, and sometimes they close over somehow and you have to switch to a sharp needle for a couple of days. But eventually, after a couple of months, they become very reliable. All you need is a little patience, both as they develop, and also every time you put the needles in. Sometimes one needle might not go in right away, but if you stay calm and play with it a bit as we are tought, it goes in. There’s no need for alternating the sites, because you are using the same holes every time. To the fistula, basically, it doesn’t matter if you use the hole once or a hundred times, because it’s still the same hole.
There’s no need for alternating the sites, because you are using the same holes every time. To the fistula, basically, it doesn’t matter if you use the hole once or a hundred times, because it’s still the same hole.
Again, this is an area where there is a difference of opinion. The originators of the buttonhole technique do suggest that you have two sites and rotate them. Many people do not, my center was very adament that I create the second site so I did after about 6 months. I find that they don’t get as sore when I rotate them, but again I have VERY sensitive skin.
I did NxStage, as well as nocturnal, alone. no problem and nobody in the way. with an upper arm fistula needle removal was no problem because I could use the hand with the fistula to pull needles. I guess the same could be done with lower arm fistula.
I would love to know who started the “you must rotate the needle site” rumor but I never had a hematoma with buttonholing.
someone mentioned the “mood” of center staff and believe me it can be an issue.
I have a very large boyfriend who told me after my 3rd or 4th hematoma that next time I come home with a bruise, whoever did it to me was going to have a bruise. I told that to staff and NEVER had another hematoma.
by the way, I am much more likely to bruise you than he is, he’s a very large teddy bear, but staff didn’t know that. there were some who were bound and determined to find the vein no matter how long it took. soon as I mentioned my boyfriend’s threat they were looking for someone with better skills. I am not a toy to be played with and if you don’t have good needling skills, find another job or find someone else to practice on.
My centre actually did mention the potential desireability of having two sets of buttonholes. I think the concern was not so much about any need to rotate them, but more about having an extra set ready should it be needed - especially for nocturnal patients. And to keep both sets of buttonholes useable, you would have to keep using them both, which means rotating them, I guess. But, whatever, you have to work with what you’ve got. After 3 years of in-centre hemo, I have two big aneurysms and little room left for more than one set of buttonholes. They seem happy knowing that I could needle myself with sharps in another location if I really had to. I don’t know anyone on home hemo locally who has two sets of buttonholes. It’s not that critical, I think, for patients like me who can just as easily go to the dialysis centre or the home dialysis unit itself for a few days if it ever becomes necessary.
Pierre
Well, looks like this has turned into a ’ to alternate or not’ topic.
I don’t alternate I don’t know why, probably cause I don’t wanna.
I don’t use button hole needles neither. Probably same reason.
What am i rebelling against? right, ‘Whataya got?’
I did try the button hole needles, it was like trying to gently push a truck through the wrong size pillow case. Anyway, I didn’t like it, so never did it.
My sword is razor sharp and gleaming and goes in like through butter.
My arteriole site is about 8 years old give or take. the venous I have moved 4 or 5 times…they got to a point where I couldn’t advance, and about everywhere I was going(I’ve moved around a bit)I was the only one that had ever used or even seen a ‘buttonhole’(staff thought they were’screw-caps’ or something.)I had to figure it out for myself.
Now, my venous is pretty-knock-on-wood-‘trouble free’.
hi Jane!
re: “Lol, I would love to see this! Something I have wondered, do you think you would be just as resourceful if you had your access in your dominant arm and had to use your non-dominant hand to cannulate?”
Who are you calling a ‘righty’ ?
one of the things I was dragging my feet about was that I had no vision in my left eye and I didn’t think I would be able to see the site well enough to stick… but mother’s programming was always’ if there’s a will, there’s a way’. I don’t think there is anything that can’t be overcome when you have enough will and focus.
I forget, do you do nocturnal or short daily? I don’t think I personally wouldn’t be very comfortable with sharp needles in my fistula overnight while sleeping, but, I guess it wouldn’t be a problem most of the time.
It’s true that buttonholes can be problematic the first month or so. Mine kept healing and I had to use a sharp instead about once a week. But not anymore (touch wood).
I also had concerns about vision and putting in needles. No blindness in my case, but I’m very farsighted, and it’s very hard to focus clearly when looking at my fistula. It’s just too close even for the reading part of my bifocals. If I can ever afford it, I’ll get some glasses specifically for that distance, but for now, I just manage. I sort of supplement my vision by feeling with the tip of the dull needle when it’s in the hole.
Pierre,
Short Daily…but I never think of it as short, is the night time short or long I quess it depends on whether you sleep through it or not.
I also feel about with the tip of the needle after I pull the ‘plug’ on the buttonhole. I’ve never infiltrated execept during cannulation in the ‘old’ center days and a freakess ‘take off’ …not sure I would want sharps while sleeping either. I 1st tried a ‘button hole’ needle when my buttonhole was about 2 years old. With the sharps I am just careful finesse them.
Do you think your Dx sleep is as deep and uninteruppted as your day off sleep?
Jane,
about the heparin… since 1997 i’ve been taking minimal heparin. At 1st because I had some hemoraging in my eyes mainly because I’m a vegetarian and don’t want dying animal vibrations in me.
So with some help from a Head Nurse (Yay! , see nurses can be fun, too)
She had always told me that it was not the patient that needed the heparin but the Dialyzer and lines. So it’s kinda like driving your whole car through a vat of lubircating oil because the ball joints need it…
I developed a routine where I would heparinize the lines and the Dialyzer 1st and then flush them with a liter of saline, what remains is what clings to the tubing and the fibers of the dialyzer. I do it slightly different with the PHD since you can’t flush it with Saline. I never put heparin in my blood. My PHD gets an average of 20-30 uses per lines and Dialyzer.
I think we adapt to the kind of sleep we need. When I’m on nocturnal, I fall asleep, but I’m aware I have to be able to wake up if an alarm goes off, so, it’s not as deep a sleep as on the off-night. I find it’s not that different than how I slept sometimes when I was in the military. It does make that free Saturday night feel extra special, that’s for sure.
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