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Thinking of switching to PD from HH.

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  • stumpr54
    replied
    Hello Nicole28,

    I'm surprised to read of your issues getting blunt needles into your button hole access. There are several factors that can contribute to your difficulties and the one that is most likely is the alignment of the tract to the fistula flap.

    Presuming that you are using "soft touch" cannulation that involves holding the needle by the tube and not the wings as is done with a sharp needle for control, a simple twisting while pushing should permit the blunt needle to "auger" its way through the tract and pop open the fistula flap. If the tract and flap don't line up, you end up augering into nearby tissue or a different part of the fistula and either create a pocket in the tissue or end up pushing on the fistula. In either event you'll get no blood flash and your efforts at hemodialysis are stymied.

    I have posted extensively about the mechanics of button hole access in the string that follows: http://forums.davita.com/showthread....light=stumpr54. Additionally, I've picked up a few new tricks to "tune up" an existing buttonhole site with a sharp needle to "re-align" tract with flap. I mentioned my challenges to one of my HHD clinic's expert cannulators and she made the suggestion and it works like a champ.

    I've developed all four of button hole sites that I use on a rotational basis during the treatment week, and two of these sites have required periodic "tune ups". Generally, I will treat in these two sites twice consecutively with a sharp to re-establish the alignment between tract and flap. After that, the blunt goes in at the original angle that I used when cannulating with a sharp.

    Changes in skin and tissue, and especially continued development of the fistula (think of it as a muscle that is being exercised during dialysis) can eventually cause alignment issues with the button hole tract and fistula flap. I hate wasting time rooting around with a needle trying to get to the fistula flap and blood flash, so as soon as I have one or two of these experiences, I get out the sharp for the next two treatments and after that I'm back in business with blunt dialysis needles.

    I never would have thought to put a sharp needle into a developed buttonhole - fearing that it would adversely alter the site. Provided that you place the sharp needle at the preferred 30 deg angle, that which was used in the original development of the site, you should have no issues, the needle merely advances with greater ease than a blunt thanks to the sharp tip and somewhat sharper bevel that either cut or push away any tissue that is interfering with the path to the fistula flap.

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  • Hoofpkr
    replied
    Dear Nicole,
    !. If you switch to PD it is for the most part easier, but depending on your prescription you could need to do two exchanges during the day as well as the machine all night long.
    2. You will carry about 2 liters in your stomach so a tummy will be full and often feel bloated.
    3. You can develop a hernia that might need repairing.
    4.My doctor told me that HHD is a much better dialysis mode.
    5.The PD delivery people are top notch!
    WithHHD
    1.The Nextstage tech are only a phone call away and are quite competant.
    2. You may need vascular fistula grams at some point, with ballooning or banding.
    3.Buttonholes can be painful no matter what you have been told
    4. Your care partner must be dilligant and quick to act.
    5. You are doing all the work, the labs and the reporting.

    I hope this helps.I did PD for over 12+ years with the same catheter before I got a severe infection and almost died. Fortunately we already had decided on doing HHd because the peritoneum cavity was quite stretched. It takes us about 5 hours start to finish with a 3 hour treatment.
    Because the Lord Almighty sustains me I am able to survive the discomfort with being chair bound for the 3 hours and my care partners are terrific!
    Blessings,
    Hoofpkr.
    Last edited by Hoofpkr; 12-18-2013, 12:51 AM.

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  • Hoofpkr
    replied
    Dear Nicole
    I did PD for more than 12+ years before switching to HH. On PD the large tummy is a given. The diet on PD is stricter and you always have to be concerned with fluid overload..HH isa real commitment and you need to have a willing partner that you trust to be putting needles in your arms. The partner is going to run the machine, checking blood pressure. There is much comfort in HH as it is in your home with the same person. I would not go back to PD ecept I slept through the night exchanges were great. But if you have been doing PD for a long time the tomach will not easily get flattened. I love or strongly like doing HH. I will pray you carefully examine your options. Please talk to your doctor to be sure you are a candidate. Hoofpkr
    Last edited by Hoofpkr; 12-18-2013, 12:50 AM.

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  • Nicole28
    started a topic Thinking of switching to PD from HH.

    Thinking of switching to PD from HH.

    I have been doing HH since July of this year. So far
    Everything has been going well with the exception of dropping my BP and almost passing out multiple times. Also I am still using sharps because I am having a difficult time putting in the buttonhole needles. My fistula looks and feels fine. The thrill is good. But for some reason I just can't get them in. I don't want to rotate sites or have to do in center hemo. Also I still get anxiety about doing treatment at home without a medical professional near by. I guess I can't stop thinking about all the things that can go wrong. So I've been thinking about switching to PD. I have been trying to do some research on it. I am some what knowledgeable about PD as my younger sister did PD about 10 years ago. Not sure if anything has changed over the years. At the time she disliked PD. But currently as my care partner and seeing the workings of HH, she said she would choose PD. We also know a lot about in center hemo because our father did in center for 20 years. He did not always feel the best

    I guess one of my biggest concers is my apperance. How does it make you feel? Do you feel
    Bloated/full all the time? I was thinking of doing at night while I sleep. does this take longer then doing it thru out the day? For nocturnal treatment do would I walk around all day w a full stomaach? Does it streach out your stomach?

    Nicole
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