My dialysis has increased over the past two weeks. Instead of 12 hours per week, I have been forced to be on the machine for 15. But it’s all for a good reason. I have been undertaking home dialysis training at the Renal Unit as I prepare to begin treating myself. To get me in the mindset of having home haemodialysis (and also to make sure I know exactly what I’m doing) I have been going in every day, Monday to Friday, for three-hour sessions, first thing in the morning.
The training began with me being talked through each step of the preparation process. For the best part of the last 14 years I have become accustomed to the dialysis machines; how they look, how they sound…but not particularly how they work. I know what each part of the machine does, but when it comes to putting it all together and making sure it all works, then I’m way out of my depth. I’ve only ever been a patient who would stroll into the Renal Unit, take my place on the bed and wait for the staff to connect me to the machine.
But now, it’s down to me.
I had already been shown how to cannulate myself, so the access for home haemodialysis wasn’t going to be a problem…or so I thought. During the second day of training, my venous needle – which is the needle that shoots the cleaned, dialysed blood back into my arm – was a little uncomfortable. It’s never totally comfortable having two needles measuring just short of two inches in your arm for three hours, but this one didn’t feel quite right. Usually if there is a problem with one of the needles, it will be reflected in the pressure monitor on the machine alarming and a soreness developing in my arm where the needle sits. The pressure readings were OK, and so I wasn’t too worried. But later that night and the next day the site where the needle went in was swollen and sore. To give that site a rest and allow the soreness and swelling to go down, Judy – the Sister at the Renal Unit who takes care of all the Home Haemodialysis patients – suggested that we try an alternative site for the venous needle. I was expecting her to decide where we were going to go, and also for her to put the needle in, but she soon informed me that I would be the one doing it. The nerves soon rose and the shakes began…I had never needled myself in a fresh site before; the only previous occasions I had put my own needles in were in ‘buttonholes’, which are already established sites where the needle, theoretically, just slides into the hole. As I took hold of the needle, my shakes got marginally worse as I was anticipating the sharp sting of the needle piercing my skin. Judy had told me that patients who needle themselves experience less pain, something which I was dubious about. But it’s true. I think it must be the thought of someone else coming towards you with a needle that makes the body tense up and the brain scream “THIS IS GOING TO HURT!”, but I was pleasantly surprised that by putting the needle into the fresh, new site myself, there was hardly any pain to speak of. It still stung a bit, and it’s not something I look forward to doing, but it was nowhere near as uncomfortable or horrific as I was expecting.
Everything was going so well, both needles lodged safely in my arm, pressure readings perfect, new needle site performing excellently…until I committed the cardinal sin of the fistula owning haemodiaylsis patient — I moved my arm. Only ever so slightly, but it was enough to cause my needle to blow. As the needle is sitting in my arm and pumping blood back into my fistula, it is held in place by three strips of micropore tape, each on around 8cm in length. Any movement in my arm can dislodge the needle as cause the tip to press against the inside wall of my fistula and cause swelling, an increase in pressure and – most of all – pain. It’s quite easily resolved by taking that needle out and putting another one in a different site, but the swelling and subsequent bruising is still visible as I type, nine days later, and it’s best to leave the site well alone until it recovers. This whole episode meant I had to find another new site to needle, resulting in four separate needle sites on my fistula. Thankfully, and after guidance from Judy, I managed to get the new needle in again without any problems and so far it’s been fine. Having problems with needling the fistula is common and it was the one thing I was really concerned about. I can get used to running the machine and I’ll soon become accustomed to setting everything up, dealing with alarms and making sure my treatment goes smoothly. But there’s something about plunging a pair of two-inch needles into my arm that I don’t think I’ll ever really get used to.
But that’s a small price to pay for not having to travel to the hospital every other day.