I got this wonderful couple of questions recently in a comment on the blog. Rather than answer them there, I will create this blog post so everyone can read it. Here are the questions:
I am about to start the needles in the arm and am terrified as I hate needles. I have the script for lidocane/prilocaine cream. The above was good advice. How easy is it to stick yourselves as I do want to start the home dialysis instead of in-center. Also, has anyone heard of the self sealing hole for the needles sites?
Great questions! I’ll answer what I can.
To stick yourself? (cannulate is the technical term; self-cannulate to stick yourself) I’m not the best candidate as I don’t even watch as I am stuck by the tech. However, if I were to do so, I would begin by watching carefully as you are stuck. Take advantage of getting stuck by several techs and observe their technique; some are better than others and some have good days and bad.
For example, my regular tech is out of town for the next couple weeks. Yesterday I will prepared for the worst as I “break in” a new tech. The one assigned to me is a younger guy. I didn’t expect it to go well. He had tried to stick me before unsuccessfully. I was prepared for a multiple needle day as sometimes happens. (My record is five!). Suffice to say, I was pleasantly surprised. He was quick, confident, and relatively painless. Those are the ingredients for a “good stick”. He carefully felt for my veins and dove right in like a pro. If you are to stick yourself, watch for the elements of a good stick for you. I mention mine as an example. You may have others you consider important.
Obviously, if you are to do home dialysis, you will either have to stick yourself or your caregiver will do it. I’d plan for both so you have a backup in case you run into trouble and can’t do it yourself. As part of the training for home dialysis, you will be trained in all aspects including sticking yourself. Your caregiver will be your backup in case of alarms on the machine or if you need help.
Self-sealing holes? I believe you’re referring to “button holes”. These are locations where you stick repeatedly. Since I am not a expert in any form about self-cannulation, I will refer you to Bill Peckham who is an expert and is very interested in passing along his knowledge on this topic. He has an excellent video on YouTube about “Doing Self-Dialysis”. Bill has been doing home dialysis for several years and even took a rafting trip in the Grand Canyon, dialyzing along the way! He writes about it in his blog, “Dialysis at the Sharp End of the Needle”. Davita (a Dialysis provider) has some information about Home Hemodialysis (HHD) that might be helpful. They also cover the “buttonhole” and the “Rope Ladder” techniques but they don’t provide and photos or videos as Bill does. See “Overview of Self-Cannulation” for the Davita article. Finally, here’s a link to an article from ESRD Network 15 “The Art of Teaching Buttonhole Self-Cannulation”
About the issue of your initial experiences with getting stuck… don’t worry too much. The lidocaine cream helps as I wrote about in “Dialysis and Lidocaine“, You may have already found “Dialysis and Needle Pain” and, of course, “Dialysis and the First Stick” about the first couple treatments in the hospital and “Dialysis and the Procedure (2)” about what happens after you’re in the chair”. For information in general about Dialysis for the New Patient, click on the “New to Dialysis” button for some help with related issues.
Thank you, Cathy, for the great questions! I hope this was helpful.
Thank you for this.
I’ve been doing self-cannulation for In-Center dialysis for about two months now. It hasn’t been easy, but it has been so very worthwhile. I’ve been dialyizing for about 15 years, and needles have terrified me most of that time. I’ve found that self-cannulation via buttonholes is much less painful, and by doing my own sticks I find I am much less stressed going in to treatment.
My advice would be, take your time getting comfortable with it, and be satisfied by incremental improvements. After two months I still only have a bit better than 50% success rate. If I get one needle in successfully, I consider that a good day. The days that I get both needles in cleanly, those are great days. But, even on the days the tech needs to finish the sticks for me, as long as I gave it a try, I feel like I’m making headway.
THank you for that advice! It is sincerely appreciated.