About two weeks ago I started having problems getting a good flash with my venus buttonhole access. I normally run at 500, but on a Wednesday, I was unable to run past pump speed 350 due to high Venus pressures.

I visited the Vascular Center on Thursday and they did another angioplasty. I have had numerous procedures for problems with this part of my fistula. I returned home and setup to dialyze that night. Unfortunately, I could not get any flash at all. After trying multiple times I was finally able to get a small flash, and was able to dialyze, but at a very reduced run speed of 350 instead of my usual 500.

The next day my dialysis nurse came to my house and assisted me in using a sharp needle to attempt to start a new buttonhole above my current venus access site. I have a small fistula area, so we had very little room to place a new needle. We were successful two days, but on the following Wednesday I was again unable to run. We assumed there was a clot at the new Venus site.

Another trip to the Vascular Center and another angioplasty to attempt to remove the clot. The doctor felt confident he had removed the clot from the new venus site. The doctor said I also have narrowing in this part of my fistula. That evening, even with my dialysis nurse’s help, we could not get any flash.

The doctor told me during my visit, that I have a “branch” off my regular fistula, and that could be developed and used as a new fistula. We were forced to start using that new “branch” now.

Since I had never used this new location we had to start with small size 17 needle, and use a maximum run speed of 250. My first dialysis session ran over 4 1/2 hours. The next day I changed the flow fraction setting on my NxStage, changing it from 35 to 100. This allowed me to increase my UF rate beyond normal limits to reduce my dialysis time to just over two hours instead of 4 1/2. We used size 17 needles for three more days. Yesterday we went one size larger to size 16 sharp needles, and increased my run speed to 350. After three more days we will then use regular size 15 sharp needles for another three days using a maximum run speed of 450.

On each day the dialysis nurse inserted my sharp needles into the same tract to form my new buttonhole, in addition to developing my new fistula. After the third use of size 16 sharp needles, my new buttonhole will be fully developed and I will then begin using dull buttonhole needles.

A word of warning, do not change the flow fraction on your NxStage cycler without consulting your dialysis center. This setting is set for your personal dialysis needs and should not normally be changed. Mine needed to be changed to both allow me to run faster during fistula development. And, mine will need to ultimately be set at 70 so I can run with a new maximum speed of 450. Running at 450 instead of 500 is easier on your fistula and will help make it last longer.

I feel pretty lucky to have had this additional “branch” on my my fistula. The doctor said normally they would have tied off this extra area, but in my case it had not caused any problems, so the doctor left it as-is.

If I had not had this extra line to be used to form a new fistula, I would have had to go to the hospital and had a catheter inserted in my aorta, then had arterial surgery to create a new fistula, and then had to wait an addition two to three months for it to develop. Catheters can be used in an emergency, but there is also an increased risk of infections with catheters.

Here’s a picture of my new fistula after day three of size 17 sharp needles. Some bruising is normal, and you can clearly see the new fistula is starting to develop even after this short period of use.

A word of advice, have your fistula checked frequently by a vascular doctor. I have mine checked every six months, and have avoided many problems by doing so. My original fistula has been in use for almost nine years before I had this problem. In another week I’ll have a new venus buttonhole, and will continue to use my original arterial access.