Tricks to stop spasming fistula?

Dear patients and professionals,
5 times in as many weeks, I’ve had to abort treatment due to increasing venous pressures that wouldn’t resolve. This happens shortly after starting treatment and the pressures rise steadily from my normal 90’s to the upper 300’s before I am forced to stop treatment. One time the pressures suddenly corrected themselves. Last night, on my second attempt at treatment with a new cartridge, I sat on the floor with the pump speed of 200 to keep the pressures around 200. After an hour on the floor the pressures began to normalize over another hour. There is no blockage to the venous however, I did see the vein spasming which I now believe is causing back pressure and increases the venous pressures. The accesses are positioned correctly. There is no blockage other than the spasming fistula.

Does anyone know of anything that helps stop this type of spasming as it’s occuring?

Thank you!

Hello Wendy… Sometimes I have had problems with pressures… I was at a motel and I was doing Dialysis with my Nxstage machine… I put the machine on the floor and I laid in bed watching TV while do dialysis… my pressure were all out of wack… I couldnt run with out alarms… I could not figure what was the problem… I decide at the next motel that I would put the maching on a table close to the bed …the table was higher than the bed and again bad pressure and I couldnt run… now I went home… hook up the machine and ran as normal…pressure were good…perfect… I then tried some different positions… I laid on the floor and I also sat higher than my machine… bad pressures… I figured that the pump on the machine is not stong…and if you are not even with the machine than it influiences your pressure…
I also flip my needles to help with pressures at times…and I never put my needles all the way in … just little tricks of the trade… I have higher pressures when I first start so I keep the BFS down… with in a 20 to 30 min everything usually settledown… but there are times when I need to ajust things to make it work…Good luck and let us know how you are doing…

I called the vascular access surgeon who does my fistulagrams and asked him what he uses when patients fistulas are spasming during a procedure. He said sometimes he uses nitroglycerin cream applied directly on the fistula surface. It may lower blood pressure so that’s something to watch for. The effects wear off fairly quickly once it’s wiped off. If this persists, I’ll talk to my nephrologist about keeping some on hand just in case.

In other cases, he has used stents placed in the fistula. Hopefully, I won’t need to go that route.

Hi Kathy,
The reason I sat on the floor last night was because that was the lowest spot I could go below my machine next to my bed. I am convinced now after 5 of these episodes and a fistulagram that these are being caused by a spasming fistula right above the venous access. I could see it spasming last night during this episode. This is more than the usual slightly higher pressures at the start of a run followed by reduced pressures as the fistula relaxes a bit. These spasms start shortly after the start of dialyis following normal pressures. The pressures steadily increase over several minutes from 90 to upper 300’s with no resolve. My access is fine and I have no obstructions other than backflow caused by the spasms. Thank you for your thoughts and I will let you know if I find a solution to stop the spasming when it happens.
take care,
Wendy

Hi Wendy,my name is Alan,i do home haemodialysis,buttonhole.Every second day,no weekends off on home dialysis,but i get the fistula spasms in my veinous everytime i start& pressure starts at 120,then climbs to 200 very fast,pump speed is around 280-300,but i’d never abort treatment as i noticed a slight kink in my fistula,right up the end part of the fistula,same thing, nothing is wrong with my fistula.Over 15min the pressure would gradually work its way down to normal,120.One would think after doing buttonhole dialysis for as long as i have, the nerves would be dead but it still happens,even at a lower pump speed of 250,sometimes i think it maybe scar tissue that i’m up against,but whatever,i wish you the best of luck Wendy,after 7yrs,i know a few things,regards,Alan[QUOTE=Wendy Ramsay;20556]Dear patients and professionals,
5 times in as many weeks, I’ve had to abort treatment due to increasing venous pressures that wouldn’t resolve. This happens shortly after starting treatment and the pressures rise steadily from my normal 90’s to the upper 300’s before I am forced to stop treatment. One time the pressures suddenly corrected themselves. Last night, on my second attempt at treatment with a new cartridge, I sat on the floor with the pump speed of 200 to keep the pressures around 200. After an hour on the floor the pressures began to normalize over another hour. There is no blockage to the venous however, I did see the vein spasming which I now believe is causing back pressure and increases the venous pressures. The accesses are positioned correctly. There is no blockage other than the spasming fistula.

Does anyone know of anything that helps stop this type of spasming as it’s occuring?

Thank you![/QUOTE]

I don’t mean to derail the topic of this thread (in fact, I will ask my cannulation experts to read it and weigh in), but we DON’T recommend ever flipping needles. The cutting edge of the needle can scoop out the delicate layer of intima tissue that lines the blood vessel, which can cause damage.

Hi Dori,

Is this true as well with buttonholes. I know that flipping is a no no with sharps, but I was told by several sources that if you really have to, you can flip the buttonhole needles are they are not sharp so there is less chance of error.

///MM

Hi Wendy,Please try hard to cope as it will pass,your neurons in your brain will turn off to pain after time,i can tell you -you dont ever want a stent in place of a natural fistula,its plastic inside your vein!!!I’ll probably get into trouble saying what i’ve said,so i can only try to advise you.We are as tough as we want to be,some people faint at the sight of blood.At least we can keep a hand warm by holding onto bloodlines,Ha,ha,have a laugh,peace& love,Alan[QUOTE=Wendy Ramsay;20560]I called the vascular access surgeon who does my fistulagrams and asked him what he uses when patients fistulas are spasming during a procedure. He said sometimes he uses nitroglycerin cream applied directly on the fistula surface. It may lower blood pressure so that’s something to watch for. The effects wear off fairly quickly once it’s wiped off. If this persists, I’ll talk to my nephrologist about keeping some on hand just in case.

In other cases, he has used stents placed in the fistula. Hopefully, I won’t need to go that route.[/QUOTE]

Thanks for your thoughts Alan. I do believe this too shall pass. Fortunately there is no pain associated with these spasms!!

take good care -