Help - no thrill or pulse

[CaBauer]

I had a fistula created two weeks ago. Right after creation I could feel and hear the fistula as expected. On Wednesday of this week I and the dialysis nurses could no longer hear the thrill.

On thursday I saw my nephrologist and he referred me to my vascular surgeon for testing. My appointment to see the surgeon is next Thursday. Now I woke up this morning and could no longer feel the pulse.

Should I call my neph or vascular surgeon again even though it is a Saturday or is the fistula just gone?

Help!

[scubygear]

Cabauer you definitely need to call your surgeon. Have you told the Vascular Access Manager of your clinic? They should be able to take care of that for you. If not, please call your surgeon asap. There might be narrowing somewhere which can cause the lack of blood flow causing your new fistula to stop working. They might be able to re-open the fistula or fix the problem which caused the clotting of your fistula. Did your dialysis staff give you a stethoscope so you can listen to your access' progression?

[M3Riddler]

I had a fistula created two weeks ago. Right after creation I could feel and hear the fistula as expected. On Wednesday of this week I and the dialysis nurses could no longer hear the thrill.

On thursday I saw my nephrologist and he referred me to my vascular surgeon for testing. My appointment to see the surgeon is next Thursday. Now I woke up this morning and could no longer feel the pulse.

Should I call my neph or vascular surgeon again even though it is a Saturday or is the fistula just gone?

Help!

CaBauer,

If you cannot feel the thrill or bruit, you need to have the fistula looked at asap. This is nothing to wait around for. One issue is that I see all the time is that when a fistula issue occurs, the neph asks one of the nurses to make you an appointment. Wel.....the nurse calls to schedule you in. They totally leave out that it is an emergency procedure that needs done asap and they end up scheduling you for the next available appointment which can be several days to a week or two away. This is not accptable. Your fistula is time cruicial. You need to have that looked at the same or next day at the longest. I would call your neph and voice your concerns to him. I would ask your nephrologist politely to call on your behalf and try to squeeze you in as an emergency basis. It can be done. Anytime I needed a fistulagram, my nephrologist was the one to make the call personally and get me in no later than the next day, usualy the same day. The longer you wait, if it is a clot, the clot will grow. The longer the wait, the larger the clot gets as well as the harder the clot gets and the more difficult it is to remove.
Remember this is your lifeline. you need to advocate for yourself. They do have drugs that can break up the clots, if that is what it is. That is my guess. If it is a stenosis, they can use a balloon to open it up, but again, its time critical.
Please let me know how it turns out. I dont want to see you lose your access due to something such as a scheduling error. I have seen it happen on several occasions.

Also, if you do not already have a stethescope and a stress ball, you should get them. You should listen to your fistula daily. When you get a stenosis, you can usually tell by having a whstle wound instead of the normal " wooosh woooosh" you may hear something like a "wooosh whistleeee " or something there about. The stress ball is to exercise the fistula and keep it strong and flowing.

I hope this helps...

///M3R

[efp76]

I agree with everyone above. Even if it is a weekend, your doctor's answering service will relay any urgent messages to him/her. And this is considered urgent. The sooner they can assess the problem, the better. How do I know this? I'm currently trying to mature my own AVF, and given that I have notoriously small veins, it's been a chore. We're 4 months removed from the surgery and it is still not ready. But I keep my surgeon up to date a whole lot, and she's managed to put a strategy together to help mature my veins. It's still a work in progress and I have another procedure next month, but we're careful not to lose that thrill! Best of luck to you.

[DialyzingDiva]

Just had my surgeons look at my fistula and found there was a narrowing above and below the site where they insert the needles so they did a fistulagram and a fistulaplasty to open the narrowings. I went into the hospital at 6 am and was home by 1pm. The longer you wait the harder it is to save the fistula because once it closes they usually have to create another one.

[DevonTexas]

Diva, GREAT advice! "The longer you wait the harder it is to save the fistula because once it closes they usually have to create another one." Don't mess around when it comes to the A/V Fistula. It's your direct link to dialysis. If it fails, you go to the catheter and that's not a place to be.

Generally, the nurse at my center checks it but I'm going to make it a point to have her do it every time she checks by lungs and heart.

Devon

[CaBauer]

Thank you all for the replies. I did end up calling the surgeon that night and of course, went in for emergency surgery to try to save the fistula. Unfortunately, even though they were able to remove some clots, there is narrowing above the fistula so it will never be able to be used.

I have surgery scheduled for this Thursday, 11/1, for a new fistula to be placed.

What drives me crazy about this is that I noticed that the fistula was getting very hard and rolled around under my skin. It was very painful even four weeks after the initial placement surgery. I didn't think that was supposed to happen but this was my first fistula and I really had no clue. The surgeon told me the fistula should never be hard like that and that it was a sign of clotting....

Then - my dialysis nurse today took a BP in my fistula arm.... I was stupid and wasn't paying attention and have been kicking myself ever since. All she said is "good thing it isn't a working fistula".... UGH.

[jbeauzil]

My mom fistula get clotted also at the hospital the PCT used the arm to take her blood pressure.

[DIANEROOD]

My husband's fistula isn't working and really never did after 3 months. They will use a graft. He is not on dialysis yet.

[kcramer]

Hi Jbeauzil
Does your mom have an alert bracelet? I was told my the doctor and the nurses at the hospital to make sure I have one on so no complication occur
because having BP could damage the fistula. I still have the alert bracelet they put on me at the hospital. I plan on getting a nice one (girly) from
Walmart. I saw a real nice one in pink with hearts. Hope your mom is doing better now.

[DialyzingDiva]

Check to make sure the thrill is not gone several times a day

Have you felt your
fistula
today
feel the thrill (buzz vibration)
for yourself
don’t allow a
tech to tell you the thrill is gone
if you don’t know how to feel the thrill of your fistula
ask your tech or a nurse how it is done
public service announcement brought to you by life while dialyzing support group[/center]

[jbeauzil]

Thanks, that I took so long to answer. I lost my access now I have a perm catheter which is not comfortable.

jbeauzil

[GoodHeart]

My graph clotted, but this time my whole arm hurt. And when they returned my blood the palm of my hand got really really hot. Had the tech stop returning my blood, because it hurt so bad. Want to know why this happened this time and not any other before?

[MitchsLaLa]

All of this info has helped me a lot. I just called my Nephr dr.'s office to remind them about the call to the surgeon yesterday. Now I have slight swelling below. Going to Walmart tomorrow to get an Alert bracelet. Oh, this website has been a God-send. Thank you!
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