Well I’ve finished three weeks of training/dialysis (only 12 sessions of dialysis due to machine problems, infiltration and a day the training staff wasn’t available). I am doing everything myself now and this week will work without supervision to see if I am ready to go home.
I have one buttonhole established, have used the buttonhold needles 6 times in it and it is getting easier and easier. We will try a buttonhole on the arterial site on Monday. I’ve tried 3 areas for the arterial as we had some problems, but this site seems to be working well. I will start a third site to allow rotation which they believe will be better for my fistula.
I can get on the machine in just over an hour now, and can get off and up to the countdown on the heat cycle in about 45 minutes. Friday bleaching adds about 30 minutes.
Now if they will only get the construction done on the house so I am not waiting on them!! They keep saying it will only take a couple of days, but they were here on Thursday and all I can see that they did was put a small hole in the wall. We should be ordering supplies this week, but scheduling delivery may be difficult since I need to be at dialysis daily. Can’t wait to see how much space a month’s worth of supplies will take up in additional to all the various pieces of equipment they send!!
Can you say more on your experience of going to the buttonhole technique? Are you establishing the bh’s yourself or is someone doing it for you? Can EMLA cream be used when starting the tunnels? How experienced is the person who is starting the tunnels? Why is it necessary to try differnt locations for the tunnels?
you are doing really well, your fistula must be a very good one.
once the buttonhole is well established your needle will almost find its own way in.
I don’t know why Emla can’t be used but it wasn’t on me and I guess after you’ve been stuck many times you just accept the pain.
just some advice Cathy, once you get home alone and have to do your dialysis the very first time on your own, expect to panic and forget everything. it happens to almost everyone and just do it like saying your ABC’s. think about every step as if you were in training.
we all get through it tho your head will seem empty at the time.
First, believe it or not, I have made all sticks but the very first arterial stick (guess the training nurse didn’t think I’d be brave enough). I have never used EMLA and it should not be used for buttonholes. The pain isn’t that bad. I honestly believe when you stick yourself that your brain concentration overrides the pain sensors. FWIW I had not had dialysis prior to the home training, so of all the sticks to my fistula I have made all but one.
To establish my buttonholes I simply stuck as close as possible to the same spot for 6 times in a row. It is important that the same person make all the sticks when establishing a buttonhole. On the seventh time we used the buttonhole needle. When I use the buttonhole needle I don’t even hold the “grips” I simply “wiggle” the needle in holding the tubing behind the grips.
My unit believes it is best to have 4 buttonholes established and to rotate them. I have a VERY curvy fistula and we have really only found 3 appropriate areas, so I will establish 3 buttonholes and rotate them. I do know that there are plenty of people who only use 2 and it seems to work for them.
[quote=" it happens to almost everyone and just do it like saying your ABC’s. think about every step as if you were in training.
we all get through it tho your head will seem empty at the time.[/quote]I’
I’m already ahead of you. I’ve typed up cheat sheets that list all the steps and I always double check myself. My training is so fast, plus I hadn’t been on dialysis before, so I need this for my own comfort.
News today is that they are planning on me being at home on Friday, my 17th day of dialysis. This is dependent on them finishing the construction and getting supplies delivered.
Hi Cathy,
Congratulations on doing almost every one your own needle sticks. I’ve talked with many patients (and staff, for that matter) that can’t believe patients would be interested in sticking themselves. I believe more people can learn to do this and know most need to do their own sticks to do home hemodialysis. However, fear of needles can be a huge barrier in the minds of patients so far as considering home dialysis. Low expectations of staff can be a huge barrier in the minds of staff so far as encouraging home hemodialysis.
How did you prepare yourself mentally to do your own sticks?
What did your training nurse do or say to help?
How did you feel after your did your first successful needle stick?
What would you say to someone else who is nervous about sticking himself/herself?
What would you say to a staff member who believes patients would not be interested in sticking themselves and thus could not learn home hemodialysis?
If anyone else has comments on these questions, feel free to post them. We’re hoping to dispel myths and break down barriers to home hemodialysis and your help could be invaluable in that effort.
How did you prepare yourself mentally to do your own sticks? I have no needle phobias, plus I was trained to do home hemo when I was 18 (many moons ago lol) so have “stuck” before. I simply felt it was better to “get it over with” than wait. Additionally they say it is best for the same person to make every stick when creating a buttonhole, so I decided to “just do it” to coin a phrase.
What did your training nurse do or say to help? My training nurse encouraged me most by her shock of my willingness to do it I guess. She is very gentle and calm which also helps. She positioned my hand and was there to step in immediately if there was a problem.
How did you feel after your did your first successful needle stick? That it was a heck of a lot easier than I thought it would be and that it didn’t really hurt very much. Sometimes it stings a bit due to the alcohol dab I insert through, and one buttonhole is a bit more sensitive, but the pain is not bad at all.
What would you say to someone else who is nervous about sticking himself/herself? I guess I would say do you really believe someone else is going to be more gentle that you are??
What would you say to a staff member who believes patients would not be interested in sticking themselves and thus could not learn home hemodialysis? Well personally I might conclude that this particular staff person is not one who accepts that patients are individual. But I would ask them to ask all of their patients, especially the healthier ones, they might get a surprise!! I do believe, though, that unless the patients educate themselves about their options that the staff member may be correct. I’m not sure that many patients understand just how sick they are on normal dialysis. That their “numbers” get close to toxic levels between treatments, and that with daily dialysis that they come much closer to actually attaining and maintaining normal kidney function.
If Bill or someone else who has been on long term daily dialysis would be willing to share their pre and post “average” numbers I’d love to see it. I know my pre and post numbers from this week were creatinine 8.1 pre to 4.7 post and BUN 55 pre (I’ve never had super high BUN) to 30 post. Now this is only on 2 hours vs. 3 hours, but still these are the same levels I had BEFORE starting dialysis. It has only confirmed that in spite of the time commitment, that daily dialysis is the only way for me to ever get back a quality of life!!
Cathy that’s a great point to remind people considering self-cannulation.
I’m doing labs tonight, I should have the results on Tuesday and I’d be happy to post them. I don’t think I get post creatinine numbers only post BUN info. To be honest I don’t pay much attention to my numbers other than phos. and potas. I use to but now I just go by how I feel and call it good.
To be honest I don’t pay much attention to my numbers other than phos. and potas.
Yes, I am concerned about those numbers, but primarily that they will get too low. I’ve never (okay once maybe) had a high potassium or phosphorus and on a 3k bath daily I think it may go low. It is funny to actually plan on eating medium to high potassium foods. My pre potassium after two days off was only at 4.4 after adding in some potassium so next week when I start long dialysis on a daily basis I’m probably going to need to add even more. So strange after years of limiting, my dietian even told me I can have diet coke (my favorite beverage) now, but still take the binders until they can evaluate my levels after a period of long daily dialysis.