Over the last week or two I have had problems when inserting needles in my button-hole fistula. I have been told by my Nephrologist that button-hole fistula last about four years and mine is almost five and a half years old.
On the Friday before the 4th of July weekend, I again had problems with just the Venus potion of my fistula, and was unable to dialyze over the next four days because of the the 4th of July holiday.

On Tuesday July 5th I had an angioplasty and both a clot removed from the Venus portion of my fistula, and had narrowing removed around it to improve my blood flow.

Unfortunately, one of the two incisions made for this treatment was very close to the arterial portion of my fistula, and caused problems with the arterial portion of my access.

Just over one week later I was again unable to dialyze because of a clot in the arterial portion of my fistula. I had another angioplasty on the following Wednesday, but they were unable to remove the clot and the arterial part of the fistula no longer worked.
Now on my third day after no dialysis, I am running in-center for the first time in coming up on six years, using a dull needle in the Venus portion of my fistula, and a sharp needle in the arterial portion.

The plan will be to create a new arterial button hole over a period of time, and go back to using dull needles in both sides of my fistula.

I have been told multiple times by my Nephrologist that the maximum time a dialysis patient can go without dialysis is 96 hours, and I went that length of time just over a week ago, and went 72 hour again just over one week later.

What can you do if you have fistula problems, and cannot dialyze?
I am very careful with my food and especially liquid intake, severely restricting both. To avoid issues with high potassium I also used Kayexcellate on a daily basis to reduce my potassium. I also took extra Renvella, a phosphorus binder to control my phosphorus level.

I guess I have proven you can survive this, but you have to be very careful with diet, fluid intake and levels of potassium and phosphorus. I was also very careful with sodium intake, as it can also become life threatening without dialysis.

On the fourth day I felt very tired, but not as bad as I thought it would feel to be approaching the danger point. I asked the Nephrologist how I would know when I was in serious trouble. She responded that I would become more and more tired, I would become nauseated and may begin vomiting, and that if my pulse dropped to 50 or below I needed to go to the hospital immediately.

I began wearing my Fitbit to constantly monitor my pulse and by the time I had reached the 95 hour mark my pulse had dropped to 58. Luckily we returned home from the angioplasty and I immediately dialyzed.

I’m sure you have heard this before, but take extra care with your fistula – it really is your life-line. Without a functioning fistula, you have about 96 hours before it may become life threatening.