For me, every Monday starts a new week with the needle brothers (needles are definitely male).  So I thought it would be interesting to get close up and personal with the mechanics of needle access each time I connect to the machine.

I am a little different from most, in that I connect up 5 days per week, starting early (7am) on Monday, with afternoons on Tuesday, Wednesday and Thursday, and then another early start on Saturday.  And since I use the buttonhole technique, both my Needle Brothers are blunt and go into the same access holes (almost) every time.  Non-intuitively, there seems to be no ill effect on the strength of the fistula wall (but I am always watching…).

For each hole I clean the area thoroughly, coat it with antiseptic (Betadine) and start to remove the scab using a sharp 19 gauge poking needle.  There is a trick here.  Because the scab is being constantly removed before the hole has a chance to heal, it tends to grow back a little more aggressively each time.  It begins thick and proud and easily lifted off, but after about day 4, it grows back low and thin and tightly attached, especially if I have pushed the needle fully into the hole with the collar hard against the skin.  For some reason best known to the scab, it then grows back concave, into the cavity formed by the collar and is very time-consuming to remove.  I have found the best way to avoid this when connecting is to leave a little (1/2 mm) of the dialysis needle out of the hole.  The scab then continues to regrow on top.  Also, by day 4 or 5, the scab is so thin, it is easier to scratch through it than to remove it.

Once removed, I feel around the exposed flesh for the entry hole.  When I find it, I poke the small needle lightly into the hole to provide an easy entry for his big brother.  I then insert the large blunt needle into the track, and if all is lined up, it glides effortlessly down the shaft, pushes open the puckered hole in my fistula and settles in place for a few hours’ blood flow.  I tape the needle into place, usually packed up by a rolled up gauze pad, leaving a very small area of the needle shaft showing, and positioning the tip in position away from the internal wall of the fistula for easy flow.

I then do the same for the other needle.

Sometimes there are problems.  My fistula has a habit of moving about under my skin, so that one day the hole lines up with the track and the next day it is over to one side, and I have to chase it.  I do this by feeling this way and that with the tip of the needle (I NEVER push it hard) until either I find it, or I give up and replace arm-friendly Mr Blunt Needle with potentially arm-hostile Mr Sharp Needle.  Hole movement happens naturally over a week or two, and more often when I go to the gym regularly.  I find that exercises aimed at building up my biceps or triceps tend to either build muscle or flesh between the track and the hole or nudge the fistula this way or that, moving the hole away from the tunnel (I call it the Schwarzenegger curse).

I wish someone would invent a fistula hole finder (like the reverse of a stud finder for plaster walls). Life would be sweet and Mr Blunt would prevail.

Removing the needles at the end of the run is simple.  First remove the tape holding it in place, loosen the needle so it is easily moved, then position a small sterile gauze pad over the needle exit.  Simultaneously remove the needle and press the pad firmly onto the fistula hole to stop blood escaping.  Do not Press down on the pad while the needle is still in place.  It hurts, and it damages the tunnel and the hole in the fistula.  The pad should be folded so that it enables focussed pressure on the fistula hole rather than general pressure around the access point.

Once the bleeding stops tape or seal the hole as appropriate.  I use gauze and tape, other use dots.  Buttonhole holes tend to stop bleeding within 5 minutes.  I take off the tapes after a couple of hours.  Other need longer; it depends on you.

Well, that’s it.

Oh, also, as preparation, when I am on my way to each session I spend a few minutes visualising the whole access process.  Then, when I arrive, I am in the right frame of mind to get started.