Pain Intense with decannulation

Hi Stuart -
Thought I would ask this question here since I imagine others may have the same issue. So Robert is doing GREAT (because of your help and expertise) with the touch cannulation on buttonholes with the JMS needles. He has been cannulating the same buttonholes for years. I have two questions.

The first question is: Lately, the last couple of months or so, de-cannulation is quite painful for him. Pulling the needles now hurts way more than putting them in. He is very sensitive and even pulling the tape off is painful no matter how careful and gentle I am. I am trying to figure out what I should/can do to make it better. Even the slightest pressure is really bad.

Second question: On the arterial, the needle slides in with literally NO resistance. Makes me worry that it’s so slack I wonder how the bleeding ever stops. The venous is more resistant and always has been. I cannulate arterial first.

So…should I create new buttonholes? Other than the above these buttonholes are working GREAT. What, if anything, can I do to ease the pain when removing the needles? I am trying to be very careful not to put pressure until the needle is out, but you know it is a timing thing…avoiding blood going everywhere without putting pressure on the needle as you are pulling it. Finesse is everything.

OK Mr. Fistula Whisperer…what is your wisdom? Y’all reading this…I am not kidding this guy (Stuart Mott) is a genius. You can’t go wrong with his advice.

  • Martha

Hi Martha. I am not Stuart, and hopefully he will see this and weigh in. If not, LMK, and I will email him to be sure he does. I have known folks who have had the painful decannulation problem you describe. There are two things that could be happening. First, it’s crucial not to apply pressure until AFTER the needle is fully out–or the cutting edge (even with a blunt needle) could be cutting the inside of the vessel, which is painful. I’m going to guess that this is not the issue, but thought I would mention it, because it does happen.

What I suspect is happening is a vasospasm. Try putting a hot compress over the needle sites for 10 minutes or so before removing the needles. This should relax the vessel walls and help the problem.

Martha what an interesting question I’m racking my mind if II have to go back to 2008 to have a case like yours. Of 1000 of buttonholes that I have done I had a woman in her late 50 that had this same problem. When she pulled her needle I notice that she pulled them out at a higher angle. So I would pull them out and the problem disappeared, but she went to home dialysis so we decide to start new buttonholes, which work out well. My recommendation is to start a new set of buttonholes, let us know how it works out.

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Thank you Dori. We will try that.